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FIRST COMMUNITY BANK HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameFIRST COMMUNITY BANK HEALTH AND WELFARE PLAN
Plan identification number 501

FIRST COMMUNITY BANK HEALTH AND WELFARE 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):742058750
    NAIC Classification:522110
    NAIC Description:Commercial Banking

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan FIRST COMMUNITY BANK HEALTH AND WELFARE PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5012022-01-01ANITA BOSWELL2023-07-25
    5012021-01-01ANITA BOSWELL2022-07-25
    5012020-01-01ANITA BOSWELL2021-08-04
    5012019-01-01ANITA BOSWELL2021-08-04
    5012018-01-01ANITA BOSWELL2021-08-04
    5012017-01-01

    Plan Statistics for FIRST COMMUNITY BANK HEALTH AND WELFARE PLAN

    401k plan membership statisitcs for FIRST COMMUNITY BANK HEALTH AND WELFARE PLAN

    Measure Date Value
    2022: FIRST COMMUNITY BANK HEALTH AND WELFARE PLAN 2022 401k membership
    Total participants, beginning-of-year2022-01-01118
    Total number of active participants reported on line 7a of the Form 55002022-01-01120
    Number of retired or separated participants receiving benefits2022-01-010
    Number of other retired or separated participants entitled to future benefits2022-01-010
    Total of all active and inactive participants2022-01-01120
    2021: FIRST COMMUNITY BANK HEALTH AND WELFARE PLAN 2021 401k membership
    Total participants, beginning-of-year2021-01-01113
    Total number of active participants reported on line 7a of the Form 55002021-01-01117
    Number of retired or separated participants receiving benefits2021-01-011
    Number of other retired or separated participants entitled to future benefits2021-01-011
    Total of all active and inactive participants2021-01-01119
    2020: FIRST COMMUNITY BANK HEALTH AND WELFARE PLAN 2020 401k membership
    Total participants, beginning-of-year2020-01-01113
    Total number of active participants reported on line 7a of the Form 55002020-01-01114
    Number of retired or separated participants receiving benefits2020-01-012
    Number of other retired or separated participants entitled to future benefits2020-01-012
    Total of all active and inactive participants2020-01-01118
    2019: FIRST COMMUNITY BANK HEALTH AND WELFARE PLAN 2019 401k membership
    Total participants, beginning-of-year2019-01-01109
    Total number of active participants reported on line 7a of the Form 55002019-01-01113
    Number of retired or separated participants receiving benefits2019-01-010
    Number of other retired or separated participants entitled to future benefits2019-01-010
    Total of all active and inactive participants2019-01-01113
    2018: FIRST COMMUNITY BANK HEALTH AND WELFARE PLAN 2018 401k membership
    Total participants, beginning-of-year2018-01-01107
    Total number of active participants reported on line 7a of the Form 55002018-01-01110
    Number of retired or separated participants receiving benefits2018-01-010
    Number of other retired or separated participants entitled to future benefits2018-01-010
    Total of all active and inactive participants2018-01-01110
    2017: FIRST COMMUNITY BANK HEALTH AND WELFARE PLAN 2017 401k membership
    Total participants, beginning-of-year2017-01-01107
    Total number of active participants reported on line 7a of the Form 55002017-01-01110
    Number of retired or separated participants receiving benefits2017-01-010
    Number of other retired or separated participants entitled to future benefits2017-01-010
    Total of all active and inactive participants2017-01-01110

