FDIC AS RECEIVER OF ALLENDALE COUNTY BANK has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan SOUTH CAROLINA BANKERS INSURANCE TRUST
| Measure | Date | Value |
|---|
| 2014: SOUTH CAROLINA BANKERS INSURANCE TRUST 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 12 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 0 |
| Total of all active and inactive participants | 2014-01-01 | 0 |
| 2013: SOUTH CAROLINA BANKERS INSURANCE TRUST 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 10 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 12 |
| Total of all active and inactive participants | 2013-01-01 | 12 |
| 2012: SOUTH CAROLINA BANKERS INSURANCE TRUST 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 10 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 10 |
| Total of all active and inactive participants | 2012-01-01 | 10 |
| 2011: SOUTH CAROLINA BANKERS INSURANCE TRUST 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 13 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 10 |
| Total of all active and inactive participants | 2011-01-01 | 10 |
| 2010: SOUTH CAROLINA BANKERS INSURANCE TRUST 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 13 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 13 |
| Total of all active and inactive participants | 2010-01-01 | 13 |
| 2009: SOUTH CAROLINA BANKERS INSURANCE TRUST 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 16 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 13 |
| Total of all active and inactive participants | 2009-01-01 | 13 |
| Measure | Date | Value |
|---|
| 2014 : SOUTH CAROLINA BANKERS INSURANCE TRUST 2014 401k financial data |
|---|
| Total plan liabilities at beginning of year | 2014-12-31 | $3,970 |
| Total income from all sources | 2014-12-31 | $29,101 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $51,477 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $48,457 |
| Total plan assets at beginning of year | 2014-12-31 | $26,346 |
| Total contributions received or receivable from participants | 2014-12-31 | $2,910 |
| Net income (gross income less expenses) | 2014-12-31 | $-22,376 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $22,376 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $26,191 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2014-12-31 | $3,020 |
| 2013 : SOUTH CAROLINA BANKERS INSURANCE TRUST 2013 401k financial data |
|---|
| Total plan liabilities at end of year | 2013-12-31 | $3,970 |
| Total plan liabilities at beginning of year | 2013-12-31 | $5,163 |
| Total income from all sources | 2013-12-31 | $87,587 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $92,544 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $92,544 |
| Total plan assets at end of year | 2013-12-31 | $26,346 |
| Total plan assets at beginning of year | 2013-12-31 | $32,496 |
| Total contributions received or receivable from participants | 2013-12-31 | $8,759 |
| Net income (gross income less expenses) | 2013-12-31 | $-4,957 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $22,376 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $27,333 |
| Total contributions received or receivable from employer(s) | 2013-12-31 | $78,828 |
| 2012 : SOUTH CAROLINA BANKERS INSURANCE TRUST 2012 401k financial data |
|---|
| Total plan liabilities at end of year | 2012-12-31 | $5,163 |
| Total plan liabilities at beginning of year | 2012-12-31 | $3,971 |
| Total income from all sources | 2012-12-31 | $95,756 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $88,134 |
| Benefits paid (including direct rollovers) | 2012-12-31 | $88,134 |
| Total plan assets at end of year | 2012-12-31 | $32,496 |
| Total plan assets at beginning of year | 2012-12-31 | $23,682 |
| Total contributions received or receivable from participants | 2012-12-31 | $9,576 |
| Net income (gross income less expenses) | 2012-12-31 | $7,622 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $27,333 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $19,711 |
| Total contributions received or receivable from employer(s) | 2012-12-31 | $86,180 |
| 2011 : SOUTH CAROLINA BANKERS INSURANCE TRUST 2011 401k financial data |
|---|
| Total plan liabilities at end of year | 2011-12-31 | $3,971 |
| Total plan liabilities at beginning of year | 2011-12-31 | $4,154 |
| Total income from all sources | 2011-12-31 | $103,763 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $96,125 |
| Benefits paid (including direct rollovers) | 2011-12-31 | $96,125 |
| Total plan assets at end of year | 2011-12-31 | $23,682 |
| Total plan assets at beginning of year | 2011-12-31 | $16,227 |
| Total contributions received or receivable from participants | 2011-12-31 | $10,376 |
| Net income (gross income less expenses) | 2011-12-31 | $7,638 |
| Net plan assets at end of year (total assets less liabilities) | 2011-12-31 | $19,711 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-12-31 | $12,073 |
| Total contributions received or receivable from employer(s) | 2011-12-31 | $93,387 |
| 2010 : SOUTH CAROLINA BANKERS INSURANCE TRUST 2010 401k financial data |
|---|
| Total plan liabilities at end of year | 2010-12-31 | $4,154 |
| Total plan liabilities at beginning of year | 2010-12-31 | $7,934 |
| Total income from all sources | 2010-12-31 | $104,437 |
| Expenses. Total of all expenses incurred | 2010-12-31 | $96,082 |
| Benefits paid (including direct rollovers) | 2010-12-31 | $96,082 |
| Total plan assets at end of year | 2010-12-31 | $16,227 |
| Total plan assets at beginning of year | 2010-12-31 | $11,652 |
| Total contributions received or receivable from participants | 2010-12-31 | $10,444 |
| Net income (gross income less expenses) | 2010-12-31 | $8,355 |
| Net plan assets at end of year (total assets less liabilities) | 2010-12-31 | $12,073 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-12-31 | $3,718 |
| Total contributions received or receivable from employer(s) | 2010-12-31 | $93,993 |
| 2014: SOUTH CAROLINA BANKERS INSURANCE TRUST 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | This submission is the final filing | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement - Trust | Yes |
| 2013: SOUTH CAROLINA BANKERS INSURANCE TRUST 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement - Trust | Yes |
| 2012: SOUTH CAROLINA BANKERS INSURANCE TRUST 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement - Trust | Yes |
| 2011: SOUTH CAROLINA BANKERS INSURANCE TRUST 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement - Trust | Yes |
| 2010: SOUTH CAROLINA BANKERS INSURANCE TRUST 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement - Trust | Yes |
