401k Plan data: FIRST COMMUNITY BANK CAFETERIA PLAN plan

FIRST COMMUNITY BANK CAFETERIA PLAN 401k Plan overview

Plan Name	FIRST 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 Signed Name of Company Sponsor Date Sponsor Signed
501 2022-09-01 HEATHER FULLBRIGHT 2023-07-20 HEATHER FULLBRIGHT 2023-07-20
501 2021-09-01 HEATHER FULBRIGHT 2022-12-12 HEATHER FULBRIGHT 2022-12-12
501 2020-09-01 HEATHER FULBRIGHT 2021-05-25 HEATHER FULBRIGHT 2021-05-25
501 2019-09-01 HEATHER FULBRIGHT 2020-06-15 HEATHER FULBRIGHT 2020-06-15
501 2017-09-01 HEATHER FULBRIGHT 2019-04-10 HEATHER FULBRIGHT 2019-04-10
501 2016-09-01
501 2015-09-01
501 2014-09-01
501 2013-09-01
501 2012-09-01
501 2011-09-01 HEATHER FULBRIGHT
501 2010-09-01 HEATHER FULBRIGHT
501 2009-09-01 HEATHER FULBRIGHT
501 2008-09-01 HEATHER FULBRIGHT
501 2007-09-01 HEATHER FULBRIGHT
501 2006-09-01 HEATHER FULBRIGHT

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-09-01	HEATHER FULLBRIGHT	2023-07-20	HEATHER FULLBRIGHT	2023-07-20
501	2021-09-01	HEATHER FULBRIGHT	2022-12-12	HEATHER FULBRIGHT	2022-12-12
501	2020-09-01	HEATHER FULBRIGHT	2021-05-25	HEATHER FULBRIGHT	2021-05-25
501	2019-09-01	HEATHER FULBRIGHT	2020-06-15	HEATHER FULBRIGHT	2020-06-15
501	2017-09-01	HEATHER FULBRIGHT	2019-04-10	HEATHER FULBRIGHT	2019-04-10
501	2016-09-01
501	2015-09-01
501	2014-09-01
501	2013-09-01
501	2012-09-01
501	2011-09-01	HEATHER FULBRIGHT
501	2010-09-01	HEATHER FULBRIGHT
501	2009-09-01	HEATHER FULBRIGHT
501	2008-09-01	HEATHER FULBRIGHT
501	2007-09-01	HEATHER FULBRIGHT
501	2006-09-01	HEATHER 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-year 2022-09-01 364
Total number of active participants reported on line 7a of the Form 5500 2022-09-01 524
Total of all active and inactive participants 2022-09-01 524
Total participants 2022-09-01 524
2021: FIRST COMMUNITY BANK CAFETERIA PLAN 2021 401k membership
Total participants, beginning-of-year 2021-09-01 292
Total number of active participants reported on line 7a of the Form 5500 2021-09-01 364
Total of all active and inactive participants 2021-09-01 364
Total participants 2021-09-01 364
2020: FIRST COMMUNITY BANK CAFETERIA PLAN 2020 401k membership
Total participants, beginning-of-year 2020-09-01 281
Total number of active participants reported on line 7a of the Form 5500 2020-09-01 292
Total of all active and inactive participants 2020-09-01 292
Total participants 2020-09-01 292
2019: FIRST COMMUNITY BANK CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year 2019-09-01 278
Total number of active participants reported on line 7a of the Form 5500 2019-09-01 281
Total of all active and inactive participants 2019-09-01 281
Total participants 2019-09-01 281
2017: FIRST COMMUNITY BANK CAFETERIA PLAN 2017 401k membership
Total participants, beginning-of-year 2017-09-01 267
Total number of active participants reported on line 7a of the Form 5500 2017-09-01 278
Total of all active and inactive participants 2017-09-01 278
Total participants 2017-09-01 278
2016: FIRST COMMUNITY BANK CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year 2016-09-01 313
Total number of active participants reported on line 7a of the Form 5500 2016-09-01 267
Total of all active and inactive participants 2016-09-01 267
Total participants 2016-09-01 267
2015: FIRST COMMUNITY BANK CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year 2015-09-01 198
Total number of active participants reported on line 7a of the Form 5500 2015-09-01 313
Total of all active and inactive participants 2015-09-01 313
Total participants 2015-09-01 313
2014: FIRST COMMUNITY BANK CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year 2014-09-01 209
Total number of active participants reported on line 7a of the Form 5500 2014-09-01 196
Number of retired or separated participants receiving benefits 2014-09-01 2
Total of all active and inactive participants 2014-09-01 198
Total participants 2014-09-01 198
2013: FIRST COMMUNITY BANK CAFETERIA PLAN 2013 401k membership
Total participants, beginning-of-year 2013-09-01 193
Total number of active participants reported on line 7a of the Form 5500 2013-09-01 398
Total of all active and inactive participants 2013-09-01 398
Total participants 2013-09-01 398
2012: FIRST COMMUNITY BANK CAFETERIA PLAN 2012 401k membership
Total participants, beginning-of-year 2012-09-01 193
Total number of active participants reported on line 7a of the Form 5500 2012-09-01 329
Total of all active and inactive participants 2012-09-01 329
Total participants 2012-09-01 329
2011: FIRST COMMUNITY BANK CAFETERIA PLAN 2011 401k membership
Total participants, beginning-of-year 2011-09-01 165
Total number of active participants reported on line 7a of the Form 5500 2011-09-01 193
Total of all active and inactive participants 2011-09-01 193
Total participants 2011-09-01 193
2010: FIRST COMMUNITY BANK CAFETERIA PLAN 2010 401k membership
Total participants, beginning-of-year 2010-09-01 153
Total number of active participants reported on line 7a of the Form 5500 2010-09-01 165
Total of all active and inactive participants 2010-09-01 165
Total participants 2010-09-01 165
2009: FIRST COMMUNITY BANK CAFETERIA PLAN 2009 401k membership
Total participants, beginning-of-year 2009-09-01 144
Total number of active participants reported on line 7a of the Form 5500 2009-09-01 153
Total of all active and inactive participants 2009-09-01 153
Total participants 2009-09-01 153
2008: FIRST COMMUNITY BANK CAFETERIA PLAN 2008 401k membership
Total participants, beginning-of-year 2008-09-01 111
Total number of active participants reported on line 7a of the Form 5500 2008-09-01 144
Total of all active and inactive participants 2008-09-01 144
Total participants 2008-09-01 144
2007: FIRST COMMUNITY BANK CAFETERIA PLAN 2007 401k membership
Total participants, beginning-of-year 2007-09-01 93
Total number of active participants reported on line 7a of the Form 5500 2007-09-01 111
Total of all active and inactive participants 2007-09-01 111
Total participants 2007-09-01 111
2006: FIRST COMMUNITY BANK CAFETERIA PLAN 2006 401k membership
Total participants, beginning-of-year 2006-09-01 0
Total number of active participants reported on line 7a of the Form 5500 2006-09-01 93
Total of all active and inactive participants 2006-09-01 93
Total participants 2006-09-01 93

