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LIFE AND DISABILITY PLAN 401k Plan overview

Plan NameLIFE AND DISABILITY PLAN
Plan identification number 501

LIFE AND DISABILITY PLAN Benefits

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

401k Sponsoring company profile

STATE BANK AND TRUST COMPANY has sponsored the creation of one or more 401k plans.

Company Name:STATE BANK AND TRUST COMPANY
Employer identification number (EIN):201908771
NAIC Classification:522110
NAIC Description:Commercial Banking

Additional information about STATE BANK AND TRUST COMPANY

Jurisdiction of Incorporation: Georgia Department of States Corporations Division
Incorporation Date:
Company Identification Number: 309550

More information about STATE BANK AND TRUST COMPANY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LIFE AND DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012017-01-01DAN THOMASON
5012016-01-01DAN THOMASON
5012015-01-01SUE SHIN
5012015-01-01
5012014-01-01DAN THOMASON
5012014-01-01ABRIEL DAVIS
5012013-01-01ABRIEL DAVIS
5012012-01-01ADAM POLAKOV
5012011-01-01ADAM POLAKOV
5012009-01-01DAN THOMASON DAN THOMASON2010-07-26

Plan Statistics for LIFE AND DISABILITY PLAN

401k plan membership statisitcs for LIFE AND DISABILITY PLAN

Measure Date Value
2017: LIFE AND DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01282
Total number of active participants reported on line 7a of the Form 55002017-01-01298
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 participants2017-01-01298
2016: LIFE AND DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01597
Total number of active participants reported on line 7a of the Form 55002016-01-01604
Total of all active and inactive participants2016-01-01604
2015: LIFE AND DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01562
Total number of active participants reported on line 7a of the Form 55002015-01-01844
Total of all active and inactive participants2015-01-01844
Total participants2015-01-01844
2014: LIFE AND DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01528
Total number of active participants reported on line 7a of the Form 55002014-01-01506
Total of all active and inactive participants2014-01-01506
Total participants2014-01-01562
2013: LIFE AND DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01574
Total number of active participants reported on line 7a of the Form 55002013-01-01573
Total of all active and inactive participants2013-01-01573
Total participants2013-01-01573
2012: LIFE AND DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01856
Total number of active participants reported on line 7a of the Form 55002012-01-01241
Total of all active and inactive participants2012-01-01241
Total participants2012-01-01241
2011: LIFE AND DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01421
Total number of active participants reported on line 7a of the Form 55002011-01-01856
Total of all active and inactive participants2011-01-01856
Total participants2011-01-01856
2009: LIFE AND DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0112
Total number of active participants reported on line 7a of the Form 55002009-01-0112
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-0112

