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FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 401k Plan overview

Plan NameFIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN
Plan identification number 502

FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

FIRST FARMERS BANK & TRUST has sponsored the creation of one or more 401k plans.

Company Name:FIRST FARMERS BANK & TRUST
Employer identification number (EIN):350722410
NAIC Classification:522110
NAIC Description:Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-05-01TAMMY PENCE, CHIEF HR OFFICER2023-10-30
5022021-05-01DAVID L. EIKENBERRY, EVP, COO2022-11-04
5022020-05-01DAVID L. EIKENBERRY, EVP, COO2021-10-14
5022019-05-01DAVID L. EIKENBERRY, EVP, COO2020-10-28
5022018-05-01DAVID L. EIKENBERRY, EVP, COO2019-11-15
5022017-05-01
5022016-05-01
5022015-05-01
5022014-05-01DAVID L. EIKENBERRY, COO
5022013-05-01DAVID L. EIKENBERRY, COO
5022012-05-01DAVID L. EIKENBERRY, COO
5022011-05-01DAVID L. EIKENBERRY, COO
5022010-05-01DAVID L. EIKENBERRY, COO
5022009-05-01DAVID L. EIKENBERRY, COO
5022008-05-01DAVID L. EIKENBERRY, COO
5022007-05-01DAVID L. EIKENBERRY, COO
5022006-08-01DAVID L. EIKENBERRY, COO
5022005-08-01DAVID L. EIKENBERRY, COO
5022004-08-01DAVID L. EIKENBERRY, COO
5022003-08-01DAVID L. EIKENBERRY, COO
5022002-08-01DAVID L. EIKENBERRY, COO

Plan Statistics for FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN

401k plan membership statisitcs for FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN

Measure Date Value
2022: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2022 401k membership
Total participants, beginning-of-year2022-05-01340
Total number of active participants reported on line 7a of the Form 55002022-05-01371
Number of retired or separated participants receiving benefits2022-05-010
Number of other retired or separated participants entitled to future benefits2022-05-010
Total of all active and inactive participants2022-05-01371
2021: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2021 401k membership
Total participants, beginning-of-year2021-05-01355
Total number of active participants reported on line 7a of the Form 55002021-05-01340
Number of retired or separated participants receiving benefits2021-05-010
Number of other retired or separated participants entitled to future benefits2021-05-010
Total of all active and inactive participants2021-05-01340
2020: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2020 401k membership
Total participants, beginning-of-year2020-05-01351
Total number of active participants reported on line 7a of the Form 55002020-05-01354
Number of retired or separated participants receiving benefits2020-05-011
Number of other retired or separated participants entitled to future benefits2020-05-010
Total of all active and inactive participants2020-05-01355
2019: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2019 401k membership
Total participants, beginning-of-year2019-05-01336
Total number of active participants reported on line 7a of the Form 55002019-05-01350
Number of retired or separated participants receiving benefits2019-05-011
Number of other retired or separated participants entitled to future benefits2019-05-010
Total of all active and inactive participants2019-05-01351
2018: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2018 401k membership
Total participants, beginning-of-year2018-05-01335
Total number of active participants reported on line 7a of the Form 55002018-05-01335
Number of retired or separated participants receiving benefits2018-05-011
Number of other retired or separated participants entitled to future benefits2018-05-010
Total of all active and inactive participants2018-05-01336
2017: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year2017-05-01333
Total number of active participants reported on line 7a of the Form 55002017-05-01335
Number of retired or separated participants receiving benefits2017-05-010
Number of other retired or separated participants entitled to future benefits2017-05-010
Total of all active and inactive participants2017-05-01335
2016: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year2016-05-01321
Total number of active participants reported on line 7a of the Form 55002016-05-01333
Number of retired or separated participants receiving benefits2016-05-010
Number of other retired or separated participants entitled to future benefits2016-05-010
Total of all active and inactive participants2016-05-01333
2015: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year2015-05-01308
Total number of active participants reported on line 7a of the Form 55002015-05-01321
Number of retired or separated participants receiving benefits2015-05-010
Number of other retired or separated participants entitled to future benefits2015-05-010
Total of all active and inactive participants2015-05-01321
2014: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year2014-05-01256
Total number of active participants reported on line 7a of the Form 55002014-05-01308
Number of retired or separated participants receiving benefits2014-05-010
Number of other retired or separated participants entitled to future benefits2014-05-010
Total of all active and inactive participants2014-05-01308
2013: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year2013-05-01242
Total number of active participants reported on line 7a of the Form 55002013-05-01256
Number of retired or separated participants receiving benefits2013-05-010
Number of other retired or separated participants entitled to future benefits2013-05-010
Total of all active and inactive participants2013-05-01256
2012: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year2012-05-01196
Total number of active participants reported on line 7a of the Form 55002012-05-01242
Number of retired or separated participants receiving benefits2012-05-010
Number of other retired or separated participants entitled to future benefits2012-05-010
Total of all active and inactive participants2012-05-01242
2011: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year2011-05-01194
Total number of active participants reported on line 7a of the Form 55002011-05-01196
Number of retired or separated participants receiving benefits2011-05-010
Number of other retired or separated participants entitled to future benefits2011-05-010
Total of all active and inactive participants2011-05-01196
2010: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2010 401k membership
Total participants, beginning-of-year2010-05-01190
Total number of active participants reported on line 7a of the Form 55002010-05-01194
Number of retired or separated participants receiving benefits2010-05-010
Number of other retired or separated participants entitled to future benefits2010-05-010
Total of all active and inactive participants2010-05-01194
2009: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year2009-05-01160
Total number of active participants reported on line 7a of the Form 55002009-05-01190
Number of retired or separated participants receiving benefits2009-05-010
Number of other retired or separated participants entitled to future benefits2009-05-010
Total of all active and inactive participants2009-05-01190
2008: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2008 401k membership
Total participants, beginning-of-year2008-05-01165
Total number of active participants reported on line 7a of the Form 55002008-05-01160
Number of retired or separated participants receiving benefits2008-05-010
Number of other retired or separated participants entitled to future benefits2008-05-010
Total of all active and inactive participants2008-05-01160
2007: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2007 401k membership
Total participants, beginning-of-year2007-05-01163
Total number of active participants reported on line 7a of the Form 55002007-05-01165
Number of retired or separated participants receiving benefits2007-05-010
Number of other retired or separated participants entitled to future benefits2007-05-010
Total of all active and inactive participants2007-05-01165
2006: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2006 401k membership
Total participants, beginning-of-year2006-08-01138
Total number of active participants reported on line 7a of the Form 55002006-08-01163
Number of retired or separated participants receiving benefits2006-08-010
Number of other retired or separated participants entitled to future benefits2006-08-010
Total of all active and inactive participants2006-08-01163
2005: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2005 401k membership
Total participants, beginning-of-year2005-08-01131
Total number of active participants reported on line 7a of the Form 55002005-08-01138
Number of retired or separated participants receiving benefits2005-08-010
Number of other retired or separated participants entitled to future benefits2005-08-010
Total of all active and inactive participants2005-08-01138
2004: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2004 401k membership
Total participants, beginning-of-year2004-08-01131
Total number of active participants reported on line 7a of the Form 55002004-08-01131
Number of retired or separated participants receiving benefits2004-08-010
Number of other retired or separated participants entitled to future benefits2004-08-010
Total of all active and inactive participants2004-08-01131
2003: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2003 401k membership
Total participants, beginning-of-year2003-08-01117
Total number of active participants reported on line 7a of the Form 55002003-08-01131
Number of retired or separated participants receiving benefits2003-08-010
Number of other retired or separated participants entitled to future benefits2003-08-010
Total of all active and inactive participants2003-08-01131
2002: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2002 401k membership
Total participants, beginning-of-year2002-08-010
Total number of active participants reported on line 7a of the Form 55002002-08-01117
Number of retired or separated participants receiving benefits2002-08-010
Number of other retired or separated participants entitled to future benefits2002-08-010
Total of all active and inactive participants2002-08-01117