Measure	Date	Value
2022: FIRST COMMUNITY BANK CAFETERIA PLAN 2022 401k membership
Total participants, beginning-of-year	2022-09-01	364
Total number of active participants reported on line 7a of the Form 5500	2022-09-01	524
Total of all active and inactive participants	2022-09-01	524
Total participants	2022-09-01	524
2021: FIRST COMMUNITY BANK CAFETERIA PLAN 2021 401k membership
Total participants, beginning-of-year	2021-09-01	292
Total number of active participants reported on line 7a of the Form 5500	2021-09-01	364
Total of all active and inactive participants	2021-09-01	364
Total participants	2021-09-01	364
2020: FIRST COMMUNITY BANK CAFETERIA PLAN 2020 401k membership
Total participants, beginning-of-year	2020-09-01	281
Total number of active participants reported on line 7a of the Form 5500	2020-09-01	292
Total of all active and inactive participants	2020-09-01	292
Total participants	2020-09-01	292
2019: FIRST COMMUNITY BANK CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year	2019-09-01	278
Total number of active participants reported on line 7a of the Form 5500	2019-09-01	281
Total of all active and inactive participants	2019-09-01	281
Total participants	2019-09-01	281
2017: FIRST COMMUNITY BANK CAFETERIA PLAN 2017 401k membership
Total participants, beginning-of-year	2017-09-01	267
Total number of active participants reported on line 7a of the Form 5500	2017-09-01	278
Total of all active and inactive participants	2017-09-01	278
Total participants	2017-09-01	278
2016: FIRST COMMUNITY BANK CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year	2016-09-01	313
Total number of active participants reported on line 7a of the Form 5500	2016-09-01	267
Total of all active and inactive participants	2016-09-01	267
Total participants	2016-09-01	267
2015: FIRST COMMUNITY BANK CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year	2015-09-01	198
Total number of active participants reported on line 7a of the Form 5500	2015-09-01	313
Total of all active and inactive participants	2015-09-01	313
Total participants	2015-09-01	313
2014: FIRST COMMUNITY BANK CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year	2014-09-01	209
Total number of active participants reported on line 7a of the Form 5500	2014-09-01	196
Number of retired or separated participants receiving benefits	2014-09-01	2
Total of all active and inactive participants	2014-09-01	198
Total participants	2014-09-01	198
2013: FIRST COMMUNITY BANK CAFETERIA PLAN 2013 401k membership
Total participants, beginning-of-year	2013-09-01	193
Total number of active participants reported on line 7a of the Form 5500	2013-09-01	398
Total of all active and inactive participants	2013-09-01	398
Total participants	2013-09-01	398
2012: FIRST COMMUNITY BANK CAFETERIA PLAN 2012 401k membership
Total participants, beginning-of-year	2012-09-01	193
Total number of active participants reported on line 7a of the Form 5500	2012-09-01	329
Total of all active and inactive participants	2012-09-01	329
Total participants	2012-09-01	329
2011: FIRST COMMUNITY BANK CAFETERIA PLAN 2011 401k membership
Total participants, beginning-of-year	2011-09-01	165
Total number of active participants reported on line 7a of the Form 5500	2011-09-01	193
Total of all active and inactive participants	2011-09-01	193
Total participants	2011-09-01	193
2010: FIRST COMMUNITY BANK CAFETERIA PLAN 2010 401k membership
Total participants, beginning-of-year	2010-09-01	153
Total number of active participants reported on line 7a of the Form 5500	2010-09-01	165
Total of all active and inactive participants	2010-09-01	165
Total participants	2010-09-01	165
2009: FIRST COMMUNITY BANK CAFETERIA PLAN 2009 401k membership
Total participants, beginning-of-year	2009-09-01	144
Total number of active participants reported on line 7a of the Form 5500	2009-09-01	153
Total of all active and inactive participants	2009-09-01	153
Total participants	2009-09-01	153
2008: FIRST COMMUNITY BANK CAFETERIA PLAN 2008 401k membership
Total participants, beginning-of-year	2008-09-01	111
Total number of active participants reported on line 7a of the Form 5500	2008-09-01	144
Total of all active and inactive participants	2008-09-01	144
Total participants	2008-09-01	144
2007: FIRST COMMUNITY BANK CAFETERIA PLAN 2007 401k membership
Total participants, beginning-of-year	2007-09-01	93
Total number of active participants reported on line 7a of the Form 5500	2007-09-01	111
Total of all active and inactive participants	2007-09-01	111
Total participants	2007-09-01	111
2006: FIRST COMMUNITY BANK CAFETERIA PLAN 2006 401k membership
Total participants, beginning-of-year	2006-09-01	0
Total number of active participants reported on line 7a of the Form 5500	2006-09-01	93
Total of all active and inactive participants	2006-09-01	93
Total participants	2006-09-01	93