Form 5500 Responses for LIFE AND DISABILITY PLAN

2017: LIFE AND DISABILITY PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
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 – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: LIFE AND DISABILITY PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: LIFE AND DISABILITY PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: LIFE AND DISABILITY PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: LIFE AND DISABILITY PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: LIFE AND DISABILITY PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: LIFE AND DISABILITY PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: LIFE AND DISABILITY PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 2
Insurance contract or identification number00845
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $7,870
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY DEP LIFE SPOUSE/FAM
Welfare Benefit Premiums Paid to CarrierUSD $52,463
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,611
Insurance broker organization code?3
Insurance broker nameBENEFIT COMPANY LLC
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 1
Insurance contract or identification number00845
Number of Individuals Covered391
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $17,079
Total amount of fees paid to insurance companyUSD $255
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY LIFE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $113,858
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,347
Insurance broker organization code?3
Amount paid for insurance broker fees255
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker nameAXA ASSISTANCE, USA
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 3
Insurance contract or identification number00845
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,063
Life Insurance Welfare BenefitYes
Other welfare benefits providedBASIC DEP LIFE SPOUSE/FAM
Welfare Benefit Premiums Paid to CarrierUSD $7,085
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $893
Insurance broker organization code?3
Insurance broker nameBENEFIT COMPANY LLC
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 6
Insurance contract or identification number00845
Number of Individuals Covered317
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $11,804
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $78,693
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,916
Insurance broker organization code?3
Insurance broker nameBENEFIT COMPANY LLC
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 4
Insurance contract or identification number00845
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $260
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY DEP LIFE CHILD
Welfare Benefit Premiums Paid to CarrierUSD $1,730
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $218
Insurance broker organization code?3
Insurance broker nameBENEFIT COMPANY LLC
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 5
Insurance contract or identification number00845
Number of Individuals Covered796
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $20,228
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $134,857
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,993
Insurance broker organization code?3
Insurance broker nameBENEFIT COMPANY LLC
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 7
Insurance contract or identification number00845
Number of Individuals Covered844
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $19,922
Life Insurance Welfare BenefitYes
Other welfare benefits providedBASIC LIFE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $132,815
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,736
Insurance broker organization code?3
Insurance broker nameBENEFIT COMPANY LLC
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 8
Insurance contract or identification number00845
Number of Individuals Covered804
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $4,059
Life Insurance Welfare BenefitYes
Other welfare benefits providedBASIC AD&D INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $27,058
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,410
Insurance broker organization code?3
Insurance broker nameBENEFIT COMPANY LLC
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 2
Insurance contract or identification number00845
Number of Individuals Covered260
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $11,784
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY LIFE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $101,359
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,784
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 4
Insurance contract or identification number00845
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $622
Life Insurance Welfare BenefitYes
Other welfare benefits providedBASIC DEP LIFE SPOUSE/FAM
Welfare Benefit Premiums Paid to CarrierUSD $5,352
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $622
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 5
Insurance contract or identification number00845
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $125
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY DEP LIFE CHILD
Welfare Benefit Premiums Paid to CarrierUSD $1,071
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $125
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 6
Insurance contract or identification number00845
Number of Individuals Covered535
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $12,778
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $109,905
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,778
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 7
Insurance contract or identification number00845
Number of Individuals Covered188
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $7,175
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $61,711
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,175
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 8
Insurance contract or identification number00845
Number of Individuals Covered562
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $9,336
Life Insurance Welfare BenefitYes
Other welfare benefits providedBASIC LIFE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $80,304
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,336
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 9
Insurance contract or identification number00845
Number of Individuals Covered535
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $2,025
Life Insurance Welfare BenefitYes
Other welfare benefits providedBASIC AD&D INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $17,416
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,025
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 3
Insurance contract or identification number00845
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $4,558
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY DEP LIFE SPOUSE/FAM
Welfare Benefit Premiums Paid to CarrierUSD $39,201
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,558
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 1
Insurance contract or identification number00845
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $6
Total amount of fees paid to insurance companyUSD $193
Life Insurance Welfare BenefitYes
Other welfare benefits providedBASIC LIFE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $52
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6
Insurance broker organization code?3
Amount paid for insurance broker fees193
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker nameAXA ASSISTANCE, USA
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 9
Insurance contract or identification number00845
Number of Individuals Covered551
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $2,733
Life Insurance Welfare BenefitYes
Other welfare benefits providedBASIC AD&D INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $18,218
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,733
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 8
Insurance contract or identification number00845
Number of Individuals Covered573
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $16,712
Life Insurance Welfare BenefitYes
Other welfare benefits providedBASIC LIFE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $111,415
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,712
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 7
Insurance contract or identification number00845
Number of Individuals Covered183
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $8,952
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $59,677
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,952
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 6
Insurance contract or identification number00845
Number of Individuals Covered552
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $19,521
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $130,142
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,521
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 5
Insurance contract or identification number00845
Number of Individuals Covered0
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $181
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY DEP LIFE CHILD
Welfare Benefit Premiums Paid to CarrierUSD $1,208
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $181
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 3
Insurance contract or identification number00845
Number of Individuals Covered0
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $7,580
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY DEP LIFE SPOUSE/FAM
Welfare Benefit Premiums Paid to CarrierUSD $50,530
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,580
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 2
Insurance contract or identification number00845
Number of Individuals Covered264
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $15,545
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY LIFE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $103,634
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,545
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 1
