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FIRST COMMUNITY BANK CAFETERIA PLAN 401k Plan overview

Plan NameFIRST COMMUNITY BANK CAFETERIA PLAN
Plan identification number 501

FIRST COMMUNITY BANK CAFETERIA PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    FIRST COMMUNITY BANK has sponsored the creation of one or more 401k plans.

    Company Name:FIRST COMMUNITY BANK
    Employer identification number (EIN):731536018
    NAIC Classification:522110
    NAIC Description:Commercial Banking

    Additional information about FIRST COMMUNITY BANK

    Jurisdiction of Incorporation: Arkansas Secretary of State
    Incorporation Date:
    Company Identification Number: 200000126

    More information about FIRST COMMUNITY BANK

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan FIRST COMMUNITY BANK CAFETERIA PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5012021-09-01HEATHER FULBRIGHT2022-12-12 HEATHER FULBRIGHT2022-12-12
    5012020-09-01HEATHER FULBRIGHT2021-05-25 HEATHER FULBRIGHT2021-05-25
    5012019-09-01HEATHER FULBRIGHT2020-06-15 HEATHER FULBRIGHT2020-06-15
    5012017-09-01HEATHER FULBRIGHT2019-04-10 HEATHER FULBRIGHT2019-04-10
    5012016-09-01
    5012015-09-01
    5012014-09-01
    5012013-09-01
    5012012-09-01
    5012011-09-01HEATHER FULBRIGHT
    5012010-09-01HEATHER FULBRIGHT
    5012009-09-01HEATHER FULBRIGHT
    5012008-09-01HEATHER FULBRIGHT
    5012007-09-01HEATHER FULBRIGHT
    5012006-09-01HEATHER FULBRIGHT

    Plan Statistics for FIRST COMMUNITY BANK CAFETERIA PLAN

    401k plan membership statisitcs for FIRST COMMUNITY BANK CAFETERIA PLAN

    Measure Date Value
    2021: FIRST COMMUNITY BANK CAFETERIA PLAN 2021 401k membership
    Total participants, beginning-of-year2021-09-01292
    Total number of active participants reported on line 7a of the Form 55002021-09-01364
    Total of all active and inactive participants2021-09-01364
    Total participants2021-09-01364
    2020: FIRST COMMUNITY BANK CAFETERIA PLAN 2020 401k membership
    Total participants, beginning-of-year2020-09-01281
    Total number of active participants reported on line 7a of the Form 55002020-09-01292
    Total of all active and inactive participants2020-09-01292
    Total participants2020-09-01292
    2019: FIRST COMMUNITY BANK CAFETERIA PLAN 2019 401k membership
    Total participants, beginning-of-year2019-09-01278
    Total number of active participants reported on line 7a of the Form 55002019-09-01281
    Total of all active and inactive participants2019-09-01281
    Total participants2019-09-01281
    2017: FIRST COMMUNITY BANK CAFETERIA PLAN 2017 401k membership
    Total participants, beginning-of-year2017-09-01267
    Total number of active participants reported on line 7a of the Form 55002017-09-01278
    Total of all active and inactive participants2017-09-01278
    Total participants2017-09-01278
    2016: FIRST COMMUNITY BANK CAFETERIA PLAN 2016 401k membership
    Total participants, beginning-of-year2016-09-01313
    Total number of active participants reported on line 7a of the Form 55002016-09-01267
    Total of all active and inactive participants2016-09-01267
    Total participants2016-09-01267
    2015: FIRST COMMUNITY BANK CAFETERIA PLAN 2015 401k membership
    Total participants, beginning-of-year2015-09-01198
    Total number of active participants reported on line 7a of the Form 55002015-09-01313
    Total of all active and inactive participants2015-09-01313
    Total participants2015-09-01313
    2014: FIRST COMMUNITY BANK CAFETERIA PLAN 2014 401k membership
    Total participants, beginning-of-year2014-09-01209
    Total number of active participants reported on line 7a of the Form 55002014-09-01196
    Number of retired or separated participants receiving benefits2014-09-012
    Total of all active and inactive participants2014-09-01198
    Total participants2014-09-01198
    2013: FIRST COMMUNITY BANK CAFETERIA PLAN 2013 401k membership
    Total participants, beginning-of-year2013-09-01193
    Total number of active participants reported on line 7a of the Form 55002013-09-01398
    Total of all active and inactive participants2013-09-01398
    Total participants2013-09-01398
    2012: FIRST COMMUNITY BANK CAFETERIA PLAN 2012 401k membership
    Total participants, beginning-of-year2012-09-01193
    Total number of active participants reported on line 7a of the Form 55002012-09-01329
    Total of all active and inactive participants2012-09-01329
    Total participants2012-09-01329
    2011: FIRST COMMUNITY BANK CAFETERIA PLAN 2011 401k membership
    Total participants, beginning-of-year2011-09-01165
    Total number of active participants reported on line 7a of the Form 55002011-09-01193
    Total of all active and inactive participants2011-09-01193
    Total participants2011-09-01193
    2010: FIRST COMMUNITY BANK CAFETERIA PLAN 2010 401k membership
    Total participants, beginning-of-year2010-09-01153
    Total number of active participants reported on line 7a of the Form 55002010-09-01165
    Total of all active and inactive participants2010-09-01165
    Total participants2010-09-01165
    2009: FIRST COMMUNITY BANK CAFETERIA PLAN 2009 401k membership
    Total participants, beginning-of-year2009-09-01144
    Total number of active participants reported on line 7a of the Form 55002009-09-01153
    Total of all active and inactive participants2009-09-01153
    Total participants2009-09-01153
    2008: FIRST COMMUNITY BANK CAFETERIA PLAN 2008 401k membership
    Total participants, beginning-of-year2008-09-01111
    Total number of active participants reported on line 7a of the Form 55002008-09-01144
    Total of all active and inactive participants2008-09-01144
    Total participants2008-09-01144
    2007: FIRST COMMUNITY BANK CAFETERIA PLAN 2007 401k membership
    Total participants, beginning-of-year2007-09-0193
    Total number of active participants reported on line 7a of the Form 55002007-09-01111
    Total of all active and inactive participants2007-09-01111
    Total participants2007-09-01111
    2006: FIRST COMMUNITY BANK CAFETERIA PLAN 2006 401k membership
    Total participants, beginning-of-year2006-09-010
    Total number of active participants reported on line 7a of the Form 55002006-09-0193
    Total of all active and inactive participants2006-09-0193
    Total participants2006-09-0193