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 plan	2022-12-31	$5,000,000
2015 : FIRST COMMUNITY BANK CAFETERIA PLAN 2015 401k financial data
Total income from all sources	2015-08-31	$1,774,845
Expenses. Total of all expenses incurred	2015-08-31	$1,774,845
Benefits paid (including direct rollovers)	2015-08-31	$1,499,621
Total contributions received or receivable from participants	2015-08-31	$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 sources	2014-08-31	$1,314,207
Expenses. Total of all expenses incurred	2014-08-31	$1,226,618
Benefits paid (including direct rollovers)	2014-08-31	$1,018,419
Total contributions received or receivable from participants	2014-08-31	$532,223
Expenses. Other expenses not covered elsewhere	2014-08-31	$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 sources	2013-08-31	$112,713
Expenses. Total of all expenses incurred	2013-08-31	$112,713
Benefits paid (including direct rollovers)	2013-08-31	$96,952
Total contributions received or receivable from participants	2013-08-31	$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 year	2012-08-31	$0
Total plan liabilities at beginning of year	2012-08-31	$0
Total income from all sources	2012-08-31	$334,048
Expenses. Total of all expenses incurred	2012-08-31	$334,048
Benefits paid (including direct rollovers)	2012-08-31	$294,076
Total plan assets at end of year	2012-08-31	$0
Total plan assets at beginning of year	2012-08-31	$0
Total contributions received or receivable from participants	2012-08-31	$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 year	2011-08-31	$0
Total plan liabilities at beginning of year	2011-08-31	$0
Total income from all sources	2011-08-31	$1,003,325
Expenses. Total of all expenses incurred	2011-08-31	$1,003,325
Benefits paid (including direct rollovers)	2011-08-31	$865,045
Total plan assets at end of year	2011-08-31	$0
Total plan assets at beginning of year	2011-08-31	$0
Total contributions received or receivable from participants	2011-08-31	$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 year	2010-08-31	$0
Total plan liabilities at beginning of year	2010-08-31	$0
Total income from all sources	2010-08-31	$893,143
Expenses. Total of all expenses incurred	2010-08-31	$893,143
Benefits paid (including direct rollovers)	2010-08-31	$752,196
Total plan assets at end of year	2010-08-31	$0
Total plan assets at beginning of year	2010-08-31	$0
Total contributions received or receivable from participants	2010-08-31	$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 year	2009-08-31	$0
Total plan liabilities at beginning of year	2009-08-31	$0
Total income from all sources	2009-08-31	$144,771
Expenses. Total of all expenses incurred	2009-08-31	$144,771
Benefits paid (including direct rollovers)	2009-08-31	$132,387
Total plan assets at end of year	2009-08-31	$0
Total plan assets at beginning of year	2009-08-31	$0
Total contributions received or receivable from participants	2009-08-31	$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 year	2008-08-31	$0
Total plan liabilities at beginning of year	2008-08-31	$0
Total income from all sources	2008-08-31	$77,189
Expenses. Total of all expenses incurred	2008-08-31	$77,189
Benefits paid (including direct rollovers)	2008-08-31	$72,872
Total plan assets at end of year	2008-08-31	$0
Total plan assets at beginning of year	2008-08-31	$0
Total contributions received or receivable from participants	2008-08-31	$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 year	2007-08-31	$0
Total plan liabilities at beginning of year	2007-08-31	$0
Total income from all sources	2007-08-31	$59,087
Expenses. Total of all expenses incurred	2007-08-31	$59,087
Benefits paid (including direct rollovers)	2007-08-31	$55,786
Total plan assets at end of year	2007-08-31	$0
Total plan assets at beginning of year	2007-08-31	$0
Total contributions received or receivable from participants	2007-08-31	$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
2022-09-01	Type of plan entity	Single employer plan
2022-09-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2022-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-09-01	Plan benefit arrangement – Insurance	Yes
2021: FIRST COMMUNITY BANK CAFETERIA PLAN 2021 form 5500 responses
2021-09-01	Type of plan entity	Single employer plan
2021-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-09-01	Plan benefit arrangement – Insurance	Yes
2020: FIRST COMMUNITY BANK CAFETERIA PLAN 2020 form 5500 responses
2020-09-01	Type of plan entity	Single employer plan
2020-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-09-01	Plan benefit arrangement – Insurance	Yes
2019: FIRST COMMUNITY BANK CAFETERIA PLAN 2019 form 5500 responses
2019-09-01	Type of plan entity	Single employer plan
2019-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-09-01	Plan benefit arrangement – Insurance	Yes
2017: FIRST COMMUNITY BANK CAFETERIA PLAN 2017 form 5500 responses
2017-09-01	Type of plan entity	Single employer plan
2017-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-09-01	Plan benefit arrangement – Insurance	Yes
2016: FIRST COMMUNITY BANK CAFETERIA PLAN 2016 form 5500 responses
2016-09-01	Type of plan entity	Single employer plan
2016-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-09-01	Plan benefit arrangement – Insurance	Yes
2015: FIRST COMMUNITY BANK CAFETERIA PLAN 2015 form 5500 responses
2015-09-01	Type of plan entity	Single employer plan
2015-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-09-01	Plan benefit arrangement – Insurance	Yes
2014: FIRST COMMUNITY BANK CAFETERIA PLAN 2014 form 5500 responses
2014-09-01	Type of plan entity	Single employer plan
2014-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-09-01	Plan benefit arrangement – Insurance	Yes
2013: FIRST COMMUNITY BANK CAFETERIA PLAN 2013 form 5500 responses
2013-09-01	Type of plan entity	Single employer plan
2013-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-09-01	Plan benefit arrangement – Insurance	Yes
2012: FIRST COMMUNITY BANK CAFETERIA PLAN 2012 form 5500 responses
2012-09-01	Type of plan entity	Single employer plan
2012-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-09-01	Plan benefit arrangement – Insurance	Yes
2011: FIRST COMMUNITY BANK CAFETERIA PLAN 2011 form 5500 responses
2011-09-01	Type of plan entity	Single employer plan
2011-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-09-01	Plan benefit arrangement – Insurance	Yes
2010: FIRST COMMUNITY BANK CAFETERIA PLAN 2010 form 5500 responses
2010-09-01	Type of plan entity	Single employer plan
2010-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-09-01	Plan benefit arrangement – Insurance	Yes
2009: FIRST COMMUNITY BANK CAFETERIA PLAN 2009 form 5500 responses
2009-09-01	Type of plan entity	Single employer plan
2009-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-09-01	Plan benefit arrangement – Insurance	Yes
2008: FIRST COMMUNITY BANK CAFETERIA PLAN 2008 form 5500 responses
2008-09-01	Type of plan entity	Single employer plan
2008-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2008-09-01	Plan benefit arrangement – Insurance	Yes
2007: FIRST COMMUNITY BANK CAFETERIA PLAN 2007 form 5500 responses
2007-09-01	Type of plan entity	Single employer plan
2007-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2007-09-01	Plan benefit arrangement – Insurance	Yes
2006: FIRST COMMUNITY BANK CAFETERIA PLAN 2006 form 5500 responses
2006-09-01	Type of plan entity	Single employer plan
2006-09-01	First time form 5500 has been submitted	Yes
2006-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2006-09-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