Form 5500 Responses for FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN

2022: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2022 form 5500 responses
2022-05-01Type of plan entitySingle employer plan
2022-05-01Submission has been amendedNo
2022-05-01This submission is the final filingNo
2022-05-01This return/report is a short plan year return/report (less than 12 months)No
2022-05-01Plan is a collectively bargained planNo
2022-05-01Plan funding arrangement – InsuranceYes
2022-05-01Plan funding arrangement – General assets of the sponsorYes
2022-05-01Plan benefit arrangement – InsuranceYes
2022-05-01Plan benefit arrangement – General assets of the sponsorYes
2021: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2021 form 5500 responses
2021-05-01Type of plan entitySingle employer plan
2021-05-01Submission has been amendedNo
2021-05-01This submission is the final filingNo
2021-05-01This return/report is a short plan year return/report (less than 12 months)No
2021-05-01Plan is a collectively bargained planNo
2021-05-01Plan funding arrangement – InsuranceYes
2021-05-01Plan funding arrangement – General assets of the sponsorYes
2021-05-01Plan benefit arrangement – InsuranceYes
2021-05-01Plan benefit arrangement – General assets of the sponsorYes
2020: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2020 form 5500 responses
2020-05-01Type of plan entitySingle employer plan
2020-05-01Submission has been amendedNo
2020-05-01This submission is the final filingNo
2020-05-01This return/report is a short plan year return/report (less than 12 months)No
2020-05-01Plan is a collectively bargained planNo
2020-05-01Plan funding arrangement – InsuranceYes
2020-05-01Plan funding arrangement – General assets of the sponsorYes
2020-05-01Plan benefit arrangement – InsuranceYes
2020-05-01Plan benefit arrangement – General assets of the sponsorYes
2019: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2019 form 5500 responses
2019-05-01Type of plan entitySingle employer plan
2019-05-01Submission has been amendedNo
2019-05-01This submission is the final filingNo
2019-05-01This return/report is a short plan year return/report (less than 12 months)No
2019-05-01Plan is a collectively bargained planNo
2019-05-01Plan funding arrangement – InsuranceYes
2019-05-01Plan funding arrangement – General assets of the sponsorYes
2019-05-01Plan benefit arrangement – InsuranceYes
2019-05-01Plan benefit arrangement – General assets of the sponsorYes
2018: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2018 form 5500 responses
2018-05-01Type of plan entitySingle employer plan
2018-05-01Submission has been amendedNo
2018-05-01This submission is the final filingNo
2018-05-01This return/report is a short plan year return/report (less than 12 months)No
2018-05-01Plan is a collectively bargained planNo
2018-05-01Plan funding arrangement – InsuranceYes
2018-05-01Plan funding arrangement – General assets of the sponsorYes
2018-05-01Plan benefit arrangement – InsuranceYes
2018-05-01Plan benefit arrangement – General assets of the sponsorYes
2017: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2017 form 5500 responses
2017-05-01Type of plan entitySingle employer plan
2017-05-01Submission has been amendedNo
2017-05-01This submission is the final filingNo
2017-05-01This return/report is a short plan year return/report (less than 12 months)No
2017-05-01Plan is a collectively bargained planNo
2017-05-01Plan funding arrangement – InsuranceYes
2017-05-01Plan funding arrangement – General assets of the sponsorYes
2017-05-01Plan benefit arrangement – InsuranceYes
2017-05-01Plan benefit arrangement – General assets of the sponsorYes
2016: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2016 form 5500 responses
2016-05-01Type of plan entitySingle employer plan
2016-05-01Submission has been amendedNo
2016-05-01This submission is the final filingNo
2016-05-01This return/report is a short plan year return/report (less than 12 months)No
2016-05-01Plan is a collectively bargained planNo
2016-05-01Plan funding arrangement – InsuranceYes
2016-05-01Plan funding arrangement – General assets of the sponsorYes
2016-05-01Plan benefit arrangement – InsuranceYes
2016-05-01Plan benefit arrangement – General assets of the sponsorYes
2015: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2015 form 5500 responses
2015-05-01Type of plan entitySingle employer plan
2015-05-01Submission has been amendedNo
2015-05-01This submission is the final filingNo
2015-05-01This return/report is a short plan year return/report (less than 12 months)No
2015-05-01Plan is a collectively bargained planNo
2015-05-01Plan funding arrangement – InsuranceYes
2015-05-01Plan funding arrangement – General assets of the sponsorYes
2015-05-01Plan benefit arrangement – InsuranceYes
2015-05-01Plan benefit arrangement – General assets of the sponsorYes
2014: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2014 form 5500 responses
2014-05-01Type of plan entitySingle employer plan
2014-05-01Submission has been amendedNo
2014-05-01This submission is the final filingNo
2014-05-01This return/report is a short plan year return/report (less than 12 months)No
2014-05-01Plan is a collectively bargained planNo
2014-05-01Plan funding arrangement – InsuranceYes
2014-05-01Plan funding arrangement – General assets of the sponsorYes
2014-05-01Plan benefit arrangement – InsuranceYes
2014-05-01Plan benefit arrangement – General assets of the sponsorYes
2013: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2013 form 5500 responses
2013-05-01Type of plan entitySingle employer plan
2013-05-01Submission has been amendedNo
2013-05-01This submission is the final filingNo
2013-05-01This return/report is a short plan year return/report (less than 12 months)No
