401k Plan data: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN plan

ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 401k Plan overview

Plan Name	ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN
Plan identification number	501

ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN Benefits

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

401k Sponsoring company profile

ARKANSAS FAMILY CARE NETWORK, P.A. has sponsored the creation of one or more 401k plans.

Company Name: ARKANSAS FAMILY CARE NETWORK, P.A.

Employer identification number (EIN): 710418504

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2019-01-01
501 2018-01-01
501 2017-01-01 BRAD D. HARPER BRAD D. HARPER 2018-10-08
501 2016-01-01 BRAD D. HARPER BRAD D. HARPER 2017-10-05
501 2015-01-01 BRAD D. HARPER BRAD D. HARPER 2016-08-24
501 2014-01-01 BRAD D. HARPER BRAD D. HARPER 2015-10-15
501 2013-01-01 BRAD D. HARPER BRAD D. HARPER 2014-08-22
501 2012-01-01 BRAD D. HARPER BRAD D. HARPER 2013-07-22
501 2011-01-01 BRAD D. HARPER BRAD D. HARPER 2012-07-23
501 2010-01-01 BRAD D. HARPER BRAD D. HARPER 2011-07-22
501 2009-01-01 BRAD D. HARPER BRAD D. HARPER 2010-07-28

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2019-01-01
501	2018-01-01
501	2017-01-01	BRAD D. HARPER	BRAD D. HARPER	2018-10-08
501	2016-01-01	BRAD D. HARPER	BRAD D. HARPER	2017-10-05
501	2015-01-01	BRAD D. HARPER	BRAD D. HARPER	2016-08-24
501	2014-01-01	BRAD D. HARPER	BRAD D. HARPER	2015-10-15
501	2013-01-01	BRAD D. HARPER	BRAD D. HARPER	2014-08-22
501	2012-01-01	BRAD D. HARPER	BRAD D. HARPER	2013-07-22
501	2011-01-01	BRAD D. HARPER	BRAD D. HARPER	2012-07-23
501	2010-01-01	BRAD D. HARPER	BRAD D. HARPER	2011-07-22
501	2009-01-01	BRAD D. HARPER	BRAD D. HARPER	2010-07-28

Plan Statistics for ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN

401k plan membership statisitcs for ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN

Measure Date Value
2019: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 724
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 0
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 0
2018: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 407
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 724
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 2018-01-01 724
2017: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 381
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 407
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 2017-01-01 407
2016: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 348
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 381
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 381
2015: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 231
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 348
Total of all active and inactive participants 2015-01-01 348
Total participants 2015-01-01 348
2014: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 225
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 231
Total of all active and inactive participants 2014-01-01 231
Total participants 2014-01-01 231
2013: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 302
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 225
Total of all active and inactive participants 2013-01-01 225
Total participants 2013-01-01 225
2012: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 274
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 302
Total of all active and inactive participants 2012-01-01 302
Total participants 2012-01-01 302
2011: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 273
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 274
Total of all active and inactive participants 2011-01-01 274
Total participants 2011-01-01 274
2010: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 268
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 273
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 273
Total participants 2010-01-01 273
2009: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 243
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 268
Total of all active and inactive participants 2009-01-01 268
Total participants 2009-01-01 268

Measure	Date	Value
2019: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	724
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	0
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	0
2018: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	407
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	724
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	724
2017: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	381
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	407
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	407
2016: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	348
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	381
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	381
2015: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	231
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	348
Total of all active and inactive participants	2015-01-01	348
Total participants	2015-01-01	348
2014: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	225
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	231
Total of all active and inactive participants	2014-01-01	231
Total participants	2014-01-01	231
2013: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	302
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	225
Total of all active and inactive participants	2013-01-01	225
Total participants	2013-01-01	225
2012: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	274
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	302
Total of all active and inactive participants	2012-01-01	302
Total participants	2012-01-01	302
2011: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	273
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	274
Total of all active and inactive participants	2011-01-01	274
Total participants	2011-01-01	274
2010: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	268
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	273
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	273
Total participants	2010-01-01	273
2009: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	243
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	268
Total of all active and inactive participants	2009-01-01	268
Total participants	2009-01-01	268

Form 5500 Responses for ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN

2019: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	This submission is the final filing	Yes
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: ARKANSAS PHYSICIAN MANAGEMENT, INC. CAFETERIA PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000400001000

Policy instance

Insurance contract or identification number	000400001000
Number of Individuals Covered	197
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $9,845
Total amount of fees paid to insurance company	USD $5,723
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOL CHILD LIFE; SPOUSE AD&D AND AD&
Welfare Benefit Premiums Paid to Carrier	USD $65,636
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,845
Insurance broker organization code?	3
Amount paid for insurance broker fees	3754

NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )

Policy contract number

659217

Policy instance

Insurance contract or identification number	659217
Number of Individuals Covered	623
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $5,097
Total amount of fees paid to insurance company	USD $1,273
Long Term Disability Insurance Welfare Benefit	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 $4,247
Amount paid for insurance broker fees	1070
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000002780

Policy instance

Insurance contract or identification number	000002780
Number of Individuals Covered	873
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $26,932
Dental Insurance Welfare Benefit	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 $26,932
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5940775

Policy instance

Insurance contract or identification number	5940775
Number of Individuals Covered	1191
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $20,049
Total amount of fees paid to insurance company	USD $1,323
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $53,627
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,147
Amount paid for insurance broker fees	988
Insurance broker organization code?	3

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0361500000

Policy instance

Insurance contract or identification number	0361500000
Number of Individuals Covered	83
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $11,753
Other welfare benefits provided	COMBO CANCER-CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $29,467
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,029
Insurance broker organization code?	3

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0361500000

Policy instance

Insurance contract or identification number	0361500000
Number of Individuals Covered	239
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $14,096
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $54,492
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,428
Insurance broker organization code?	3

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50021163

Policy instance

Insurance contract or identification number	50021163
Number of Individuals Covered	203
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $11,965
Total amount of fees paid to insurance company	USD $952
Other welfare benefits provided	ECR HOSPITAL CARE
Welfare Benefit Premiums Paid to Carrier	USD $37,457
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,618
Insurance broker organization code?	3
Amount paid for insurance broker fees	952

HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95442 )

Policy contract number

781205/781206

Policy instance

Insurance contract or identification number	781205/781206
Number of Individuals Covered	671
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $30,189
Health Insurance Welfare Benefit	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 $30,189
Insurance broker organization code?	5

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0361500000

Policy instance

Insurance contract or identification number	0361500000
Number of Individuals Covered	149
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $28,426
Other welfare benefits provided	UNIVERSAL LIFE
Welfare Benefit Premiums Paid to Carrier	USD $67,895
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,318
Insurance broker organization code?	3

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0361500000

Policy instance

Insurance contract or identification number	0361500000
Number of Individuals Covered	114
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $13,694
Other welfare benefits provided	CRITICAL HEALTH EVENTS
Welfare Benefit Premiums Paid to Carrier	USD $42,908
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,011
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010247476

Policy instance

Insurance contract or identification number	000010247476
Number of Individuals Covered	223
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $12,408
Total amount of fees paid to insurance company	USD $7,175
Other welfare benefits provided	WEEKLY INCOME
Welfare Benefit Premiums Paid to Carrier	USD $82,723
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,408
Insurance broker organization code?	3
Amount paid for insurance broker fees	4693

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010247475

Policy instance

Insurance contract or identification number	000010247475
Number of Individuals Covered	635
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,518
Total amount of fees paid to insurance company	USD $1,857
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $25,177
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,518
Insurance broker organization code?	3
Amount paid for insurance broker fees	1102

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0361500000

Policy instance

Insurance contract or identification number	0361500000
Number of Individuals Covered	119
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $6,579
Other welfare benefits provided	COMBO CANCER-CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $28,565
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,657
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5940775

Policy instance

Insurance contract or identification number	5940775
Number of Individuals Covered	1062
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $8,763
Total amount of fees paid to insurance company	USD $246
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $148,865
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,763
Amount paid for insurance broker fees	246
Insurance broker organization code?	3

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000002780

Policy instance

Insurance contract or identification number	000002780
Number of Individuals Covered	669
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $18,714
Dental Insurance Welfare Benefit	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 $11,983
Insurance broker organization code?	3

NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )

Policy contract number

659217

Policy instance

Insurance contract or identification number	659217
Number of Individuals Covered	502
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $9,967
Long Term Disability Insurance Welfare Benefit	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 $8,349
Insurance broker organization code?	3

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0361500000

Policy instance

Insurance contract or identification number	0361500000
Number of Individuals Covered	271
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $4,495
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $24,850
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,300
Insurance broker organization code?	3

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50021163

Policy instance

Insurance contract or identification number	50021163
Number of Individuals Covered	134
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $4,091
Total amount of fees paid to insurance company	USD $61
Other welfare benefits provided	ECR HOSPITAL CARE
Welfare Benefit Premiums Paid to Carrier	USD $8,779
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,251
Insurance broker organization code?	3
Amount paid for insurance broker fees	61

HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95442 )

Policy contract number

781205/781206

Policy instance

Insurance contract or identification number	781205/781206
Number of Individuals Covered	724
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $12,514
Total amount of fees paid to insurance company	USD $215,124
Health Insurance Welfare Benefit	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 $12,514
Amount paid for insurance broker fees	215124
Insurance broker organization code?	5

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0361500000

Policy instance

Insurance contract or identification number	0361500000
Number of Individuals Covered	166
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $5,362
Other welfare benefits provided	UNIVERSAL LIFE
Welfare Benefit Premiums Paid to Carrier	USD $20,837
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,362
Insurance broker organization code?	3

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0361500000

Policy instance

Insurance contract or identification number	0361500000
Number of Individuals Covered	107
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Other welfare benefits provided	CRITICAL LIFE EVENTS
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )

Policy contract number

659217

Policy instance

Insurance contract or identification number	659217
Number of Individuals Covered	269
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $8,159
Long Term Disability Insurance Welfare Benefit	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 $6,504
Insurance broker organization code?	3
Insurance broker name	MEEKS FNCL GRP LLC

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

000002780

Policy instance

Insurance contract or identification number	000002780
Number of Individuals Covered	337
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $12,743
Dental Insurance Welfare Benefit	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 $12,743
Insurance broker organization code?	3
Insurance broker name	REGIONS INSURANCE

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TM05940775

Policy instance

Insurance contract or identification number	TM05940775
Number of Individuals Covered	585
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $13,692
Total amount of fees paid to insurance company	USD $2,840
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $81,880
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,692
Amount paid for insurance broker fees	2840
Insurance broker organization code?	3
Insurance broker name	REGIONS INSURANCE INC.

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0361500000

Policy instance

Insurance contract or identification number	0361500000
Number of Individuals Covered	47
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,573
Other welfare benefits provided	COMBO CANCER-CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $13,363
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,573
Insurance broker organization code?	3
Insurance broker name	REGIONS INSURANCE INC

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0361500000

Policy instance

Insurance contract or identification number	0361500000
Number of Individuals Covered	44
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,917
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $11,596
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,917
Insurance broker organization code?	3
Insurance broker name	REGIONS INSURANCE INC.

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50021163

Policy instance

Insurance contract or identification number	50021163
Number of Individuals Covered	28
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,043
Total amount of fees paid to insurance company	USD $43
Other welfare benefits provided	ECR HOSPITAL CARE
Welfare Benefit Premiums Paid to Carrier	USD $5,311
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $836
Insurance broker organization code?	3
Amount paid for insurance broker fees	36
Insurance broker name	KAREN BAGLEY

HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95442 )

Policy contract number

781205/781206

Policy instance

Insurance contract or identification number	781205/781206
Number of Individuals Covered	407
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $30,596
Total amount of fees paid to insurance company	USD $144,236
Health Insurance Welfare Benefit	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 $30,596
Amount paid for insurance broker fees	144236
Insurance broker organization code?	5
Insurance broker name	HEALTH ADVANTAGE

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0ATXN

Policy instance

Insurance contract or identification number	GVTL0ATXN
Number of Individuals Covered	65
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,524
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOL. LIFE AD&D
Welfare Benefit Premiums Paid to Carrier	USD $16,826
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,524
Insurance broker organization code?	3
Insurance broker name	REGIONS INSURANCE INC. -MS

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E3879855

Policy instance

Insurance contract or identification number	E3879855
Number of Individuals Covered	64
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,465
Total amount of fees paid to insurance company	USD $55
Other welfare benefits provided	SUPPLEMENTAL
Welfare Benefit Premiums Paid to Carrier	USD $4,783
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $662
Insurance broker organization code?	3
Amount paid for insurance broker fees	24
Insurance broker name	CHUCK CALDWELL

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC0ATXN

Policy instance

Insurance contract or identification number	GUC0ATXN
Number of Individuals Covered	50
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,338
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOL. STD
Welfare Benefit Premiums Paid to Carrier	USD $15,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,338
Insurance broker organization code?	3
Insurance broker name	REGIONS INSURANCE INC.-MS

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0ATXN

Policy instance

Insurance contract or identification number	GLUG0ATXN
Number of Individuals Covered	217
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,638
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $10,920
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,638
Insurance broker organization code?	3
Insurance broker name	REGIONS INSURANCE INC.-MS

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

30016332

Policy instance

Insurance contract or identification number	30016332
Number of Individuals Covered	134
Insurance policy start date	2014-11-01
Insurance policy end date	2015-10-31
Total amount of commissions paid to insurance broker	USD $1,274
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,591
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,274
Insurance broker organization code?	3
Insurance broker name	REGIONS INSURANCE INC.

