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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 TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Temporary disability (accident and sickness)
  • Long-term disability cover

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

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
5012022-09-01HEATHER FULLBRIGHT2023-07-20 HEATHER FULLBRIGHT2023-07-20
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
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
2022: FIRST COMMUNITY BANK CAFETERIA PLAN 2022 401k membership
Total participants, beginning-of-year2022-09-01364
Total number of active participants reported on line 7a of the Form 55002022-09-01524
Total of all active and inactive participants2022-09-01524
Total participants2022-09-01524
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
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
2022 : FIRST COMMUNITY BANK CAFETERIA PLAN 2022 401k financial data
Value of fidelity bond covering the plan2022-12-31$5,000,000
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

2022: FIRST COMMUNITY BANK CAFETERIA PLAN 2022 form 5500 responses
2022-09-01Type of plan entitySingle employer plan
2022-09-01This return/report is a short plan year return/report (less than 12 months)Yes
2022-09-01Plan funding arrangement – General assets of the sponsorYes
2022-09-01Plan benefit arrangement – InsuranceYes
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
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 9
Insurance contract or identification number836856
Number of Individuals Covered295
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $26,816
Other welfare benefits providedLIFESTYLE A D D, LIFESTYLE LIFE
Welfare Benefit Premiums Paid to CarrierUSD $178,798
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,816
Insurance broker organization code?3
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 Covered56
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,593
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 $1,593
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 Covered513
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $11,285
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $205,507
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,285
Insurance broker organization code?3
(National Association of Insurance Commissioners NAIC id number: )
Policy contract number
Policy instance 3
Number of Individuals Covered351
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $100,825
Total amount of fees paid to insurance companyUSD $196,609
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $755,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $100,825
Insurance broker organization code?3
Amount paid for insurance broker fees142163
Additional information about fees paid to insurance brokerADMINISTRATION FEES
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )
Policy contract number000006251-10000
Policy instance 4
Insurance contract or identification number000006251-10000
Number of Individuals Covered4
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $244
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 $244
Insurance broker organization code?3
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )
Policy contract number000006251-10000
Policy instance 5
Insurance contract or identification number000006251-10000
Number of Individuals Covered771
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $27,850
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 $27,850
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number30059830
Policy instance 6
Insurance contract or identification number30059830
Number of Individuals Covered314
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $4,481
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $52,748
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,636
Insurance broker organization code?3
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )
Policy contract number000006251-20000
Policy instance 7
Insurance contract or identification number000006251-20000
Number of Individuals Covered59
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,803
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 $1,803
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 8
Insurance contract or identification number836855
Number of Individuals Covered188
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $16,438
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $109,587
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,438
Insurance broker organization code?3
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
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
(National Association of Insurance Commissioners NAIC id number: )
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
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
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
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
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 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
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
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
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
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
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
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
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
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 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
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
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 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 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
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
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 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
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 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 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
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
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
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.
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
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.
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
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 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
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 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 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.
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
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
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 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
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
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
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
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
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
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
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
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
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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