    Form 5500 Responses for FIRST COMMUNITY BANK HEALTH AND WELFARE PLAN

    2022: FIRST COMMUNITY BANK HEALTH AND WELFARE PLAN 2022 form 5500 responses
    2022-01-01Type of plan entitySingle employer plan
    2022-01-01Submission has been amendedNo
    2022-01-01This submission is the final filingNo
    2022-01-01This return/report is a short plan year return/report (less than 12 months)No
    2022-01-01Plan is a collectively bargained planNo
    2022-01-01Plan funding arrangement – InsuranceYes
    2022-01-01Plan benefit arrangement – InsuranceYes
    2021: FIRST COMMUNITY BANK HEALTH AND WELFARE PLAN 2021 form 5500 responses
    2021-01-01Type of plan entitySingle employer plan
    2021-01-01Submission has been amendedNo
    2021-01-01This submission is the final filingNo
    2021-01-01This return/report is a short plan year return/report (less than 12 months)No
    2021-01-01Plan is a collectively bargained planNo
    2021-01-01Plan funding arrangement – InsuranceYes
    2021-01-01Plan benefit arrangement – InsuranceYes
    2020: FIRST COMMUNITY BANK HEALTH AND WELFARE PLAN 2020 form 5500 responses
    2020-01-01Type of plan entitySingle employer plan
    2020-01-01Submission has been amendedNo
    2020-01-01This submission is the final filingNo
    2020-01-01This return/report is a short plan year return/report (less than 12 months)No
    2020-01-01Plan is a collectively bargained planNo
    2020-01-01Plan funding arrangement – InsuranceYes
    2020-01-01Plan benefit arrangement – InsuranceYes
    2019: FIRST COMMUNITY BANK HEALTH AND WELFARE PLAN 2019 form 5500 responses
    2019-01-01Type of plan entitySingle employer plan
    2019-01-01Submission has been amendedNo
    2019-01-01This submission is the final filingNo
    2019-01-01This return/report is a short plan year return/report (less than 12 months)No
    2019-01-01Plan is a collectively bargained planNo
    2019-01-01Plan funding arrangement – InsuranceYes
    2019-01-01Plan benefit arrangement – InsuranceYes
    2018: FIRST COMMUNITY BANK HEALTH AND WELFARE PLAN 2018 form 5500 responses
    2018-01-01Type of plan entitySingle employer plan
    2018-01-01Submission has been amendedNo
    2018-01-01This submission is the final filingNo
    2018-01-01This return/report is a short plan year return/report (less than 12 months)No
    2018-01-01Plan is a collectively bargained planNo
    2018-01-01Plan funding arrangement – InsuranceYes
    2018-01-01Plan benefit arrangement – InsuranceYes
    2017: FIRST COMMUNITY BANK HEALTH AND WELFARE PLAN 2017 form 5500 responses
    2017-01-01Type of plan entitySingle employer plan
    2017-01-01First time form 5500 has been submittedYes
    2017-01-01Submission has been amendedNo
    2017-01-01This submission is the final filingNo
    2017-01-01This return/report is a short plan year return/report (less than 12 months)No
    2017-01-01Plan is a collectively bargained planNo
    2017-01-01Plan funding arrangement – InsuranceYes
    2017-01-01Plan benefit arrangement – InsuranceYes