ONE BEACON INSURANCE GROUP (National Association of Insurance Commissioners NAIC id number: 0876- )

Policy contract number

Policy instance

Number of Individuals Covered	351
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $100,825
Total amount of fees paid to insurance company	USD $196,609
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $755,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $100,825
Insurance broker organization code?	3
Amount paid for insurance broker fees	142163
Additional information about fees paid to insurance broker	ADMINISTRATION FEES

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000006251

Policy instance

Insurance contract or identification number	000006251
Number of Individuals Covered	56
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,593
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,593
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

836854

Policy instance

Insurance contract or identification number	836854
Number of Individuals Covered	513
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $11,285
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $205,507
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,285
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000006251-10000

Policy instance

Insurance contract or identification number	000006251-10000
Number of Individuals Covered	4
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $244
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $244
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000006251-10000

Policy instance

Insurance contract or identification number	000006251-10000
Number of Individuals Covered	771
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $27,850
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,850
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

30059830

Policy instance

Insurance contract or identification number	30059830
Number of Individuals Covered	314
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $4,481
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $52,748
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,636
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000006251-20000

Policy instance

Insurance contract or identification number	000006251-20000
Number of Individuals Covered	59
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,803
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,803
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

836855

Policy instance

Insurance contract or identification number	836855
Number of Individuals Covered	188
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $16,438
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $109,587
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,438
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

836856

Policy instance

Insurance contract or identification number	836856
Number of Individuals Covered	295
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $26,816
Other welfare benefits provided	LIFESTYLE A D D, LIFESTYLE LIFE
Welfare Benefit Premiums Paid to Carrier	USD $178,798
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,816
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000006251

Policy instance

Insurance contract or identification number	000006251
Number of Individuals Covered	814
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $28,803
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,803

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

30059830

Policy instance

Insurance contract or identification number	30059830
Number of Individuals Covered	280
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $4,874
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $45,288
Commission paid to Insurance Broker	USD $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

Number of Individuals Covered	315
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $92,075
Total amount of fees paid to insurance company	USD $177,704
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $711,468
Commission paid to Insurance Broker	USD $92,075
Insurance broker organization code?	3
Amount paid for insurance broker fees	127983
Additional information about fees paid to insurance broker	ADMIN FEES

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

836855

Policy instance

Insurance contract or identification number	836855
Number of Individuals Covered	56
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $11,010
Temporary Disability Insurance Welfare Benefit	Yes
Commission paid to Insurance Broker	USD $11,010

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

836856

Policy instance

Insurance contract or identification number	836856
Number of Individuals Covered	262
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $17,411
Other welfare benefits provided	LIFESTYLE A D D LIFESTYLE LIFE
Commission paid to Insurance Broker	USD $17,411

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

836854

Policy instance

Insurance contract or identification number	836854
Number of Individuals Covered	155
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $6,828
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,828

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

836854

Policy instance

Insurance contract or identification number	836854
Number of Individuals Covered	420
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $8,248
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $117,896
Commission paid to Insurance Broker	USD $8,248
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

Number of Individuals Covered	760
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $86,900
Total amount of fees paid to insurance company	USD $166,154
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $449,082
Commission paid to Insurance Broker	USD $86,900
Insurance broker organization code?	3
Amount paid for insurance broker fees	166095
Additional information about fees paid to insurance broker	ADMINISTRATION FEES, REPRICING FEES, TELADOC FEES

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

30059830

Policy instance

Insurance contract or identification number	30059830
Number of Individuals Covered	225
Insurance policy start date	2019-08-01
Insurance policy end date	2020-07-31
Total amount of commissions paid to insurance broker	USD $718
Vision Insurance Welfare Benefit	Yes
Commission paid to Insurance Broker	USD $718
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

836855

Policy instance

Insurance contract or identification number	836855
Number of Individuals Covered	170
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $11,807
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $78,711
Commission paid to Insurance Broker	USD $11,807
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000006251

Policy instance

Insurance contract or identification number	000006251
Number of Individuals Covered	760
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $25,298
Dental Insurance Welfare Benefit	Yes
Commission paid to Insurance Broker	USD $25,298
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

836856

Policy instance

Insurance contract or identification number	836856
Number of Individuals Covered	223
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $16,445
Other welfare benefits provided	VOLUNTARY A D D
Welfare Benefit Premiums Paid to Carrier	USD $109,022
Commission paid to Insurance Broker	USD $16,445
Insurance broker organization code?	3

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50014152

Policy instance

Insurance contract or identification number	50014152
Temporary Disability Insurance Welfare Benefit	Yes

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

027366

Policy instance

Insurance contract or identification number	027366
Dental Insurance Welfare Benefit	Yes

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50014152

Policy instance

Insurance contract or identification number	50014152
Life Insurance Welfare Benefit	Yes