    Financial Data on FIRST COMMUNITY BANK CAFETERIA PLAN

    Measure Date Value
    2015 : FIRST COMMUNITY BANK CAFETERIA PLAN 2015 401k financial data
    Total income from all sources2015-08-31$1,774,845
    Expenses. Total of all expenses incurred2015-08-31$1,774,845
    Benefits paid (including direct rollovers)2015-08-31$1,499,621
    Total contributions received or receivable from participants2015-08-31$777,177
    Total contributions received or receivable from employer(s)2015-08-31$997,668
    Expenses. Administrative service providers (salaries,fees and commissions)2015-08-31$275,224
    2014 : FIRST COMMUNITY BANK CAFETERIA PLAN 2014 401k financial data
    Total income from all sources2014-08-31$1,314,207
    Expenses. Total of all expenses incurred2014-08-31$1,226,618
    Benefits paid (including direct rollovers)2014-08-31$1,018,419
    Total contributions received or receivable from participants2014-08-31$532,223
    Expenses. Other expenses not covered elsewhere2014-08-31$31,110
    Net income (gross income less expenses)2014-08-31$87,589
    Total contributions received or receivable from employer(s)2014-08-31$781,984
    Expenses. Administrative service providers (salaries,fees and commissions)2014-08-31$177,089
    2013 : FIRST COMMUNITY BANK CAFETERIA PLAN 2013 401k financial data
    Total income from all sources2013-08-31$112,713
    Expenses. Total of all expenses incurred2013-08-31$112,713
    Benefits paid (including direct rollovers)2013-08-31$96,952
    Total contributions received or receivable from participants2013-08-31$63,567
    Total contributions received or receivable from employer(s)2013-08-31$49,146
    Expenses. Administrative service providers (salaries,fees and commissions)2013-08-31$15,761
    2012 : FIRST COMMUNITY BANK CAFETERIA PLAN 2012 401k financial data
    Total plan liabilities at end of year2012-08-31$0
    Total plan liabilities at beginning of year2012-08-31$0
    Total income from all sources2012-08-31$334,048
    Expenses. Total of all expenses incurred2012-08-31$334,048
    Benefits paid (including direct rollovers)2012-08-31$294,076
    Total plan assets at end of year2012-08-31$0
    Total plan assets at beginning of year2012-08-31$0
    Total contributions received or receivable from participants2012-08-31$142,822
    Total contributions received or receivable from employer(s)2012-08-31$191,226
    Expenses. Administrative service providers (salaries,fees and commissions)2012-08-31$39,972
    2011 : FIRST COMMUNITY BANK CAFETERIA PLAN 2011 401k financial data
    Total plan liabilities at end of year2011-08-31$0
    Total plan liabilities at beginning of year2011-08-31$0
    Total income from all sources2011-08-31$1,003,325
    Expenses. Total of all expenses incurred2011-08-31$1,003,325
    Benefits paid (including direct rollovers)2011-08-31$865,045
    Total plan assets at end of year2011-08-31$0
    Total plan assets at beginning of year2011-08-31$0
    Total contributions received or receivable from participants2011-08-31$409,860
    Total contributions received or receivable from employer(s)2011-08-31$593,465
    Expenses. Administrative service providers (salaries,fees and commissions)2011-08-31$138,280
    2010 : FIRST COMMUNITY BANK CAFETERIA PLAN 2010 401k financial data
    Total plan liabilities at end of year2010-08-31$0
    Total plan liabilities at beginning of year2010-08-31$0
    Total income from all sources2010-08-31$893,143
    Expenses. Total of all expenses incurred2010-08-31$893,143
    Benefits paid (including direct rollovers)2010-08-31$752,196
    Total plan assets at end of year2010-08-31$0
    Total plan assets at beginning of year2010-08-31$0
    Total contributions received or receivable from participants2010-08-31$367,164
    Total contributions received or receivable from employer(s)2010-08-31$525,979
    Expenses. Administrative service providers (salaries,fees and commissions)2010-08-31$140,947
    2009 : FIRST COMMUNITY BANK CAFETERIA PLAN 2009 401k financial data
    Total plan liabilities at end of year2009-08-31$0
    Total plan liabilities at beginning of year2009-08-31$0
    Total income from all sources2009-08-31$144,771
    Expenses. Total of all expenses incurred2009-08-31$144,771
    Benefits paid (including direct rollovers)2009-08-31$132,387
    Total plan assets at end of year2009-08-31$0
    Total plan assets at beginning of year2009-08-31$0
    Total contributions received or receivable from participants2009-08-31$63,199
    Total contributions received or receivable from employer(s)2009-08-31$81,572
    Expenses. Administrative service providers (salaries,fees and commissions)2009-08-31$12,384
    2008 : FIRST COMMUNITY BANK CAFETERIA PLAN 2008 401k financial data
    Total plan liabilities at end of year2008-08-31$0
    Total plan liabilities at beginning of year2008-08-31$0
    Total income from all sources2008-08-31$77,189
    Expenses. Total of all expenses incurred2008-08-31$77,189
    Benefits paid (including direct rollovers)2008-08-31$72,872
    Total plan assets at end of year2008-08-31$0
    Total plan assets at beginning of year2008-08-31$0
    Total contributions received or receivable from participants2008-08-31$30,876
    Total contributions received or receivable from employer(s)2008-08-31$46,313
    Expenses. Administrative service providers (salaries,fees and commissions)2008-08-31$4,317
    2007 : FIRST COMMUNITY BANK CAFETERIA PLAN 2007 401k financial data
    Total plan liabilities at end of year2007-08-31$0
    Total plan liabilities at beginning of year2007-08-31$0
    Total income from all sources2007-08-31$59,087
    Expenses. Total of all expenses incurred2007-08-31$59,087
    Benefits paid (including direct rollovers)2007-08-31$55,786
    Total plan assets at end of year2007-08-31$0
    Total plan assets at beginning of year2007-08-31$0
    Total contributions received or receivable from participants2007-08-31$23,635
    Total contributions received or receivable from employer(s)2007-08-31$35,452
    Expenses. Administrative service providers (salaries,fees and commissions)2007-08-31$3,301