2013-05-01Plan is a collectively bargained planNo
2013-05-01Plan funding arrangement – InsuranceYes
2013-05-01Plan funding arrangement – General assets of the sponsorYes
2013-05-01Plan benefit arrangement – InsuranceYes
2013-05-01Plan benefit arrangement – General assets of the sponsorYes
2012: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2012 form 5500 responses
2012-05-01Type of plan entitySingle employer plan
2012-05-01Submission has been amendedNo
2012-05-01This submission is the final filingNo
2012-05-01This return/report is a short plan year return/report (less than 12 months)No
2012-05-01Plan is a collectively bargained planNo
2012-05-01Plan funding arrangement – InsuranceYes
2012-05-01Plan benefit arrangement – InsuranceYes
2011: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2011 form 5500 responses
2011-05-01Type of plan entitySingle employer plan
2011-05-01Submission has been amendedNo
2011-05-01This submission is the final filingNo
2011-05-01This return/report is a short plan year return/report (less than 12 months)No
2011-05-01Plan is a collectively bargained planNo
2011-05-01Plan funding arrangement – InsuranceYes
2011-05-01Plan benefit arrangement – InsuranceYes
2010: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2010 form 5500 responses
2010-05-01Type of plan entitySingle employer plan
2010-05-01Submission has been amendedNo
2010-05-01This submission is the final filingNo
2010-05-01This return/report is a short plan year return/report (less than 12 months)No
2010-05-01Plan is a collectively bargained planNo
2010-05-01Plan funding arrangement – InsuranceYes
2010-05-01Plan benefit arrangement – InsuranceYes
2009: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2009 form 5500 responses
2009-05-01Type of plan entitySingle employer plan
2009-05-01Submission has been amendedNo
2009-05-01This submission is the final filingNo
2009-05-01This return/report is a short plan year return/report (less than 12 months)No
2009-05-01Plan is a collectively bargained planNo
2009-05-01Plan funding arrangement – InsuranceYes
2009-05-01Plan benefit arrangement – InsuranceYes
2008: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2008 form 5500 responses
2008-05-01Type of plan entitySingle employer plan
2008-05-01Submission has been amendedNo
2008-05-01This submission is the final filingNo
2008-05-01This return/report is a short plan year return/report (less than 12 months)No
2008-05-01Plan is a collectively bargained planNo
2008-05-01Plan funding arrangement – InsuranceYes
2008-05-01Plan benefit arrangement – InsuranceYes
2007: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2007 form 5500 responses
2007-05-01Type of plan entitySingle employer plan
2007-05-01Submission has been amendedNo
2007-05-01This submission is the final filingNo
2007-05-01This return/report is a short plan year return/report (less than 12 months)No
2007-05-01Plan is a collectively bargained planNo
2007-05-01Plan funding arrangement – InsuranceYes
2007-05-01Plan benefit arrangement – InsuranceYes
2006: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2006 form 5500 responses
2006-08-01Type of plan entitySingle employer plan
2006-08-01Submission has been amendedNo
2006-08-01This submission is the final filingNo
2006-08-01This return/report is a short plan year return/report (less than 12 months)Yes
2006-08-01Plan is a collectively bargained planNo
2006-08-01Plan funding arrangement – InsuranceYes
2006-08-01Plan benefit arrangement – InsuranceYes
2005: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2005 form 5500 responses
2005-08-01Type of plan entitySingle employer plan
2005-08-01Submission has been amendedNo
2005-08-01This submission is the final filingNo
2005-08-01This return/report is a short plan year return/report (less than 12 months)No
2005-08-01Plan is a collectively bargained planNo
2005-08-01Plan funding arrangement – InsuranceYes
2005-08-01Plan benefit arrangement – InsuranceYes
2004: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2004 form 5500 responses
2004-08-01Type of plan entitySingle employer plan
2004-08-01Submission has been amendedNo
2004-08-01This submission is the final filingNo
2004-08-01This return/report is a short plan year return/report (less than 12 months)No
2004-08-01Plan is a collectively bargained planNo
2004-08-01Plan funding arrangement – InsuranceYes
2004-08-01Plan benefit arrangement – InsuranceYes
2003: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2003 form 5500 responses
2003-08-01Type of plan entitySingle employer plan
2003-08-01Submission has been amendedNo
2003-08-01This submission is the final filingNo
2003-08-01This return/report is a short plan year return/report (less than 12 months)No
2003-08-01Plan is a collectively bargained planNo
2003-08-01Plan funding arrangement – InsuranceYes
2003-08-01Plan benefit arrangement – InsuranceYes
2002: FIRST FARMERS BANK & TRUST LIFE AND DISABILITY PLAN 2002 form 5500 responses
2002-08-01Type of plan entitySingle employer plan
2002-08-01First time form 5500 has been submittedYes
2002-08-01Submission has been amendedNo
2002-08-01This submission is the final filingNo
2002-08-01This return/report is a short plan year return/report (less than 12 months)No
2002-08-01Plan is a collectively bargained planNo
2002-08-01Plan funding arrangement – InsuranceYes
2002-08-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30003620
Policy instance 2
Insurance contract or identification number30003620
Number of Individuals Covered239
Insurance policy start date2022-05-01
Insurance policy end date2023-04-30
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 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 $6,734
