MID-DELTA COMMUNITY SERVICES has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN
401k plan membership statisitcs for MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN
| Measure | Date | Value |
|---|
| 2022: MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 68 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 64 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 64 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2022-01-01 | 0 |
| Total participants | 2022-01-01 | 64 |
| Number of participants with account balances | 2022-01-01 | 64 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2022-01-01 | 9 |
| 2021: MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 75 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 68 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 68 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2021-01-01 | 0 |
| Total participants | 2021-01-01 | 68 |
| Number of participants with account balances | 2021-01-01 | 68 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2021-01-01 | 6 |
| 2020: MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 63 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 73 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 73 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2020-01-01 | 0 |
| Total participants | 2020-01-01 | 73 |
| Number of participants with account balances | 2020-01-01 | 73 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2020-01-01 | 5 |
| 2019: MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 65 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 63 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 63 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2019-01-01 | 0 |
| Total participants | 2019-01-01 | 63 |
| Number of participants with account balances | 2019-01-01 | 63 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2019-01-01 | 2 |
| 2018: MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 71 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 65 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 65 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2018-01-01 | 0 |
| Total participants | 2018-01-01 | 65 |
| Number of participants with account balances | 2018-01-01 | 65 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2018-01-01 | 6 |
| 2017: MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 71 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 71 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 71 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2017-01-01 | 0 |
| Total participants | 2017-01-01 | 71 |
| Number of participants with account balances | 2017-01-01 | 71 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2017-01-01 | 2 |
| 2016: MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 75 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 71 |
| Total of all active and inactive participants | 2016-01-01 | 71 |
| Total participants | 2016-01-01 | 71 |
| Number of participants with account balances | 2016-01-01 | 71 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2016-01-01 | 6 |
| 2015: MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 63 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 75 |
| Total of all active and inactive participants | 2015-01-01 | 75 |
| Total participants | 2015-01-01 | 75 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2015-01-01 | 0 |
| 2014: MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 63 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 63 |
| Total of all active and inactive participants | 2014-01-01 | 63 |
| Total participants | 2014-01-01 | 63 |
| Number of participants with account balances | 2014-01-01 | 63 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2014-01-01 | 8 |
| 2013: MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 68 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 63 |
| Total of all active and inactive participants | 2013-01-01 | 63 |
| Total participants | 2013-01-01 | 63 |
| Number of participants with account balances | 2013-01-01 | 63 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2013-01-01 | 7 |
| 2012: MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 68 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 68 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 0 |
| Total of all active and inactive participants | 2012-01-01 | 68 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2012-01-01 | 0 |
| Total participants | 2012-01-01 | 68 |
| Number of participants with account balances | 2012-01-01 | 68 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2012-01-01 | 4 |
| 2011: MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 90 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 68 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 10 |
| Total of all active and inactive participants | 2011-01-01 | 78 |
| Total participants | 2011-01-01 | 78 |
| Number of participants with account balances | 2011-01-01 | 68 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2011-01-01 | 3 |
| 2009: MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 84 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 67 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 10 |
| Total of all active and inactive participants | 2009-01-01 | 77 |
| Total participants | 2009-01-01 | 77 |
| Number of participants with account balances | 2009-01-01 | 67 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2009-01-01 | 2 |
| Measure | Date | Value |
|---|
| 2020 : MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2020 401k financial data |
|---|
| Funding deficiency by the employer to the plan for this plan year | 2020-12-31 | $0 |
| Minimum employer required contribution for this plan year | 2020-12-31 | $66,898 |
| Amount contributed by the employer to the plan for this plan year | 2020-12-31 | $66,898 |
| 2019 : MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2019 401k financial data |
|---|
| Funding deficiency by the employer to the plan for this plan year | 2019-12-31 | $0 |
| Minimum employer required contribution for this plan year | 2019-12-31 | $66,157 |
| Amount contributed by the employer to the plan for this plan year | 2019-12-31 | $66,157 |
| 2018 : MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2018 401k financial data |
|---|
| Funding deficiency by the employer to the plan for this plan year | 2018-12-31 | $0 |
| Minimum employer required contribution for this plan year | 2018-12-31 | $51,585 |
| Amount contributed by the employer to the plan for this plan year | 2018-12-31 | $51,585 |