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

038894

Policy instance

Insurance contract or identification number	038894
Health Insurance Welfare Benefit	Yes

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

028396

Policy instance

Insurance contract or identification number	028396
Health Insurance Welfare Benefit	Yes

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

027617

Policy instance

Insurance contract or identification number	027617
Insurance policy start date	2018-08-01
Insurance policy end date	2019-07-31
Total amount of commissions paid to insurance broker	USD $9,793
Total amount of fees paid to insurance company	USD $31,943
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,793
Amount paid for insurance broker fees	31943
Additional information about fees paid to insurance broker	SERVICE FEES
Insurance broker organization code?	3

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50014152

Policy instance

Insurance contract or identification number	50014152
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50014152

Policy instance

Insurance contract or identification number	50014152
Other welfare benefits provided	VOLUNTARY A D D

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

027616

Policy instance

Insurance contract or identification number	027616
Dental Insurance Welfare Benefit	Yes

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

027365

Policy instance

Insurance contract or identification number	027365
Dental Insurance Welfare Benefit	Yes

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50014152

Policy instance

Insurance contract or identification number	50014152
Long Term Disability Insurance Welfare Benefit	Yes

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

028396

Policy instance

Insurance contract or identification number	028396
Insurance policy start date	2018-08-01
Insurance policy end date	2019-07-31
Total amount of commissions paid to insurance broker	USD $18,574
Total amount of fees paid to insurance company	USD $160,542
Health Insurance Welfare Benefit	Yes
Commission paid to Insurance Broker	USD $18,574
Amount paid for insurance broker fees	160542
Additional information about fees paid to insurance broker	SERVICE FEES
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

30059830

Policy instance

Insurance contract or identification number	30059830
Number of Individuals Covered	181
Insurance policy start date	2018-08-01
Insurance policy end date	2019-07-31
Total amount of commissions paid to insurance broker	USD $2,630
Vision Insurance Welfare Benefit	Yes
Commission paid to Insurance Broker	USD $1,313
Insurance broker organization code?	3

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

028396

Policy instance

Insurance contract or identification number	028396
Number of Individuals Covered	31
Insurance policy start date	2017-08-01
Insurance policy end date	2018-07-31
Total amount of commissions paid to insurance broker	USD $2,184
Total amount of fees paid to insurance company	USD $17,475
Health Insurance Welfare Benefit	Yes
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 number

50014152

Policy instance

Insurance contract or identification number	50014152
Number of Individuals Covered	262
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $12,476
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $59,648
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 number

038894

Policy instance

Insurance contract or identification number	038894
Number of Individuals Covered	490
Insurance policy start date	2017-08-01
Insurance policy end date	2018-07-31
Total amount of commissions paid to insurance broker	USD $40,638
Total amount of fees paid to insurance company	USD $253,606
Health Insurance Welfare Benefit	Yes
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 number

50014152

Policy instance

Insurance contract or identification number	50014152
Number of Individuals Covered	333
Insurance policy start date	2017-08-01
Insurance policy end date	2018-07-31
Total amount of commissions paid to insurance broker	USD $11,358
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $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 number

027617

Policy instance

Insurance contract or identification number	027617
Number of Individuals Covered	2
Insurance policy start date	2017-08-01
Insurance policy end date	2018-07-31
Total amount of commissions paid to insurance broker	USD $37
Total amount of fees paid to insurance company	USD $119
Dental Insurance Welfare Benefit	Yes
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: 00000 )

Policy contract number

30059830

Policy instance

Insurance contract or identification number	30059830
Number of Individuals Covered	154
Insurance policy start date	2017-08-01
Insurance policy end date	2018-07-31
Total amount of commissions paid to insurance broker	USD $2,125
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $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 number

027616

Policy instance

Insurance contract or identification number	027616
Number of Individuals Covered	43
Insurance policy start date	2017-08-01
Insurance policy end date	2018-07-31
Total amount of commissions paid to insurance broker	USD $524
Total amount of fees paid to insurance company	USD $1,534
Dental Insurance Welfare Benefit	Yes
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 number

027365

Policy instance

Insurance contract or identification number	027365
Number of Individuals Covered	584
Insurance policy start date	2017-08-01
Insurance policy end date	2018-07-31
Total amount of commissions paid to insurance broker	USD $8,468
Total amount of fees paid to insurance company	USD $20,212
Dental Insurance Welfare Benefit	Yes
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 number

50014152

Policy instance

Insurance contract or identification number	50014152
Number of Individuals Covered	333
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $5,551
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,110
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 number

50014152

Policy instance

Insurance contract or identification number	50014152
Number of Individuals Covered	129
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $8,910
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $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 number

50014152

Policy instance

Insurance contract or identification number	50014152
Number of Individuals Covered	210
Insurance policy start date	2017-09-01
Insurance policy end date	2018-08-31
Total amount of commissions paid to insurance broker	USD $1,217
Other welfare benefits provided	VOLUNTARY A D D
Welfare Benefit Premiums Paid to Carrier	USD $5,817
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 number

027366

Policy instance

Insurance contract or identification number	027366
Number of Individuals Covered	41
Insurance policy start date	2017-08-01
Insurance policy end date	2018-07-31
Total amount of commissions paid to insurance broker	USD $688
Total amount of fees paid to insurance company	USD $1,823
Dental Insurance Welfare Benefit	Yes
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 number

028396

Policy instance

Insurance contract or identification number	028396
Number of Individuals Covered	47
Insurance policy start date	2017-08-01
Insurance policy end date	2018-07-31
Total amount of commissions paid to insurance broker	USD $4,132
Total amount of fees paid to insurance company	USD $33,245
Health Insurance Welfare Benefit	Yes
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 number