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number01-020467-00
Policy instance 1
Insurance contract or identification number01-020467-00
Number of Individuals Covered371
Insurance policy start date2022-05-01
Insurance policy end date2023-04-30
Total amount of commissions paid to insurance brokerUSD $24,172
Total amount of fees paid to insurance companyUSD $49,176
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 BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D, EMPLOYEE ASSISTANCE PROGRAM
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 $161,149
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,172
Amount paid for insurance broker fees49176
Additional information about fees paid to insurance brokerGROUP VOLUME BONUS
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30003620
Policy instance 2
Insurance contract or identification number30003620
Number of Individuals Covered224
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
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 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 $6,923
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AZY4
Policy instance 1
Insurance contract or identification numberG000AZY4
Number of Individuals Covered340
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
Total amount of commissions paid to insurance brokerUSD $26,784
Total amount of fees paid to insurance companyUSD $8,634
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 BenefitYes
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 $158,591
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,784
Insurance broker organization code?3
Amount paid for insurance broker fees8634
Additional information about fees paid to insurance brokerOTHER COMPENSATION
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30003620
Policy instance 2
Insurance contract or identification number30003620
Number of Individuals Covered252
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
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 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 $7,874
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AZY4
Policy instance 1
Insurance contract or identification numberG000AZY4
Number of Individuals Covered354
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Total amount of commissions paid to insurance brokerUSD $25,079
Total amount of fees paid to insurance companyUSD $8,756
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 BenefitYes
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 $148,619
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,079
Insurance broker organization code?3
Amount paid for insurance broker fees8756
Additional information about fees paid to insurance brokerOTHER COMPENSATION
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30003620
Policy instance 2
Insurance contract or identification number30003620
Number of Individuals Covered240
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
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 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 $7,443
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AZY4
Policy instance 1
Insurance contract or identification numberG000AZY4
Number of Individuals Covered350
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Total amount of commissions paid to insurance brokerUSD $23,387
Total amount of fees paid to insurance companyUSD $8,176
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 BenefitYes
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 $138,672
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,387
Insurance broker organization code?3
Amount paid for insurance broker fees8176
Additional information about fees paid to insurance brokerOTHER COMPENSATION
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30003620
Policy instance 2
Insurance contract or identification number30003620
Number of Individuals Covered234
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
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 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 $7,579
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AZY4
Policy instance 1
Insurance contract or identification numberG000AZY4
Number of Individuals Covered336
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $22,544
Total amount of fees paid to insurance companyUSD $4,299
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 BenefitYes
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 $133,664
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,544
Insurance broker organization code?3
Amount paid for insurance broker fees2376
Additional information about fees paid to insurance brokerOTHER COMPENSATION
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30003620
Policy instance 2
Insurance contract or identification number30003620
Number of Individuals Covered240
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
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 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 $7,619
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AZY4
Policy instance 1
Insurance contract or identification numberG000AZY4
Number of Individuals Covered335
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $21,783
Total amount of fees paid to insurance companyUSD $4,702
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 BenefitYes
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 $129,196
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,783
Insurance broker organization code?3
Amount paid for insurance broker fees4702
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker nameGALLAGHER BENEFIT SERVICES INC

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