    Form 5500 Responses for FIRST COMMUNITY BANK CAFETERIA PLAN

    2021: FIRST COMMUNITY BANK CAFETERIA PLAN 2021 form 5500 responses
    2021-09-01Type of plan entitySingle employer plan
    2021-09-01Plan funding arrangement – General assets of the sponsorYes
    2021-09-01Plan benefit arrangement – InsuranceYes
    2020: FIRST COMMUNITY BANK CAFETERIA PLAN 2020 form 5500 responses
    2020-09-01Type of plan entitySingle employer plan
    2020-09-01Plan funding arrangement – General assets of the sponsorYes
    2020-09-01Plan benefit arrangement – InsuranceYes
    2019: FIRST COMMUNITY BANK CAFETERIA PLAN 2019 form 5500 responses
    2019-09-01Type of plan entitySingle employer plan
    2019-09-01Plan funding arrangement – General assets of the sponsorYes
    2019-09-01Plan benefit arrangement – InsuranceYes
    2017: FIRST COMMUNITY BANK CAFETERIA PLAN 2017 form 5500 responses
    2017-09-01Type of plan entitySingle employer plan
    2017-09-01Plan funding arrangement – General assets of the sponsorYes
    2017-09-01Plan benefit arrangement – InsuranceYes
    2016: FIRST COMMUNITY BANK CAFETERIA PLAN 2016 form 5500 responses
    2016-09-01Type of plan entitySingle employer plan
    2016-09-01Plan funding arrangement – General assets of the sponsorYes
    2016-09-01Plan benefit arrangement – InsuranceYes
    2015: FIRST COMMUNITY BANK CAFETERIA PLAN 2015 form 5500 responses
    2015-09-01Type of plan entitySingle employer plan
    2015-09-01Plan funding arrangement – General assets of the sponsorYes
    2015-09-01Plan benefit arrangement – InsuranceYes
    2014: FIRST COMMUNITY BANK CAFETERIA PLAN 2014 form 5500 responses
    2014-09-01Type of plan entitySingle employer plan
    2014-09-01Plan funding arrangement – General assets of the sponsorYes
    2014-09-01Plan benefit arrangement – InsuranceYes
    2013: FIRST COMMUNITY BANK CAFETERIA PLAN 2013 form 5500 responses
    2013-09-01Type of plan entitySingle employer plan
    2013-09-01Plan funding arrangement – General assets of the sponsorYes
    2013-09-01Plan benefit arrangement – InsuranceYes
    2012: FIRST COMMUNITY BANK CAFETERIA PLAN 2012 form 5500 responses
    2012-09-01Type of plan entitySingle employer plan
    2012-09-01Plan funding arrangement – General assets of the sponsorYes
    2012-09-01Plan benefit arrangement – InsuranceYes
    2011: FIRST COMMUNITY BANK CAFETERIA PLAN 2011 form 5500 responses
    2011-09-01Type of plan entitySingle employer plan
    2011-09-01Plan funding arrangement – General assets of the sponsorYes
    2011-09-01Plan benefit arrangement – InsuranceYes
    2010: FIRST COMMUNITY BANK CAFETERIA PLAN 2010 form 5500 responses
    2010-09-01Type of plan entitySingle employer plan
    2010-09-01Plan funding arrangement – General assets of the sponsorYes
    2010-09-01Plan benefit arrangement – InsuranceYes
    2009: FIRST COMMUNITY BANK CAFETERIA PLAN 2009 form 5500 responses
    2009-09-01Type of plan entitySingle employer plan
    2009-09-01Plan funding arrangement – General assets of the sponsorYes
    2009-09-01Plan benefit arrangement – InsuranceYes
    2008: FIRST COMMUNITY BANK CAFETERIA PLAN 2008 form 5500 responses
    2008-09-01Type of plan entitySingle employer plan
    2008-09-01Plan funding arrangement – General assets of the sponsorYes
    2008-09-01Plan benefit arrangement – InsuranceYes
    2007: FIRST COMMUNITY BANK CAFETERIA PLAN 2007 form 5500 responses
    2007-09-01Type of plan entitySingle employer plan
    2007-09-01Plan funding arrangement – General assets of the sponsorYes
    2007-09-01Plan benefit arrangement – InsuranceYes
    2006: FIRST COMMUNITY BANK CAFETERIA PLAN 2006 form 5500 responses
    2006-09-01Type of plan entitySingle employer plan
    2006-09-01First time form 5500 has been submittedYes
    2006-09-01Plan funding arrangement – General assets of the sponsorYes
    2006-09-01Plan benefit arrangement – InsuranceYes