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0361500000

Policy instance

Insurance contract or identification number	0361500000
Number of Individuals Covered	45
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $7,682
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	COMBO CANCER/CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $11,525
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,682
Insurance broker organization code?	3
Insurance broker name	REGIONS INSURANCE INC.

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0361500000

Policy instance

Insurance contract or identification number	0361500000
Number of Individuals Covered	40
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $6,542
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $10,063
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,542
Insurance broker organization code?	3
Insurance broker name	REGIONS INSURANCE INC.

HEALTH ADVANTAGE (National Association of Insurance Commissioners NAIC id number: 95442 )

Policy contract number

781205/781206

Policy instance

Insurance contract or identification number	781205/781206
Number of Individuals Covered	348
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $155,414
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	155414
Additional information about fees paid to insurance broker	CLAIMS PROCESSING
Insurance broker organization code?	5
Insurance broker name

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

2780

Policy instance

Insurance contract or identification number	2780
Number of Individuals Covered	300
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $11,583
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	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 $11,583
Insurance broker organization code?	3
Insurance broker name	REGIONS INSURANCE INC.

NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )

Policy contract number

659217

Policy instance

Insurance contract or identification number	659217
Number of Individuals Covered	166
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $7,397
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	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 $5,724
Insurance broker organization code?	3
Insurance broker name	NATHAN DANIEL KINARD

UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 )

Policy contract number

04WM;04WP

Policy instance

Insurance contract or identification number	04WM;04WP
Number of Individuals Covered	377
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $35,237
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,151,330
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,463
Insurance broker organization code?	3
Insurance broker name	REGIONS INSURANCE INC.

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

474624

Policy instance

Insurance contract or identification number	474624
Number of Individuals Covered	226
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,085
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $724
Insurance broker organization code?	3
Insurance broker name	REGIONS INSURANCE INC.

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

30016332

Policy instance

Insurance contract or identification number	30016332
Number of Individuals Covered	136
Insurance policy start date	2013-11-01
Insurance policy end date	2014-10-31
Total amount of commissions paid to insurance broker	USD $1,204
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,087
Insurance broker organization code?	3
Insurance broker name	REGIONS INSURANCE INC.

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

2780

Policy instance

Insurance contract or identification number	2780
Number of Individuals Covered	325
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $11,172
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,463
Insurance broker organization code?	3
Insurance broker name	REGIONS INSURANCE INC.

NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )

Policy contract number

659217

Policy instance

Insurance contract or identification number	659217
Number of Individuals Covered	231
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $8,395
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,494
Insurance broker organization code?	3
Insurance broker name	MEEKS FNCL GRP LLC

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E3879855

Policy instance

Insurance contract or identification number	E3879855
Number of Individuals Covered	68
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $16,276
Total amount of fees paid to insurance company	USD $4,248
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	SUPPLEMENTAL
Welfare Benefit Premiums Paid to Carrier	USD $60,521
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,473
Insurance broker organization code?	3
Amount paid for insurance broker fees	3431
Insurance broker name	CHARLES L. WHITWORTH JR

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E3879855

Policy instance

Insurance contract or identification number	E3879855
Number of Individuals Covered	70
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $15,089
Total amount of fees paid to insurance company	USD $2,810
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	SUPPLEMENTAL
Welfare Benefit Premiums Paid to Carrier	USD $65,776
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,840
Insurance broker organization code?	3
Amount paid for insurance broker fees	2229
Insurance broker name	CHARLES L. WHITWORTH JR

NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )

Policy contract number

659217

Policy instance

Insurance contract or identification number	659217
Number of Individuals Covered	222
Insurance policy start date	2012-12-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $5,628
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,133
Insurance broker organization code?	3
Insurance broker name	MEEKS FNCL GRP LLC

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

2780

Policy instance

Insurance contract or identification number	2780
Number of Individuals Covered	315
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $9,768
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,768
Insurance broker organization code?	3
Insurance broker name	STEPKA & ASSOCIATES, INC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

30016332

Policy instance

Insurance contract or identification number	30016332
Number of Individuals Covered	133
Insurance policy start date	2012-11-01
Insurance policy end date	2013-10-31
Total amount of commissions paid to insurance broker	USD $1,124
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,611
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,124
Insurance broker organization code?	3
Insurance broker name	STEPKA & ASSOCIATES, INC