| 2009: SOUTH CAROLINA BANKERS INSURANCE TRUST 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement - Trust | Yes |
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 68181-4 |
| Policy instance | 2 |
| Insurance contract or identification number | 68181-4 | | Number of Individuals Covered | 33 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-04-30 | | Total amount of commissions paid to insurance broker | USD $108 | | Total amount of fees paid to insurance company | USD $31 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,021 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $108 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 31 | | Additional information about fees paid to insurance broker | SERVICE FEE | | Insurance broker name | THE BENEFIT COMPANY, INC. |
|
| DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 ) |
| Policy contract number | 61691000 |
| Policy instance | 3 |
| Insurance contract or identification number | 61691000 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $134 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,432 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $89 | | Insurance broker organization code? | 3 | | Insurance broker name | THE BENEFIT COMPANY, INC. |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 03-51236 |
| Policy instance | 1 |
| Insurance contract or identification number | 03-51236 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 03-51236 |
| Policy instance | 1 |
| Insurance contract or identification number | 03-51236 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 348118-0005 |
| Policy instance | 2 |
| Insurance contract or identification number | 348118-0005 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $311 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,072 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $311 | | Insurance broker organization code? | 3 | | Insurance broker name | THE THORNE CORPORATION |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 105531-0005 |
| Policy instance | 3 |
| Insurance contract or identification number | 105531-0005 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $167 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,946 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $167 | | Insurance broker organization code? | 3 | | Insurance broker name | THE THORNE CORPORATION |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TS05469906 |
| Policy instance | 4 |
| Insurance contract or identification number | TS05469906 | | Number of Individuals Covered | 29 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $258 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,386 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $258 | | Insurance broker organization code? | 3 | | Insurance broker name | S.C. BANKERS EMPLOYEE BENEFIT TRUST |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 03-51236 |
| Policy instance | 1 |
| Insurance contract or identification number | 03-51236 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TS05469906 |
| Policy instance | 4 |
| Insurance contract or identification number | TS05469906 | | Number of Individuals Covered | 29 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $238 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,792 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $238 | | Insurance broker organization code? | 3 | | Insurance broker name | S.C. BANKERS EMPLOYEE BENEFIT TRUST |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 105531-0005 |
| Policy instance | 3 |
| Insurance contract or identification number | 105531-0005 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $167 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,108 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $167 | | Insurance broker organization code? | 3 | | Insurance broker name | THE THORNE CORPORATION |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 348118-0005 |
| Policy instance | 2 |
| Insurance contract or identification number | 348118-0005 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $311 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,072 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $311 | | Insurance broker organization code? | 3 | | Insurance broker name | THE THORNE CORPORATION |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 105531-0005 |
| Policy instance | 3 |
| Insurance contract or identification number | 105531-0005 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $176 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,052 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 348118-0005 |
| Policy instance | 2 |
| Insurance contract or identification number | 348118-0005 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $334 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,224 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 03-51236-83-9 |
| Policy instance | 1 |
| Insurance contract or identification number | 03-51236-83-9 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TS05469906 |
| Policy instance | 4 |
| Insurance contract or identification number | TS05469906 | | Number of Individuals Covered | 31 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $239 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,840 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TS05469906 |
| Policy instance | 4 |
| Insurance contract or identification number | TS05469906 | | Number of Individuals Covered | 33 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $274 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,817 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $274 | | Insurance broker organization code? | 3 | | Insurance broker name | S.C. BANKERS EMPLOYEE BENEFIT TRUST |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 348118-0005 |
| Policy instance | 2 |
| Insurance contract or identification number | 348118-0005 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $318 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,316 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $318 | | Insurance broker organization code? | 3 | | Insurance broker name | THE THORNE CORPORATION |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 03-51236-83-9 |
| Policy instance | 1 |
| Insurance contract or identification number | 03-51236-83-9 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 105531-0005 |
| Policy instance | 3 |
| Insurance contract or identification number | 105531-0005 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $166 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,114 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $166 | | Insurance broker organization code? | 3 | | Insurance broker name | THE THORNE CORPORATION |
|