    Insurance Providers Used on plan

    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract number836856
    Policy instance 6
    Insurance contract or identification number836856
    Number of Individuals Covered262
    Insurance policy start date2021-01-01
    Insurance policy end date2021-12-31
    Total amount of commissions paid to insurance brokerUSD $17,411
    Other welfare benefits providedLIFESTYLE A D D LIFESTYLE LIFE
    Commission paid to Insurance BrokerUSD $17,411
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract number836855
    Policy instance 5
    Insurance contract or identification number836855
    Number of Individuals Covered56
    Insurance policy start date2021-01-01
    Insurance policy end date2021-12-31
    Total amount of commissions paid to insurance brokerUSD $11,010
    Temporary Disability Insurance Welfare BenefitYes
    Commission paid to Insurance BrokerUSD $11,010
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 0000 )
    Policy contract number30059830
    Policy instance 4
    Insurance contract or identification number30059830
    Number of Individuals Covered280
    Insurance policy start date2021-01-01
    Insurance policy end date2021-12-31
    Total amount of commissions paid to insurance brokerUSD $4,874
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $45,288
    Commission paid to Insurance BrokerUSD $2,268
    Insurance broker organization code?3
    ONE BEACON INSURANCE GROUP (National Association of Insurance Commissioners NAIC id number: 0876- )
    Policy contract number
    Policy instance 3
    Number of Individuals Covered315
    Insurance policy start date2021-01-01
    Insurance policy end date2021-12-31
    Total amount of commissions paid to insurance brokerUSD $92,075
    Total amount of fees paid to insurance companyUSD $177,704
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $711,468
    Commission paid to Insurance BrokerUSD $92,075
    Insurance broker organization code?3
    Amount paid for insurance broker fees127983
    Additional information about fees paid to insurance brokerADMIN FEES
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract number836854
    Policy instance 2
    Insurance contract or identification number836854
    Number of Individuals Covered155
    Insurance policy start date2021-01-01
    Insurance policy end date2021-12-31
    Total amount of commissions paid to insurance brokerUSD $6,828
    Life Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedADD
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $6,828
    DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )
    Policy contract number000006251
    Policy instance 1
    Insurance contract or identification number000006251
    Number of Individuals Covered814
    Insurance policy start date2021-01-01
    Insurance policy end date2021-12-31
    Total amount of commissions paid to insurance brokerUSD $28,803
    Dental Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $28,803
    DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )
    Policy contract number000006251
    Policy instance 1
    Insurance contract or identification number000006251
    Number of Individuals Covered760
    Insurance policy start date2020-01-01
    Insurance policy end date2020-12-31
    Total amount of commissions paid to insurance brokerUSD $25,298
    Dental Insurance Welfare BenefitYes
    Commission paid to Insurance BrokerUSD $25,298
    Insurance broker organization code?3
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract number836854
    Policy instance 2
    Insurance contract or identification number836854
    Number of Individuals Covered420
    Insurance policy start date2020-01-01
    Insurance policy end date2021-01-01
    Total amount of commissions paid to insurance brokerUSD $8,248
    Life Insurance Welfare BenefitYes
    Other welfare benefits providedADD
    Welfare Benefit Premiums Paid to CarrierUSD $117,896
    Commission paid to Insurance BrokerUSD $8,248
    Insurance broker organization code?3
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 0000 )
    Policy contract number30059830
    Policy instance 4
    Insurance contract or identification number30059830
    Number of Individuals Covered225
    Insurance policy start date2019-08-01
    Insurance policy end date2020-07-31
    Total amount of commissions paid to insurance brokerUSD $718
    Vision Insurance Welfare BenefitYes
    Commission paid to Insurance BrokerUSD $718
    Insurance broker organization code?3
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract number836855
    Policy instance 5
    Insurance contract or identification number836855
    Number of Individuals Covered170
    Insurance policy start date2020-01-01
    Insurance policy end date2021-01-01
    Total amount of commissions paid to insurance brokerUSD $11,807
    Temporary Disability Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $78,711
    Commission paid to Insurance BrokerUSD $11,807
    Insurance broker organization code?3
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract number836856
    Policy instance 6
    Insurance contract or identification number836856
    Number of Individuals Covered223
    Insurance policy start date2020-01-01
    Insurance policy end date2021-01-01
    Total amount of commissions paid to insurance brokerUSD $16,445
    Other welfare benefits providedVOLUNTARY A D D
    Welfare Benefit Premiums Paid to CarrierUSD $109,022
    Commission paid to Insurance BrokerUSD $16,445
    Insurance broker organization code?3
    STANDARD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 52413 )
    Policy contract number
    Policy instance 3
    Number of Individuals Covered760
    Insurance policy start date2020-01-01
    Insurance policy end date2020-12-31
    Total amount of commissions paid to insurance brokerUSD $86,900
    Total amount of fees paid to insurance companyUSD $166,154
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $449,082
    Commission paid to Insurance BrokerUSD $86,900
    Insurance broker organization code?3
    Amount paid for insurance broker fees166095
    Additional information about fees paid to insurance brokerADMINISTRATION FEES, REPRICING FEES, TELADOC FEES
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50014152
    Policy instance 9
    Insurance contract or identification number50014152
    Other welfare benefits providedVOLUNTARY A D D
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50014152
    Policy instance 10
    Insurance contract or identification number50014152
    Life Insurance Welfare BenefitYes
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number027366
    Policy instance 11
    Insurance contract or identification number027366
    Dental Insurance Welfare BenefitYes
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number038894
    Policy instance 12
    Insurance contract or identification number038894
    Health Insurance Welfare BenefitYes
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number028396
    Policy instance 13
    Insurance contract or identification number028396
    Health Insurance Welfare BenefitYes
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50014152
    Policy instance 8
    Insurance contract or identification number50014152
    Temporary Disability Insurance Welfare BenefitYes
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50014152
    Policy instance 7
    Insurance contract or identification number50014152
    Long Term Disability Insurance Welfare BenefitYes
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number027616
    Policy instance 5
    Insurance contract or identification number027616
    Dental Insurance Welfare BenefitYes
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number027365
    Policy instance 6
    Insurance contract or identification number027365
    Dental Insurance Welfare BenefitYes
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 0000 )
    Policy contract number30059830
    Policy instance 4
    Insurance contract or identification number30059830