028396

Policy instance

Insurance contract or identification number	028396
Number of Individuals Covered	34
Insurance policy start date	2015-08-01
Insurance policy end date	2016-07-31
Total amount of commissions paid to insurance broker	USD $2,510
Total amount of fees paid to insurance company	USD $19,452
Health Insurance Welfare Benefit	Yes
Commission paid to Insurance Broker	USD $2,510
Insurance broker organization code?	3
Amount paid for insurance broker fees	19452
Additional information about fees paid to insurance broker	SERVICE FEES
Insurance broker name	ARKANSAS BLUE CROSS AND BLUE SHIELD

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50014152

Policy instance

Insurance contract or identification number	50014152
Number of Individuals Covered	267
Insurance policy start date	2015-09-01
Insurance policy end date	2016-08-31
Total amount of commissions paid to insurance broker	USD $8,509
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $54,684
Commission paid to Insurance Broker	USD $8,203
Insurance broker organization code?	3
Insurance broker name	MCCALL MARTIN

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

027366

Policy instance

Insurance contract or identification number	027366
Number of Individuals Covered	32
Insurance policy start date	2015-08-01
Insurance policy end date	2016-07-31
Total amount of commissions paid to insurance broker	USD $523
Total amount of fees paid to insurance company	USD $1,725
Dental Insurance Welfare Benefit	Yes
Commission paid to Insurance Broker	USD $523
Insurance broker organization code?	3
Amount paid for insurance broker fees	1725
Additional information about fees paid to insurance broker	SERVICE FEES
Insurance broker name	ARKANSAS BLUE CROSS AND BLUE SHIELD

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

027365

Policy instance

Insurance contract or identification number	027365
Number of Individuals Covered	515
Insurance policy start date	2015-08-01
Insurance policy end date	2016-07-31
Total amount of commissions paid to insurance broker	USD $6,987
Total amount of fees paid to insurance company	USD $23,057
Dental Insurance Welfare Benefit	Yes
Commission paid to Insurance Broker	USD $6,987
Insurance broker organization code?	3
Amount paid for insurance broker fees	23057
Additional information about fees paid to insurance broker	SERVICE FEES
Insurance broker name	ARKANSAS BLUE CROSS AND BLUE SHIELD

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

101746801

Policy instance

Insurance contract or identification number	101746801
Number of Individuals Covered	111
Insurance policy start date	2015-09-01
Insurance policy end date	2016-08-31
Total amount of commissions paid to insurance broker	USD $3,747
Other welfare benefits provided	CANCER
Welfare Benefit Premiums Paid to Carrier	USD $28,919
Commission paid to Insurance Broker	USD $3,112
Insurance broker organization code?	3
Insurance broker name	MARTIN MCCALL

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50014152

Policy instance

Insurance contract or identification number	50014152
Number of Individuals Covered	263
Insurance policy start date	2015-09-01
Insurance policy end date	2016-08-31
Total amount of commissions paid to insurance broker	USD $9,948
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $42,743
Commission paid to Insurance Broker	USD $7,461
Insurance broker organization code?	3
Insurance broker name	MCCALL, MARTIN

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

061027

Policy instance

Insurance contract or identification number	061027
Vision Insurance Welfare Benefit	Yes
Insurance broker organization code?	3
Insurance broker name	ARKANSAS BLUE CROSS AND BLUE SHIELD

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

061029

Policy instance

Insurance contract or identification number	061029
Vision Insurance Welfare Benefit	Yes
Insurance broker organization code?	3
Insurance broker name	ARKANSAS BLUE CROSS AND BLUE SHIELD

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50014152

Policy instance

Insurance contract or identification number	50014152
Number of Individuals Covered	267
Insurance policy start date	2015-09-01
Insurance policy end date	2016-08-31
Total amount of commissions paid to insurance broker	USD $4,167
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,591
Commission paid to Insurance Broker	USD $3,839
Insurance broker organization code?	3
Insurance broker name	MCCALL, MARTIN

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50014152

Policy instance

Insurance contract or identification number	50014152
Number of Individuals Covered	108
Insurance policy start date	2015-09-01
Insurance policy end date	2016-08-31
Total amount of commissions paid to insurance broker	USD $7,075
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $45,456
Commission paid to Insurance Broker	USD $6,818
Insurance broker organization code?	3
Insurance broker name	MCCALL, MARTIN

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

101746801

Policy instance

Insurance contract or identification number	101746801
Number of Individuals Covered	125
Insurance policy start date	2015-09-01
Insurance policy end date	2016-08-31
Total amount of commissions paid to insurance broker	USD $3,124
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $22,023
Commission paid to Insurance Broker	USD $2,630
Insurance broker organization code?	3
Insurance broker name	MARTIN MCCALL

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

038894

Policy instance

Insurance contract or identification number	038894
Number of Individuals Covered	449
Insurance policy start date	2015-08-01
Insurance policy end date	2016-07-31
Total amount of commissions paid to insurance broker	USD $26,514
Total amount of fees paid to insurance company	USD $128,860
Health Insurance Welfare Benefit	Yes
Commission paid to Insurance Broker	USD $26,514
Insurance broker organization code?	3
Amount paid for insurance broker fees	128860
Additional information about fees paid to insurance broker	SERVICE FEES
Insurance broker name	ARKANSAS BLUE CROSS AND BLUE SHIELD

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50014152

Policy instance

Insurance contract or identification number	50014152
Number of Individuals Covered	213
Insurance policy start date	2015-09-01
Insurance policy end date	2016-08-31
Total amount of commissions paid to insurance broker	USD $983
Other welfare benefits provided	VOLUNTARY A D D
Welfare Benefit Premiums Paid to Carrier	USD $4,915
Commission paid to Insurance Broker	USD $737
Insurance broker organization code?	3
Insurance broker name	MCCALL, MARTIN

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

101746801

Policy instance

Insurance contract or identification number	101746801
Number of Individuals Covered	46
Insurance policy start date	2015-09-01
Insurance policy end date	2016-08-31
Total amount of commissions paid to insurance broker	USD $769
Other welfare benefits provided	CRITICAL CARE
Welfare Benefit Premiums Paid to Carrier	USD $5,310
Commission paid to Insurance Broker	USD $642
Insurance broker organization code?	3
Insurance broker name	MARTIN MCCALL