    Insurance Providers Used on plan

    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number801110G
    Policy instance 2
    Insurance contract or identification number801110G
    Number of Individuals Covered118
    Insurance policy start date2022-01-01
    Insurance policy end date2022-12-31
    Total amount of commissions paid to insurance brokerUSD $9,749
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedADD
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $67,432
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $9,749
    Insurance broker organization code?3
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number905798
    Policy instance 1
    Insurance contract or identification number905798
    Number of Individuals Covered211
    Insurance policy start date2022-01-01
    Insurance policy end date2022-12-31
    Total amount of commissions paid to insurance brokerUSD $6,158
    Total amount of fees paid to insurance companyUSD $35,149
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $729,821
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $6,158
    Amount paid for insurance broker fees35149
    Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
    Insurance broker organization code?3
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number801110G
    Policy instance 2
    Insurance contract or identification number801110G
    Number of Individuals Covered117
    Insurance policy start date2021-01-01
    Insurance policy end date2021-12-31
    Total amount of commissions paid to insurance brokerUSD $10,293
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedADD
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $68,616
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $10,293
    Insurance broker organization code?3
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number905798
    Policy instance 1
    Insurance contract or identification number905798
    Number of Individuals Covered344
    Insurance policy start date2021-01-01
    Insurance policy end date2021-12-31
    Total amount of commissions paid to insurance brokerUSD $6,535
    Total amount of fees paid to insurance companyUSD $30,535
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $1,896,536
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $6,535
    Amount paid for insurance broker fees30535
    Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
    Insurance broker organization code?3
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number801110G
    Policy instance 2
    Insurance contract or identification number801110G
    Number of Individuals Covered113
    Insurance policy start date2020-01-01
    Insurance policy end date2020-12-31
    Total amount of commissions paid to insurance brokerUSD $9,802
    Total amount of fees paid to insurance companyUSD $323
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedADD
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $65,347
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $9,802
    Amount paid for insurance broker fees323
    Additional information about fees paid to insurance brokerBONUS PAID
    Insurance broker organization code?3
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number0905798
    Policy instance 1
    Insurance contract or identification number0905798
    Number of Individuals Covered347
    Insurance policy start date2020-01-01
    Insurance policy end date2020-12-31
    Total amount of commissions paid to insurance brokerUSD $6,555
    Total amount of fees paid to insurance companyUSD $32,285
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $656,803
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $6,555
    Amount paid for insurance broker fees32285
    Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
    Insurance broker organization code?3
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number801110G
    Policy instance 2
    Insurance contract or identification number801110G
    Number of Individuals Covered113
    Insurance policy start date2019-01-01
    Insurance policy end date2019-12-31
    Total amount of commissions paid to insurance brokerUSD $10,183
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedADD
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $70,373
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $10,183
    Insurance broker organization code?3
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number905798
    Policy instance 1
    Insurance contract or identification number905798
    Number of Individuals Covered229
    Insurance policy start date2019-01-01
    Insurance policy end date2019-12-31
    Total amount of commissions paid to insurance brokerUSD $5,398
    Total amount of fees paid to insurance companyUSD $30,856
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $641,943
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,398
    Amount paid for insurance broker fees30856
    Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
    Insurance broker organization code?3
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number905798
    Policy instance 3
    Insurance contract or identification number905798
    Number of Individuals Covered210
    Insurance policy start date2018-01-01
    Insurance policy end date2018-12-31
    Total amount of commissions paid to insurance brokerUSD $4,756
    Total amount of fees paid to insurance companyUSD $31,991
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $658,187
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,756
    Amount paid for insurance broker fees31991
    Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
    Insurance broker organization code?3
    HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
    Policy contract number801110G
    Policy instance 2
    Insurance contract or identification number801110G
    Number of Individuals Covered110
    Insurance policy start date2018-09-01
    Insurance policy end date2018-12-31
    Total amount of commissions paid to insurance brokerUSD $2,475
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedADD
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $14,016
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,475
    Insurance broker organization code?3
    AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
    Policy contract number86371777 507941
    Policy instance 1
    Insurance contract or identification number86371777 507941
    Number of Individuals Covered110
    Insurance policy start date2018-01-01
    Insurance policy end date2018-08-31
    Total amount of commissions paid to insurance brokerUSD $7,130
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD&D
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $39,460
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $7,130
    Insurance broker organization code?3
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number905798
    Policy instance 2
    Insurance contract or identification number905798
    Number of Individuals Covered131
    Insurance policy start date2017-01-01
    Insurance policy end date2017-12-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $28,738
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitNo
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitNo
    Unemployment Insurance Welfare BenefitNo
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $546,353
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Amount paid for insurance broker fees28738
    Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
    Insurance broker organization code?3
    Insurance broker nameSHEPARD & WALTON LIFE INS
    AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
    Policy contract number86371777 507941
    Policy instance 1
    Insurance contract or identification number86371777 507941
    Number of Individuals Covered110
    Insurance policy start date2017-01-01
    Insurance policy end date2017-12-31
    Total amount of commissions paid to insurance brokerUSD $11,918
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD&D
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Welfare Benefit Premiums Paid to CarrierUSD $104,277
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $11,918
    Insurance broker organization code?3
    Insurance broker nameSHEPARD & WALTON LIFE INSURANCE

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