    Number of Individuals Covered181
    Insurance policy start date2018-08-01
    Insurance policy end date2019-07-31
    Total amount of commissions paid to insurance brokerUSD $2,630
    Vision Insurance Welfare BenefitYes
    Commission paid to Insurance BrokerUSD $1,313
    Insurance broker organization code?3
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number028396
    Policy instance 3
    Insurance contract or identification number028396
    Insurance policy start date2018-08-01
    Insurance policy end date2019-07-31
    Total amount of commissions paid to insurance brokerUSD $18,574
    Total amount of fees paid to insurance companyUSD $160,542
    Health Insurance Welfare BenefitYes
    Commission paid to Insurance BrokerUSD $18,574
    Amount paid for insurance broker fees160542
    Additional information about fees paid to insurance brokerSERVICE FEES
    Insurance broker organization code?3
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50014152
    Policy instance 2
    Insurance contract or identification number50014152
    Life Insurance Welfare BenefitYes
    Other welfare benefits providedADD
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number027617
    Policy instance 1
    Insurance contract or identification number027617
    Insurance policy start date2018-08-01
    Insurance policy end date2019-07-31
    Total amount of commissions paid to insurance brokerUSD $9,793
    Total amount of fees paid to insurance companyUSD $31,943
    Dental Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $9,793
    Amount paid for insurance broker fees31943
    Additional information about fees paid to insurance brokerSERVICE FEES
    Insurance broker organization code?3
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number028396
    Policy instance 3
    Insurance contract or identification number028396
    Number of Individuals Covered31
    Insurance policy start date2017-08-01
    Insurance policy end date2018-07-31
    Total amount of commissions paid to insurance brokerUSD $2,184
    Total amount of fees paid to insurance companyUSD $17,475
    Health Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50014152
    Policy instance 2
    Insurance contract or identification number50014152
    Number of Individuals Covered333
    Insurance policy start date2017-08-01
    Insurance policy end date2018-07-31
    Total amount of commissions paid to insurance brokerUSD $11,358
    Life Insurance Welfare BenefitYes
    Other welfare benefits providedADD
    Welfare Benefit Premiums Paid to CarrierUSD $72,922
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number028396
    Policy instance 13
    Insurance contract or identification number028396
    Number of Individuals Covered47
    Insurance policy start date2017-08-01
    Insurance policy end date2018-07-31
    Total amount of commissions paid to insurance brokerUSD $4,132
    Total amount of fees paid to insurance companyUSD $33,245
    Health Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number038894
    Policy instance 12
    Insurance contract or identification number038894
    Number of Individuals Covered490
    Insurance policy start date2017-08-01
    Insurance policy end date2018-07-31
    Total amount of commissions paid to insurance brokerUSD $40,638
    Total amount of fees paid to insurance companyUSD $253,606
    Health Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number027366
    Policy instance 11
    Insurance contract or identification number027366
    Number of Individuals Covered41
    Insurance policy start date2017-08-01
    Insurance policy end date2018-07-31
    Total amount of commissions paid to insurance brokerUSD $688
    Total amount of fees paid to insurance companyUSD $1,823
    Dental Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50014152
    Policy instance 10
    Insurance contract or identification number50014152
    Number of Individuals Covered262
    Insurance policy start date2017-09-01
    Insurance policy end date2018-08-31
    Total amount of commissions paid to insurance brokerUSD $12,476
    Life Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $59,648
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50014152
    Policy instance 9
    Insurance contract or identification number50014152
    Number of Individuals Covered210
    Insurance policy start date2017-09-01
    Insurance policy end date2018-08-31
    Total amount of commissions paid to insurance brokerUSD $1,217
    Other welfare benefits providedVOLUNTARY A D D
    Welfare Benefit Premiums Paid to CarrierUSD $5,817
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50014152
    Policy instance 8
    Insurance contract or identification number50014152
    Number of Individuals Covered129
    Insurance policy start date2017-09-01
    Insurance policy end date2018-08-31
    Total amount of commissions paid to insurance brokerUSD $8,910
    Temporary Disability Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $57,188
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50014152
    Policy instance 7
    Insurance contract or identification number50014152
    Number of Individuals Covered333
    Insurance policy start date2017-09-01
    Insurance policy end date2018-08-31
    Total amount of commissions paid to insurance brokerUSD $5,551
    Long Term Disability Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $34,110
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number027365
    Policy instance 6
    Insurance contract or identification number027365
    Number of Individuals Covered584
    Insurance policy start date2017-08-01
    Insurance policy end date2018-07-31
    Total amount of commissions paid to insurance brokerUSD $8,468
    Total amount of fees paid to insurance companyUSD $20,212
    Dental Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number027616
    Policy instance 5
    Insurance contract or identification number027616
    Number of Individuals Covered43
    Insurance policy start date2017-08-01
    Insurance policy end date2018-07-31
    Total amount of commissions paid to insurance brokerUSD $524
    Total amount of fees paid to insurance companyUSD $1,534
    Dental Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 0000 )
    Policy contract number30059830
    Policy instance 4
    Insurance contract or identification number30059830
    Number of Individuals Covered154
    Insurance policy start date2017-08-01
    Insurance policy end date2018-07-31
    Total amount of commissions paid to insurance brokerUSD $2,125
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $22,394
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number027617
    Policy instance 1
    Insurance contract or identification number027617
    Number of Individuals Covered2
    Insurance policy start date2017-08-01
    Insurance policy end date2018-07-31
    Total amount of commissions paid to insurance brokerUSD $37
    Total amount of fees paid to insurance companyUSD $119
    Dental Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number101746801
    Policy instance 14
    Insurance contract or identification number101746801
    Number of Individuals Covered46
    Insurance policy start date2015-09-01
    Insurance policy end date2016-08-31
    Total amount of commissions paid to insurance brokerUSD $769
    Other welfare benefits providedCRITICAL CARE
    Welfare Benefit Premiums Paid to CarrierUSD $5,310
    Commission paid to Insurance BrokerUSD $642
    Insurance broker organization code?3
    Insurance broker nameMARTIN MCCALL
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number028396
    Policy instance 3
    Insurance contract or identification number028396
    Number of Individuals Covered34
    Insurance policy start date2015-08-01
    Insurance policy end date2016-07-31
    Total amount of commissions paid to insurance brokerUSD $2,510
    Total amount of fees paid to insurance companyUSD $19,452
    Health Insurance Welfare BenefitYes
    Commission paid to Insurance BrokerUSD $2,510