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

061029

Policy instance

Insurance contract or identification number	061029
Number of Individuals Covered	20
Insurance policy start date	2014-08-01
Insurance policy end date	2015-07-31
Total amount of commissions paid to insurance broker	USD $158
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,595
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $158
Insurance broker organization code?	3
Insurance broker name	BATESVILLE INSURANCE AGENCY

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

061027

Policy instance

Insurance contract or identification number	061027
Number of Individuals Covered	229
Insurance policy start date	2014-08-01
Insurance policy end date	2015-07-31
Total amount of commissions paid to insurance broker	USD $1,708
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,099
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,708
Insurance broker organization code?	3
Insurance broker name	BATESVILLE INSURANCE AGENCY INC

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

027365

Policy instance

Insurance contract or identification number	027365
Number of Individuals Covered	460
Insurance policy start date	2014-08-01
Insurance policy end date	2015-07-31
Total amount of commissions paid to insurance broker	USD $6,931
Total amount of fees paid to insurance company	USD $22,871
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,931
Insurance broker organization code?	3
Amount paid for insurance broker fees	22871
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker name	ARKANSAS BLUE CROSS AND BLUE SHIELD

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

038894

Policy instance

Insurance contract or identification number	038894
Number of Individuals Covered	417
Insurance policy start date	2014-08-01
Insurance policy end date	2015-07-31
Total amount of commissions paid to insurance broker	USD $25,407
Total amount of fees paid to insurance company	USD $123,478
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,407
Insurance broker organization code?	3
Amount paid for insurance broker fees	123478
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker name	ARKANSAS BLUE CROSS AND BLUE SHIELD

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

208396

Policy instance

Insurance contract or identification number	208396
Number of Individuals Covered	38
Insurance policy start date	2014-08-01
Insurance policy end date	2015-07-31
Total amount of commissions paid to insurance broker	USD $2,262
Total amount of fees paid to insurance company	USD $17,527
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,262
Insurance broker organization code?	3
Amount paid for insurance broker fees	17527
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker name	ARKANSAS BLUE CROSS AND BLUE SHIELD

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50014152

Policy instance

Insurance contract or identification number	50014152
Number of Individuals Covered	243
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $28,815
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,371
Insurance broker organization code?	3
Insurance broker name	BATESVILLE INSURANCE AGENCY INC

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

101746801

Policy instance

Insurance contract or identification number	101746801
Number of Individuals Covered	117
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $8,854
Other welfare benefits provided	CANCER, 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 Broker	USD $7,557
Insurance broker organization code?	3
Insurance broker name	MARTIN MCCALL

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

027366

Policy instance

Insurance contract or identification number	027366
Number of Individuals Covered	35
Insurance policy start date	2014-08-01
Insurance policy end date	2015-07-31
Total amount of commissions paid to insurance broker	USD $544
Total amount of fees paid to insurance company	USD $1,796
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $544
Insurance broker organization code?	2
Amount paid for insurance broker fees	1796
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker name	ARKANSAS BLUE CROSS AND BLUE SHIELD

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

858233G

Policy instance

Insurance contract or identification number	858233G
Number of Individuals Covered	132
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $3
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3
Insurance broker organization code?	3
Insurance broker name	BATESVILLE INSURANCE AGENCY INC

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

038894

Policy instance

Insurance contract or identification number	038894
Number of Individuals Covered	398
Insurance policy start date	2013-08-01
Insurance policy end date	2014-07-31
Total amount of commissions paid to insurance broker	USD $21,365
Total amount of fees paid to insurance company	USD $108,213
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,365
Amount paid for insurance broker fees	108213
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3
Insurance broker name	BATESVILLE INSURANCE AGENCY INC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

30035462

Policy instance

Insurance contract or identification number	30035462
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-01
Total amount of commissions paid to insurance broker	USD $1,090
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,090
Insurance broker name	EDUCATIONAL BENEFITS, INC.

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

027365

Policy instance

Insurance contract or identification number	027365
Number of Individuals Covered	624
Insurance policy start date	2013-08-01
Insurance policy end date	2014-07-31
Total amount of commissions paid to insurance broker	USD $6,042
Total amount of fees paid to insurance company	USD $19,940
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,042
Amount paid for insurance broker fees	19940
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3
Insurance broker name	BATESVILLE INSURANCE AGENCY INC

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

027366

Policy instance

Insurance contract or identification number	027366
Number of Individuals Covered	31
Insurance policy start date	2013-08-01
Insurance policy end date	2014-07-31
Total amount of commissions paid to insurance broker	USD $565
Total amount of fees paid to insurance company	USD $1,865
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $565
Amount paid for insurance broker fees	1865
Additional information about fees paid to insurance broker	ADMINISTRATION
Insurance broker organization code?	3
Insurance broker name	BATESVILLE INSURANCE AGENCY INC.

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

208396

Policy instance

Insurance contract or identification number	208396
Number of Individuals Covered	30
Insurance policy start date	2013-08-01
Insurance policy end date	2014-07-31
Total amount of commissions paid to insurance broker	USD $2,058
Total amount of fees paid to insurance company	USD $15,951
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,058
Amount paid for insurance broker fees	15951
Additional information about fees paid to insurance broker	ADMINISTRATION FEES
Insurance broker organization code?	3
Insurance broker name	BATESVILLE INSURANCE AGENCY INC

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

038894

Policy instance

Insurance contract or identification number	038894
Number of Individuals Covered	329
Insurance policy start date	2012-08-01
Insurance policy end date	2013-07-31
Total amount of commissions paid to insurance broker	USD $26,487
Total amount of fees paid to insurance company	USD $94,469
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,487
Amount paid for insurance broker fees	94469
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3
Insurance broker name	BATESVILLE INSURANCE AGENCY INC