Insurance contract or identification number00845
Number of Individuals Covered1
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $16
Total amount of fees paid to insurance companyUSD $207
Life Insurance Welfare BenefitYes
Other welfare benefits providedBASIC LIFE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $104
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16
Insurance broker organization code?3
Amount paid for insurance broker fees207
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker nameAXA ASSISTANCE, USA
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 4
Insurance contract or identification number00845
Number of Individuals Covered0
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $970
Life Insurance Welfare BenefitYes
Other welfare benefits providedBASIC DEP LIFE SPOUSE/FAM
Welfare Benefit Premiums Paid to CarrierUSD $6,466
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $970
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 7
Insurance contract or identification number00845
Number of Individuals Covered187
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $6,275
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $41,835
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,275
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 1
Insurance contract or identification number00845
Number of Individuals Covered16
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $208
Total amount of fees paid to insurance companyUSD $195
Life Insurance Welfare BenefitYes
Other welfare benefits providedBASIC LIFE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $1,387
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $208
Insurance broker organization code?3
Amount paid for insurance broker fees195
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker nameAXA ASSISTANCE, USA
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 2
Insurance contract or identification number00845
Number of Individuals Covered241
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $11,708
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY LIFE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $78,055
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,708
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 3
Insurance contract or identification number00845
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $5,025
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY DEP LIFE SPOUSE/FAM
Welfare Benefit Premiums Paid to CarrierUSD $33,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,025
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 4
Insurance contract or identification number00845
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $767
Life Insurance Welfare BenefitYes
Other welfare benefits providedBASIC DEP LIFE SPOUSE/FAM
Welfare Benefit Premiums Paid to CarrierUSD $5,116
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $767
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 5
Insurance contract or identification number00845
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $139
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY DEP LIFE CHILD
Welfare Benefit Premiums Paid to CarrierUSD $925
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $139
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 6
Insurance contract or identification number00845
Number of Individuals Covered574
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $18,049
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $120,324
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,049
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 8
Insurance contract or identification number00845
Number of Individuals Covered574
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $15,165
Life Insurance Welfare BenefitYes
Other welfare benefits providedBASIC LIFE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $101,099
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,165
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 9
Insurance contract or identification number00845
Number of Individuals Covered574
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,523
Life Insurance Welfare BenefitYes
Other welfare benefits providedBASIC AD&D INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $16,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,523
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 2
Insurance contract or identification number00845
Number of Individuals Covered1155
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $8,311
Life Insurance Welfare BenefitYes
Other welfare benefits providedBASIC LIFE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $110,817
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 3
Insurance contract or identification number00845
Number of Individuals Covered433
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $5,543
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY LIFE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $73,904
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 4
Insurance contract or identification number00845
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $2,886
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY DEP LIFE SPOUSE/FAM
Welfare Benefit Premiums Paid to CarrierUSD $38,481
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 5
Insurance contract or identification number00845
Number of Individuals Covered226
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,966
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedSHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $26,219
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 6
Insurance contract or identification number00845
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $65
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY DEP LIFE CHILD
Welfare Benefit Premiums Paid to CarrierUSD $862
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 7
Insurance contract or identification number00845
Number of Individuals Covered1127
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $9,952
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $132,681
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 8
Insurance contract or identification number00845
Number of Individuals Covered1126
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,147
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,288
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 1
Insurance contract or identification number00845
Number of Individuals Covered836
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $28,722
Total amount of fees paid to insurance companyUSD $180
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $382,964
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 9
Insurance contract or identification number00845
Number of Individuals Covered1126
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,147
Other welfare benefits providedBASIC AD&D INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $15,288
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 9
Insurance contract or identification number00845
Number of Individuals Covered458
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $914
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBASIC AD&D INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $12,191
Commission paid to Insurance BrokerUSD $914
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 1
Insurance contract or identification number00845
Number of Individuals Covered463
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $21,470
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $284,277
Commission paid to Insurance BrokerUSD $21,321
Insurance broker organization code?3
Insurance broker nameAXA ASSISTANCE, USA
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 2
Insurance contract or identification number00845
Number of Individuals Covered467
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $6,603
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedBASIC LIFE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $88,046
Commission paid to Insurance BrokerUSD $6,603
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 3
Insurance contract or identification number00845
Number of Individuals Covered181
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $5,183
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY LIFE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $69,103
Commission paid to Insurance BrokerUSD $5,183
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 4
Insurance contract or identification number00845
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,805
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY DEP LIFE SPOUSE/FAM
Welfare Benefit Premiums Paid to CarrierUSD $24,062
Commission paid to Insurance BrokerUSD $1,805
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 5
Insurance contract or identification number00845
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $828
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedBASIC DEP LIFE SPOUSE/FAM
Welfare Benefit Premiums Paid to CarrierUSD $11,034
Commission paid to Insurance BrokerUSD $828
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 7
Insurance contract or identification number00845
Number of Individuals Covered458
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $6,851
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $91,348
Commission paid to Insurance BrokerUSD $6,851
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 8
Insurance contract or identification number00845
Number of Individuals Covered458
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $914
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,191
Commission paid to Insurance BrokerUSD $914
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number00845
Policy instance 6
Insurance contract or identification number00845
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $51
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY DEP LIFE CHILD
Welfare Benefit Premiums Paid to CarrierUSD $684
Commission paid to Insurance BrokerUSD $51
Insurance broker organization code?3
Insurance broker nameHOLMES INC DBA HOLMES SHAW AGENCY

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