    Insurance broker organization code?3
    Amount paid for insurance broker fees19452
    Additional information about fees paid to insurance brokerSERVICE FEES
    Insurance broker nameARKANSAS BLUE CROSS AND BLUE SHIELD
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number038894
    Policy instance 4
    Insurance contract or identification number038894
    Number of Individuals Covered449
    Insurance policy start date2015-08-01
    Insurance policy end date2016-07-31
    Total amount of commissions paid to insurance brokerUSD $26,514
    Total amount of fees paid to insurance companyUSD $128,860
    Health Insurance Welfare BenefitYes
    Commission paid to Insurance BrokerUSD $26,514
    Insurance broker organization code?3
    Amount paid for insurance broker fees128860
    Additional information about fees paid to insurance brokerSERVICE FEES
    Insurance broker nameARKANSAS BLUE CROSS AND BLUE SHIELD
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number061027
    Policy instance 6
    Insurance contract or identification number061027
    Vision Insurance Welfare BenefitYes
    Insurance broker organization code?3
    Insurance broker nameARKANSAS BLUE CROSS AND BLUE SHIELD
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number061029
    Policy instance 7
    Insurance contract or identification number061029
    Vision Insurance Welfare BenefitYes
    Insurance broker organization code?3
    Insurance broker nameARKANSAS BLUE CROSS AND BLUE SHIELD
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number101746801
    Policy instance 13
    Insurance contract or identification number101746801
    Number of Individuals Covered111
    Insurance policy start date2015-09-01
    Insurance policy end date2016-08-31
    Total amount of commissions paid to insurance brokerUSD $3,747
    Other welfare benefits providedCANCER
    Welfare Benefit Premiums Paid to CarrierUSD $28,919
    Commission paid to Insurance BrokerUSD $3,112
    Insurance broker organization code?3
    Insurance broker nameMARTIN MCCALL
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50014152
    Policy instance 8
    Insurance contract or identification number50014152
    Number of Individuals Covered267
    Insurance policy start date2015-09-01
    Insurance policy end date2016-08-31
    Total amount of commissions paid to insurance brokerUSD $4,167
    Long Term Disability Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $25,591
    Commission paid to Insurance BrokerUSD $3,839
    Insurance broker organization code?3
    Insurance broker nameMCCALL, MARTIN
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number101746801
    Policy instance 12
    Insurance contract or identification number101746801
    Number of Individuals Covered125
    Insurance policy start date2015-09-01
    Insurance policy end date2016-08-31
    Total amount of commissions paid to insurance brokerUSD $3,124
    Temporary Disability Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $22,023
    Commission paid to Insurance BrokerUSD $2,630
    Insurance broker organization code?3
    Insurance broker nameMARTIN MCCALL
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50014152
    Policy instance 11
    Insurance contract or identification number50014152
    Number of Individuals Covered263
    Insurance policy start date2015-09-01
    Insurance policy end date2016-08-31
    Total amount of commissions paid to insurance brokerUSD $9,948
    Life Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $42,743
    Commission paid to Insurance BrokerUSD $7,461
    Insurance broker organization code?3
    Insurance broker nameMCCALL, MARTIN
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50014152
    Policy instance 10
    Insurance contract or identification number50014152
    Number of Individuals Covered213
    Insurance policy start date2015-09-01
    Insurance policy end date2016-08-31
    Total amount of commissions paid to insurance brokerUSD $983
    Other welfare benefits providedVOLUNTARY A D D
    Welfare Benefit Premiums Paid to CarrierUSD $4,915
    Commission paid to Insurance BrokerUSD $737
    Insurance broker organization code?3
    Insurance broker nameMCCALL, MARTIN
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50014152
    Policy instance 2
    Insurance contract or identification number50014152
    Number of Individuals Covered267
    Insurance policy start date2015-09-01
    Insurance policy end date2016-08-31
    Total amount of commissions paid to insurance brokerUSD $8,509
    Life Insurance Welfare BenefitYes
    Other welfare benefits providedADD
    Welfare Benefit Premiums Paid to CarrierUSD $54,684
    Commission paid to Insurance BrokerUSD $8,203
    Insurance broker organization code?3
    Insurance broker nameMCCALL MARTIN
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number027366
    Policy instance 1
    Insurance contract or identification number027366
    Number of Individuals Covered32
    Insurance policy start date2015-08-01
    Insurance policy end date2016-07-31
    Total amount of commissions paid to insurance brokerUSD $523
    Total amount of fees paid to insurance companyUSD $1,725
    Dental Insurance Welfare BenefitYes
    Commission paid to Insurance BrokerUSD $523
    Insurance broker organization code?3
    Amount paid for insurance broker fees1725
    Additional information about fees paid to insurance brokerSERVICE FEES
    Insurance broker nameARKANSAS BLUE CROSS AND BLUE SHIELD
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50014152
    Policy instance 9
    Insurance contract or identification number50014152
    Number of Individuals Covered108
    Insurance policy start date2015-09-01
    Insurance policy end date2016-08-31
    Total amount of commissions paid to insurance brokerUSD $7,075
    Temporary Disability Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $45,456
    Commission paid to Insurance BrokerUSD $6,818
    Insurance broker organization code?3
    Insurance broker nameMCCALL, MARTIN
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number027365
    Policy instance 5
    Insurance contract or identification number027365
    Number of Individuals Covered515
    Insurance policy start date2015-08-01
    Insurance policy end date2016-07-31
    Total amount of commissions paid to insurance brokerUSD $6,987
    Total amount of fees paid to insurance companyUSD $23,057
    Dental Insurance Welfare BenefitYes
    Commission paid to Insurance BrokerUSD $6,987
    Insurance broker organization code?3
    Amount paid for insurance broker fees23057
    Additional information about fees paid to insurance brokerSERVICE FEES
    Insurance broker nameARKANSAS BLUE CROSS AND BLUE SHIELD
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number061029
    Policy instance 7
    Insurance contract or identification number061029
    Number of Individuals Covered20
    Insurance policy start date2014-08-01
    Insurance policy end date2015-07-31
    Total amount of commissions paid to insurance brokerUSD $158
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $1,595
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $158
    Insurance broker organization code?3
    Insurance broker nameBATESVILLE INSURANCE AGENCY
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number027366
    Policy instance 1
    Insurance contract or identification number027366
    Number of Individuals Covered35
    Insurance policy start date2014-08-01
    Insurance policy end date2015-07-31
    Total amount of commissions paid to insurance brokerUSD $544
    Total amount of fees paid to insurance companyUSD $1,796
    Dental Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $544
    Insurance broker organization code?2
    Amount paid for insurance broker fees1796
    Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
    Insurance broker nameARKANSAS BLUE CROSS AND BLUE SHIELD
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number101746801
    Policy instance 8
    Insurance contract or identification number101746801