| 2017 : MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2017 401k financial data |
|---|
| Funding deficiency by the employer to the plan for this plan year | 2017-12-31 | $0 |
| Minimum employer required contribution for this plan year | 2017-12-31 | $56,306 |
| Amount contributed by the employer to the plan for this plan year | 2017-12-31 | $56,306 |
| 2016 : MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2016 401k financial data |
|---|
| Funding deficiency by the employer to the plan for this plan year | 2016-12-31 | $0 |
| Minimum employer required contribution for this plan year | 2016-12-31 | $57,380 |
| Amount contributed by the employer to the plan for this plan year | 2016-12-31 | $57,380 |
| 2015 : MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2015 401k financial data |
|---|
| Funding deficiency by the employer to the plan for this plan year | 2015-12-31 | $0 |
| Minimum employer required contribution for this plan year | 2015-12-31 | $48,768 |
| Amount contributed by the employer to the plan for this plan year | 2015-12-31 | $48,768 |
| 2014 : MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2014 401k financial data |
|---|
| Funding deficiency by the employer to the plan for this plan year | 2014-12-31 | $0 |
| Minimum employer required contribution for this plan year | 2014-12-31 | $39,994 |
| Amount contributed by the employer to the plan for this plan year | 2014-12-31 | $39,994 |
| 2013 : MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2013 401k financial data |
|---|
| Funding deficiency by the employer to the plan for this plan year | 2013-12-31 | $0 |
| Minimum employer required contribution for this plan year | 2013-12-31 | $34,928 |
| Amount contributed by the employer to the plan for this plan year | 2013-12-31 | $34,928 |
| 2012 : MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2012 401k financial data |
|---|
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2012-12-31 | $0 |
| Funding deficiency by the employer to the plan for this plan year | 2012-12-31 | $0 |
| Minimum employer required contribution for this plan year | 2012-12-31 | $57,087 |
| Amount contributed by the employer to the plan for this plan year | 2012-12-31 | $57,087 |
| 2011 : MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2011 401k financial data |
|---|
| Funding deficiency by the employer to the plan for this plan year | 2011-12-31 | $0 |
| Minimum employer required contribution for this plan year | 2011-12-31 | $95,300 |
| Amount contributed by the employer to the plan for this plan year | 2011-12-31 | $95,300 |
| 2010 : MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2010 401k financial data |
|---|
| Funding deficiency by the employer to the plan for this plan year | 2010-12-31 | $0 |
| Minimum employer required contribution for this plan year | 2010-12-31 | $44,892 |
| Amount contributed by the employer to the plan for this plan year | 2010-12-31 | $44,892 |
| 2009 : MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2009 401k financial data |
|---|
| Funding deficiency by the employer to the plan for this plan year | 2009-12-31 | $0 |
| Minimum employer required contribution for this plan year | 2009-12-31 | $78,651 |
| Amount contributed by the employer to the plan for this plan year | 2009-12-31 | $78,651 |
| 2022: MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | No |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: MID-DELTA COMMUNITY SERVICES, INC. EMPLOYEES RETIREMENT PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| THE LAFAYETTE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65242 ) |
| Policy contract number | C4164 |
| Policy instance | 1 |
| Insurance contract or identification number | C4164 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $650 | | Are there contracts with allocated funds for individual policies? | 1 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $650 | | Insurance broker organization code? | 3 |
|
| THE LAFAYETTE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65242 ) |
| Policy contract number | C4164 |
| Policy instance | 1 |
| Insurance contract or identification number | C4164 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $650 | | Are there contracts with allocated funds for individual policies? | 1 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $650 | | Insurance broker organization code? | 3 |
|
| THE LAFAYETTE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65242 ) |
| Policy contract number | C4164 |
| Policy instance | 1 |
| Insurance contract or identification number | C4164 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $363 | | Are there contracts with allocated funds for individual policies? | 1 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $393 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05569520 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05569520 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,200 | | Are there contracts with allocated funds for individual policies? | 1 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD & D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,200 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05569520 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05569520 | | Number of Individuals Covered | 63 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $1,075 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD & D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,075 | | Insurance broker organization code? | 3 |
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| THE LAFAYETTE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65242 ) |
| Policy contract number | C4164 |
| Policy instance | 1 |
| Insurance contract or identification number | C4164 | | Number of Individuals Covered | 63 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $690 | | Are there contracts with allocated funds for individual policies? | 1 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $690 | | Insurance broker organization code? | 3 |
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| THE LAFAYETTE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65242 ) |
| Policy contract number | C4164 |
| Policy instance | 1 |
| Insurance contract or identification number | C4164 | | Number of Individuals Covered | 65 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $200 | | Are there contracts with allocated funds for individual policies? | 1 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $200 | | Insurance broker organization code? | 3 |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05569520 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05569520 | | Number of Individuals Covered | 65 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $1,200 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,200 | | Insurance broker organization code? | 3 |