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

474624

Policy instance

Insurance contract or identification number	474624
Number of Individuals Covered	225
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,163
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,578
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,163
Insurance broker organization code?	3
Insurance broker name	STEPKA & ASSOCIATES, INC

UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 )

Policy contract number

04WM;04WP;04WQ

Policy instance

Insurance contract or identification number	04WM;04WP;04WQ
Number of Individuals Covered	377
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $28,874
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $971,325
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,874
Insurance broker name	STEPKA & ASSOCIATES, INC

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

474624

Policy instance

Insurance contract or identification number	474624
Number of Individuals Covered	216
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,050
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $9,732
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,050
Insurance broker organization code?	3
Insurance broker name	STEPKA & ASSOCIATES, INC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

30016332

Policy instance

Insurance contract or identification number	30016332
Number of Individuals Covered	110
Insurance policy start date	2011-11-01
Insurance policy end date	2012-10-31
Total amount of commissions paid to insurance broker	USD $1,006
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,205
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,006
Insurance broker organization code?	3
Insurance broker name	STEPKA & ASSOCIATES, INC

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

2780

Policy instance

Insurance contract or identification number	2780
Number of Individuals Covered	278
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $7,611
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,611
Insurance broker organization code?	3
Insurance broker name	STEPKA & ASSOCIATES, INC

NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )

Policy contract number

659217

Policy instance

Insurance contract or identification number	659217
Number of Individuals Covered	206
Insurance policy start date	2011-12-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,976
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,976
Insurance broker organization code?	3
Insurance broker name	CALVIN BIGGERS

QCA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95448 )

Policy contract number

76112

Policy instance

Insurance contract or identification number	76112
Number of Individuals Covered	302
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $22,029
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $881,178
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,029
Insurance broker organization code?	3
Insurance broker name	STEPKA & ASSOCIATES, INC

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E3879855

Policy instance

Insurance contract or identification number	E3879855
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 $35,682
Total amount of fees paid to insurance company	USD $6,279
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	SUPPLEMENTAL
Welfare Benefit Premiums Paid to Carrier	USD $59,171
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,934
Insurance broker organization code?	3
Amount paid for insurance broker fees	5630
Insurance broker name	VICKI M. WILSON

QCA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95448 )

Policy contract number

76112

Policy instance

Insurance contract or identification number	76112
Number of Individuals Covered	274
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $18,656
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $746,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )

Policy contract number

663280

Policy instance

Insurance contract or identification number	663280
Number of Individuals Covered	168
Insurance policy start date	2010-12-01
Insurance policy end date	2011-11-30
Total amount of commissions paid to insurance broker	USD $2,446
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,831
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

2780

Policy instance

Insurance contract or identification number	2780
Number of Individuals Covered	241
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $6,242
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

30018332

Policy instance

Insurance contract or identification number	30018332
Number of Individuals Covered	95
Insurance policy start date	2010-11-01
Insurance policy end date	2011-10-31
Total amount of commissions paid to insurance broker	USD $929
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,051
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

30018332

Policy instance

Insurance contract or identification number	30018332
Number of Individuals Covered	96
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $899
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,176
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $899
Insurance broker organization code?	3
Insurance broker name	STEPKA & ASSOCIATES, INC

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0714629

Policy instance

Insurance contract or identification number	0714629
Number of Individuals Covered	273
Insurance policy start date	2009-07-01
Insurance policy end date	2009-10-31
Total amount of commissions paid to insurance broker	USD $2,110
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,110
Insurance broker organization code?	3
Insurance broker name	STEPKA & ASSOCIATES, INC

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )

Policy contract number

2780

Policy instance

Insurance contract or identification number	2780
Number of Individuals Covered	229
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $6,484
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,484
Insurance broker organization code?	3
Insurance broker name	STEPKA & ASSOCIATES, INC

QCA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95448 )

Policy contract number

76112

Policy instance

Insurance contract or identification number	76112
Number of Individuals Covered	266
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $20,944
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $698,126
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,944
Insurance broker organization code?	3
Insurance broker name	STEPKA & ASSOCIATES, INC

NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )

Policy contract number

659217

Policy instance

Insurance contract or identification number	659217
Number of Individuals Covered	181
Insurance policy start date	2009-12-01
Insurance policy end date	2010-11-30
Total amount of commissions paid to insurance broker	USD $4,697
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,483
Insurance broker organization code?	3
Insurance broker name	WILLIAM JENKINS

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Company Name:	ARKANSAS FAMILY CARE NETWORK, P.A.
Employer identification number (EIN):	710418504
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)