    Number of Individuals Covered117
    Insurance policy start date2014-09-01
    Insurance policy end date2015-08-31
    Total amount of commissions paid to insurance brokerUSD $8,854
    Other welfare benefits providedCANCER, CRITICAL CARE ACCIDENT
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $7,557
    Insurance broker organization code?3
    Insurance broker nameMARTIN MCCALL
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number027365
    Policy instance 5
    Insurance contract or identification number027365
    Number of Individuals Covered460
    Insurance policy start date2014-08-01
    Insurance policy end date2015-07-31
    Total amount of commissions paid to insurance brokerUSD $6,931
    Total amount of fees paid to insurance companyUSD $22,871
    Dental Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $6,931
    Insurance broker organization code?3
    Amount paid for insurance broker fees22871
    Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
    Insurance broker nameARKANSAS BLUE CROSS AND BLUE SHIELD
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number038894
    Policy instance 4
    Insurance contract or identification number038894
    Number of Individuals Covered417
    Insurance policy start date2014-08-01
    Insurance policy end date2015-07-31
    Total amount of commissions paid to insurance brokerUSD $25,407
    Total amount of fees paid to insurance companyUSD $123,478
    Health Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $25,407
    Insurance broker organization code?3
    Amount paid for insurance broker fees123478
    Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
    Insurance broker nameARKANSAS BLUE CROSS AND BLUE SHIELD
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number208396
    Policy instance 3
    Insurance contract or identification number208396
    Number of Individuals Covered38
    Insurance policy start date2014-08-01
    Insurance policy end date2015-07-31
    Total amount of commissions paid to insurance brokerUSD $2,262
    Total amount of fees paid to insurance companyUSD $17,527
    Health Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,262
    Insurance broker organization code?3
    Amount paid for insurance broker fees17527
    Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
    Insurance broker nameARKANSAS BLUE CROSS AND BLUE SHIELD
    USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
    Policy contract number50014152
    Policy instance 2
    Insurance contract or identification number50014152
    Number of Individuals Covered243
    Insurance policy start date2014-09-01
    Insurance policy end date2015-08-31
    Total amount of commissions paid to insurance brokerUSD $28,815
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedADD
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,371
    Insurance broker organization code?3
    Insurance broker nameBATESVILLE INSURANCE AGENCY INC
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number061027
    Policy instance 6
    Insurance contract or identification number061027
    Number of Individuals Covered229
    Insurance policy start date2014-08-01
    Insurance policy end date2015-07-31
    Total amount of commissions paid to insurance brokerUSD $1,708
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $17,099
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,708
    Insurance broker organization code?3
    Insurance broker nameBATESVILLE INSURANCE AGENCY INC
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number027366
    Policy instance 1
    Insurance contract or identification number027366
    Number of Individuals Covered31
    Insurance policy start date2013-08-01
    Insurance policy end date2014-07-31
    Total amount of commissions paid to insurance brokerUSD $565
    Total amount of fees paid to insurance companyUSD $1,865
    Dental Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $565
    Amount paid for insurance broker fees1865
    Additional information about fees paid to insurance brokerADMINISTRATION
    Insurance broker organization code?3
    Insurance broker nameBATESVILLE INSURANCE AGENCY INC.
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number027365
    Policy instance 5
    Insurance contract or identification number027365
    Number of Individuals Covered624
    Insurance policy start date2013-08-01
    Insurance policy end date2014-07-31
    Total amount of commissions paid to insurance brokerUSD $6,042
    Total amount of fees paid to insurance companyUSD $19,940
    Dental Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $6,042
    Amount paid for insurance broker fees19940
    Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
    Insurance broker organization code?3
    Insurance broker nameBATESVILLE INSURANCE AGENCY INC
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number038894
    Policy instance 4
    Insurance contract or identification number038894
    Number of Individuals Covered398
    Insurance policy start date2013-08-01
    Insurance policy end date2014-07-31
    Total amount of commissions paid to insurance brokerUSD $21,365
    Total amount of fees paid to insurance companyUSD $108,213
    Health Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $21,365
    Amount paid for insurance broker fees108213
    Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
    Insurance broker organization code?3
    Insurance broker nameBATESVILLE INSURANCE AGENCY INC
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number208396
    Policy instance 3
    Insurance contract or identification number208396
    Number of Individuals Covered30
    Insurance policy start date2013-08-01
    Insurance policy end date2014-07-31
    Total amount of commissions paid to insurance brokerUSD $2,058
    Total amount of fees paid to insurance companyUSD $15,951
    Health Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,058
    Amount paid for insurance broker fees15951
    Additional information about fees paid to insurance brokerADMINISTRATION FEES
    Insurance broker organization code?3
    Insurance broker nameBATESVILLE INSURANCE AGENCY INC
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number858233G
    Policy instance 2
    Insurance contract or identification number858233G
    Number of Individuals Covered132
    Insurance policy start date2012-10-01
    Insurance policy end date2013-09-30
    Total amount of commissions paid to insurance brokerUSD $3
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3
    Insurance broker organization code?3
    Insurance broker nameBATESVILLE INSURANCE AGENCY INC
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 0000 )
    Policy contract number30035462
    Policy instance 6
    Insurance contract or identification number30035462
    Insurance policy start date2013-09-01
    Insurance policy end date2014-08-01
    Total amount of commissions paid to insurance brokerUSD $1,090
    Vision Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,090
    Insurance broker nameEDUCATIONAL BENEFITS, INC.
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number858233G
    Policy instance 2
    Insurance contract or identification number858233G
    Number of Individuals Covered206
    Insurance policy start date2011-10-01
    Insurance policy end date2012-09-30
    Total amount of commissions paid to insurance brokerUSD $15,761
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $15,761
    Insurance broker organization code?3
    Insurance broker nameBATESVILLE INSURANCE AGENCY INC
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number027366
    Policy instance 1
    Insurance contract or identification number027366
    Number of Individuals Covered34
    Insurance policy start date2012-08-01
    Insurance policy end date2013-07-31
    Total amount of commissions paid to insurance brokerUSD $533
    Total amount of fees paid to insurance companyUSD $1,758
    Dental Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $533
    Amount paid for insurance broker fees1758