|
| THE LAFAYETTE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65242 ) |
| Policy contract number | C4164 |
| Policy instance | 1 |
| Insurance contract or identification number | C4164 | | Number of Individuals Covered | 71 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,200 | | Are there contracts with allocated funds for individual policies? | 1 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,200 | | Insurance broker organization code? | 3 | | Insurance broker name | SHELBY B. HACKETT |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05569520 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05569520 | | Number of Individuals Covered | 71 | | Insurance policy start date | 2016-08-01 | | Insurance policy end date | 2017-07-31 | | Total amount of commissions paid to insurance broker | USD $951 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $951 | | Insurance broker organization code? | 3 | | Insurance broker name | SHELBY B. HACKETT |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05569520 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05569520 | | Number of Individuals Covered | 75 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2015-07-31 | | Total amount of commissions paid to insurance broker | USD $1,090 | | Are there contracts with allocated funds for individual policies? | No | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,090 | | Insurance broker organization code? | 3 | | Insurance broker name | SHELBY B. HACKETT |
|
| THE LAFAYETTE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65242 ) |
| Policy contract number | C4164 |
| Policy instance | 1 |
| Insurance contract or identification number | C4164 | | Number of Individuals Covered | 75 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $1,200 | | Are there contracts with allocated funds for individual policies? | Yes | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,200 | | Insurance broker organization code? | 3 | | Insurance broker name | SHELBY B. HACKETT |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05569520 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05569520 | | Number of Individuals Covered | 63 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-07-31 | | Total amount of commissions paid to insurance broker | USD $1,090 | | Are there contracts with allocated funds for individual policies? | No | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,090 | | Insurance broker organization code? | 3 | | Insurance broker name | SHELBY B. HACKETT |
|
| THE LAFAYETTE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65242 ) |
| Policy contract number | C4164 |
| Policy instance | 1 |
| Insurance contract or identification number | C4164 | | Number of Individuals Covered | 63 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,200 | | Are there contracts with allocated funds for individual policies? | Yes | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,200 | | Insurance broker organization code? | 3 | | Insurance broker name | SHELBY B. HACKETT |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05569520 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05569520 | | Number of Individuals Covered | 63 | | Insurance policy start date | 2012-08-01 | | Insurance policy end date | 2013-07-31 | | Total amount of commissions paid to insurance broker | USD $1,090 | | Are there contracts with allocated funds for individual policies? | No | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,090 | | Insurance broker organization code? | 3 | | Insurance broker name | SHELBY B. HACKETT |
|
| THE LAFAYETTE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65242 ) |
| Policy contract number | C4164 |
| Policy instance | 1 |
| Insurance contract or identification number | C4164 | | Number of Individuals Covered | 63 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $1,200 | | Are there contracts with allocated funds for individual policies? | Yes | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,200 | | Insurance broker organization code? | 3 | | Insurance broker name | SHELBY B. HACKETT |
|
| THE LAFAYETTE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65242 ) |
| Policy contract number | C4164 |
| Policy instance | 1 |
| Insurance contract or identification number | C4164 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $1,200 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,200 | | Insurance broker organization code? | 3 | | Insurance broker name | SHELBY B. HACKETT |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05569520 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05569520 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2012-07-31 | | Total amount of commissions paid to insurance broker | USD $1,090 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,090 | | Insurance broker organization code? | 3 | | Insurance broker name | SHELBY B. HACKETT |
|
| THE LAFAYETTE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65242 ) |
| Policy contract number | C4164 |
| Policy instance | 1 |
| Insurance contract or identification number | C4164 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $1,200 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 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 | TM05569520 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05569520 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | Total amount of commissions paid to insurance broker | USD $1,200 | | Are there contracts with allocated funds for individual policies? | No | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | 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 | TM05569520 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05569520 | | Insurance policy start date | 2009-08-01 | | Insurance policy end date | 2010-07-31 | | Total amount of commissions paid to insurance broker | USD $1,034 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LAFAYETTE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65242 ) |
| Policy contract number | C4164 |
| Policy instance | 1 |
| Insurance contract or identification number | C4164 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $1,034 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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