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

208396

Policy instance

Insurance contract or identification number	208396
Number of Individuals Covered	34
Insurance policy start date	2012-08-01
Insurance policy end date	2013-07-31
Total amount of commissions paid to insurance broker	USD $3,029
Total amount of fees paid to insurance company	USD $15,648
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,029
Amount paid for insurance broker fees	15648
Additional information about fees paid to insurance broker	ADMINISTRATION FEES
Insurance broker organization code?	3
Insurance broker name	BATESVILLE INSURANCE AGENCY INC

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

858233G

Policy instance

Insurance contract or identification number	858233G
Number of Individuals Covered	206
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $15,761
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,761
Insurance broker organization code?	3
Insurance broker name	BATESVILLE INSURANCE AGENCY INC

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

027365

Policy instance

Insurance contract or identification number	027365
Number of Individuals Covered	376
Insurance policy start date	2012-08-01
Insurance policy end date	2013-07-31
Total amount of commissions paid to insurance broker	USD $5,075
Total amount of fees paid to insurance company	USD $16,747
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,075
Amount paid for insurance broker fees	16747
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker organization code?	3
Insurance broker name	BATESVILLE INSURANCE AGENCY INC

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

027366

Policy instance

Insurance contract or identification number	027366
Number of Individuals Covered	34
Insurance policy start date	2012-08-01
Insurance policy end date	2013-07-31
Total amount of commissions paid to insurance broker	USD $533
Total amount of fees paid to insurance company	USD $1,758
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $533
Amount paid for insurance broker fees	1758
Additional information about fees paid to insurance broker	ADMINISTRATION
Insurance broker organization code?	3
Insurance broker name	BATESVILLE INSURANCE AGENCY INC.

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

858233G

Policy instance

Insurance contract or identification number	858233G
Number of Individuals Covered	206
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $15,761
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
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 number

000002338

Policy instance

Insurance contract or identification number	000002338
Insurance policy start date	2011-06-01
Insurance policy end date	2012-05-31
Total amount of commissions paid to insurance broker	USD $7,135
Dental Insurance Welfare Benefit	Yes
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 number

858233G

Policy instance

Insurance contract or identification number	858233G
Number of Individuals Covered	193
Insurance policy start date	2010-10-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $15,271
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
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 number

038894

Policy instance

Insurance contract or identification number	038894
Number of Individuals Covered	41
Insurance policy start date	2011-08-01
Insurance policy end date	2012-07-31
Total amount of commissions paid to insurance broker	USD $2,387
Health Insurance Welfare Benefit	Yes
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 number

208396

Policy instance

Insurance contract or identification number	208396
Number of Individuals Covered	41
Insurance policy start date	2011-08-01
Insurance policy end date	2012-07-31
Total amount of commissions paid to insurance broker	USD $25,033
Health Insurance Welfare Benefit	Yes
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 number

038894

Policy instance

Insurance contract or identification number	038894
Number of Individuals Covered	267
Insurance policy start date	2010-08-01
Insurance policy end date	2011-07-31
Total amount of commissions paid to insurance broker	USD $23,066
Health Insurance Welfare Benefit	Yes
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 number

208396

Policy instance

Insurance contract or identification number	208396
Number of Individuals Covered	25
Insurance policy start date	2010-08-01
Insurance policy end date	2011-07-31
Total amount of commissions paid to insurance broker	USD $1,504
Health Insurance Welfare Benefit	Yes
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 number

858233G

Policy instance

Insurance contract or identification number	858233G
Number of Individuals Covered	165
Insurance policy start date	2009-10-01
Insurance policy end date	2010-09-30
Total amount of commissions paid to insurance broker	USD $9,183
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
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 number

000002338

Policy instance

Insurance contract or identification number	000002338
Number of Individuals Covered	368
Insurance policy start date	2010-06-01
Insurance policy end date	2011-05-31
Total amount of commissions paid to insurance broker	USD $6,374
Dental Insurance Welfare Benefit	Yes
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 number

038894

Policy instance

Insurance contract or identification number	038894
Number of Individuals Covered	235
Insurance policy start date	2009-08-01
Insurance policy end date	2010-07-31
Total amount of commissions paid to insurance broker	USD $19,588
Health Insurance Welfare Benefit	Yes
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 number

208396

Policy instance

Insurance contract or identification number	208396
Number of Individuals Covered	11
Insurance policy start date	2009-08-01
Insurance policy end date	2010-07-31
Total amount of commissions paid to insurance broker	USD $1,098
Health Insurance Welfare Benefit	Yes
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 number

858233G

Policy instance

Insurance contract or identification number	858233G
Number of Individuals Covered	153
Insurance policy start date	2008-10-01
Insurance policy end date	2009-09-30
Total amount of commissions paid to insurance broker	USD $12,151
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
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 number

000002338

Policy instance

Insurance contract or identification number	000002338
Number of Individuals Covered	312
Insurance policy start date	2009-06-01
Insurance policy end date	2010-05-31
Total amount of commissions paid to insurance broker	USD $5,304
Dental Insurance Welfare Benefit	Yes
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 number

000002338

Policy instance

Insurance contract or identification number	000002338
Insurance policy start date	2008-06-01
Insurance policy end date	2009-05-31
Total amount of commissions paid to insurance broker	USD $4,828
Dental Insurance Welfare Benefit	Yes
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 number

858233G

Policy instance

Insurance contract or identification number	858233G
Number of Individuals Covered	144
Insurance policy start date	2007-10-01
Insurance policy end date	2008-09-30
Total amount of commissions paid to insurance broker	USD $7,556
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
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 number

000002338

Policy instance

Insurance contract or identification number	000002338
Number of Individuals Covered	251
Insurance policy start date	2007-06-01
Insurance policy end date	2008-05-31
Total amount of commissions paid to insurance broker	USD $4,317
Dental Insurance Welfare Benefit	Yes
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 number

000002338

Policy instance

Insurance contract or identification number	000002338
Number of Individuals Covered	225
Insurance policy start date	2006-06-01
Insurance policy end date	2007-05-31
Total amount of commissions paid to insurance broker	USD $3,301
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

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