    Additional information about fees paid to insurance brokerADMINISTRATION
    Insurance broker organization code?3
    Insurance broker nameBATESVILLE INSURANCE AGENCY INC.
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number038894
    Policy instance 4
    Insurance contract or identification number038894
    Number of Individuals Covered329
    Insurance policy start date2012-08-01
    Insurance policy end date2013-07-31
    Total amount of commissions paid to insurance brokerUSD $26,487
    Total amount of fees paid to insurance companyUSD $94,469
    Health Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $26,487
    Amount paid for insurance broker fees94469
    Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
    Insurance broker organization code?3
    Insurance broker nameBATESVILLE INSURANCE AGENCY INC
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number027365
    Policy instance 5
    Insurance contract or identification number027365
    Number of Individuals Covered376
    Insurance policy start date2012-08-01
    Insurance policy end date2013-07-31
    Total amount of commissions paid to insurance brokerUSD $5,075
    Total amount of fees paid to insurance companyUSD $16,747
    Dental Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,075
    Amount paid for insurance broker fees16747
    Additional information about fees paid to insurance brokerADMINISTRATIVE FEES
    Insurance broker organization code?3
    Insurance broker nameBATESVILLE INSURANCE AGENCY INC
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number858233G
    Policy instance 1
    Insurance contract or identification number858233G
    Number of Individuals Covered206
    Insurance policy start date2011-10-01
    Insurance policy end date2012-09-30
    Total amount of commissions paid to insurance brokerUSD $15,761
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number208396
    Policy instance 3
    Insurance contract or identification number208396
    Number of Individuals Covered34
    Insurance policy start date2012-08-01
    Insurance policy end date2013-07-31
    Total amount of commissions paid to insurance brokerUSD $3,029
    Total amount of fees paid to insurance companyUSD $15,648
    Health Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,029
    Amount paid for insurance broker fees15648
    Additional information about fees paid to insurance brokerADMINISTRATION FEES
    Insurance broker organization code?3
    Insurance broker nameBATESVILLE INSURANCE AGENCY INC
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number858233G
    Policy instance 2
    Insurance contract or identification number858233G
    Number of Individuals Covered193
    Insurance policy start date2010-10-01
    Insurance policy end date2011-09-30
    Total amount of commissions paid to insurance brokerUSD $15,271
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )
    Policy contract number000002338
    Policy instance 1
    Insurance contract or identification number000002338
    Insurance policy start date2011-06-01
    Insurance policy end date2012-05-31
    Total amount of commissions paid to insurance brokerUSD $7,135
    Dental Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number208396
    Policy instance 3
    Insurance contract or identification number208396
    Number of Individuals Covered41
    Insurance policy start date2011-08-01
    Insurance policy end date2012-07-31
    Total amount of commissions paid to insurance brokerUSD $25,033
    Health Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number038894
    Policy instance 4
    Insurance contract or identification number038894
    Number of Individuals Covered41
    Insurance policy start date2011-08-01
    Insurance policy end date2012-07-31
    Total amount of commissions paid to insurance brokerUSD $2,387
    Health Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number038894
    Policy instance 4
    Insurance contract or identification number038894
    Number of Individuals Covered267
    Insurance policy start date2010-08-01
    Insurance policy end date2011-07-31
    Total amount of commissions paid to insurance brokerUSD $23,066
    Health Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number208396
    Policy instance 3
    Insurance contract or identification number208396
    Number of Individuals Covered25
    Insurance policy start date2010-08-01
    Insurance policy end date2011-07-31
    Total amount of commissions paid to insurance brokerUSD $1,504
    Health Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )
    Policy contract number000002338
    Policy instance 1
    Insurance contract or identification number000002338
    Number of Individuals Covered368
    Insurance policy start date2010-06-01
    Insurance policy end date2011-05-31
    Total amount of commissions paid to insurance brokerUSD $6,374
    Dental Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number858233G
    Policy instance 2
    Insurance contract or identification number858233G
    Number of Individuals Covered165
    Insurance policy start date2009-10-01
    Insurance policy end date2010-09-30
    Total amount of commissions paid to insurance brokerUSD $9,183
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number858233G
    Policy instance 2
    Insurance contract or identification number858233G
    Number of Individuals Covered153
    Insurance policy start date2008-10-01
    Insurance policy end date2009-09-30
    Total amount of commissions paid to insurance brokerUSD $12,151
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number208396
    Policy instance 3
    Insurance contract or identification number208396
    Number of Individuals Covered11
    Insurance policy start date2009-08-01
    Insurance policy end date2010-07-31
    Total amount of commissions paid to insurance brokerUSD $1,098
    Health Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )
    Policy contract number000002338
    Policy instance 1
    Insurance contract or identification number000002338
    Number of Individuals Covered312
    Insurance policy start date2009-06-01
    Insurance policy end date2010-05-31
    Total amount of commissions paid to insurance brokerUSD $5,304
    Dental Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
    Policy contract number038894
    Policy instance 4
    Insurance contract or identification number038894
    Number of Individuals Covered235
    Insurance policy start date2009-08-01
    Insurance policy end date2010-07-31
    Total amount of commissions paid to insurance brokerUSD $19,588
    Health Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number858233G
    Policy instance 2
    Insurance contract or identification number858233G
    Number of Individuals Covered144
    Insurance policy start date2007-10-01
    Insurance policy end date2008-09-30
    Total amount of commissions paid to insurance brokerUSD $7,556
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )
    Policy contract number000002338
    Policy instance 1
    Insurance contract or identification number000002338
    Insurance policy start date2008-06-01
    Insurance policy end date2009-05-31
    Total amount of commissions paid to insurance brokerUSD $4,828
    Dental Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )
    Policy contract number000002338
    Policy instance 1
    Insurance contract or identification number000002338
    Number of Individuals Covered251
    Insurance policy start date2007-06-01
    Insurance policy end date2008-05-31
    Total amount of commissions paid to insurance brokerUSD $4,317
    Dental Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )
    Policy contract number000002338
    Policy instance 1
    Insurance contract or identification number000002338
    Number of Individuals Covered225
    Insurance policy start date2006-06-01
    Insurance policy end date2007-05-31
    Total amount of commissions paid to insurance brokerUSD $3,301
    Dental Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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