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SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN 401k Plan overview

Plan NameSOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN
Plan identification number 501

SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

SOUTHWEST AR COUNSELING & MENTAL has sponsored the creation of one or more 401k plans.

Company Name:SOUTHWEST AR COUNSELING & MENTAL
Employer identification number (EIN):710526149
NAIC Classification:624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-07-01
5012020-07-01
5012019-07-01
5012018-07-01
5012017-07-01DANNY STANLEY
5012016-07-01DANNY STANLEY
5012015-07-01DANNY STANLEY
5012015-07-01
5012014-07-01MICHAEL WORLEY
5012013-07-01MICHAEL WORLEY
5012012-07-01DWIGHT SPERRY
5012011-07-01DWIGHT SPERRY
5012009-07-01DWIGHT SPERRY DWIGHT SPERRY2011-01-19

Plan Statistics for SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN

401k plan membership statisitcs for SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN

Measure Date Value
2021: SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-01155
Total number of active participants reported on line 7a of the Form 55002021-07-0197
Total of all active and inactive participants2021-07-0197
Total participants2021-07-0197
2020: SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-01157
Total number of active participants reported on line 7a of the Form 55002020-07-01155
Total of all active and inactive participants2020-07-01155
Total participants2020-07-01155
2019: SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01161
Total number of active participants reported on line 7a of the Form 55002019-07-01157
Total of all active and inactive participants2019-07-01157
Total participants2019-07-01157
2018: SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01169
Total number of active participants reported on line 7a of the Form 55002018-07-01161
Total of all active and inactive participants2018-07-01161
Total participants2018-07-01161
2017: SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-01169
Total number of active participants reported on line 7a of the Form 55002017-07-01169
Total of all active and inactive participants2017-07-01169
Total participants2017-07-01169
2016: SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-01153
Total number of active participants reported on line 7a of the Form 55002016-07-01169
Total of all active and inactive participants2016-07-01169
Total participants2016-07-01169
2015: SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-01164
Total number of active participants reported on line 7a of the Form 55002015-07-01153
Total of all active and inactive participants2015-07-01153
Total participants2015-07-010
2014: SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-01161
Total number of active participants reported on line 7a of the Form 55002014-07-01164
Total of all active and inactive participants2014-07-01164
Total participants2014-07-010
2013: SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-01186
Total number of active participants reported on line 7a of the Form 55002013-07-01161
Total of all active and inactive participants2013-07-01161
Total participants2013-07-010
2012: SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-01187
Total number of active participants reported on line 7a of the Form 55002012-07-01152
Total of all active and inactive participants2012-07-01152
Total participants2012-07-010
2011: SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-01121
Total number of active participants reported on line 7a of the Form 55002011-07-01115
Total of all active and inactive participants2011-07-01115
Total participants2011-07-01115
2009: SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-07-01177
Total number of active participants reported on line 7a of the Form 55002009-07-01140
Total of all active and inactive participants2009-07-01140
Total participants2009-07-01140

Form 5500 Responses for SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN

2021: SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – InsuranceYes
2020: SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – InsuranceYes
2019: SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – InsuranceYes
2018: SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – InsuranceYes
2017: SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – InsuranceYes
2016: SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan benefit arrangement – InsuranceYes
2015: SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan benefit arrangement – InsuranceYes
2014: SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan benefit arrangement – InsuranceYes
2013: SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan benefit arrangement – InsuranceYes
2012: SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan benefit arrangement – InsuranceYes
2011: SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan benefit arrangement – InsuranceYes
2009: SOUTHWEST AR COUNSELING & MENTAL HEALTH CENTER INC., MEDICAL BENEFIT PLAN 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01Plan funding arrangement – InsuranceYes
2009-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUDE0BTSW
Policy instance 9
Insurance contract or identification numberGUDE0BTSW
Number of Individuals Covered40
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $2,093
Other welfare benefits providedVOL. CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $10,466
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,093
Insurance broker organization code?3
ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
Policy contract number029357
Policy instance 1
Insurance contract or identification number029357
Number of Individuals Covered97
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $11,560
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,560
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLLV0BTSW
Policy instance 2
Insurance contract or identification numberGLLV0BTSW
Number of Individuals Covered75
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,015
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,149
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,015
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BTSW
Policy instance 3
Insurance contract or identification numberGLUG0BTSW
Number of Individuals Covered118
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $753
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,763
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $753
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUC0BTSW
Policy instance 4
Insurance contract or identification numberGUC0BTSW
Number of Individuals Covered13
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $2,326
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,631
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,326
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0BTSW
Policy instance 5
Insurance contract or identification numberGVTL0BTSW
Number of Individuals Covered64
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $5,299
Other welfare benefits providedVOL. ACCIDENTAL LIFE & AD&D
Welfare Benefit Premiums Paid to CarrierUSD $26,495
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,299
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUPR0BTSW
Policy instance 6
Insurance contract or identification numberGUPR0BTSW
Number of Individuals Covered17
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $2,483
Other welfare benefits providedVOL. LONG TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $12,413
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,483
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUDH0BTSW
Policy instance 7
Insurance contract or identification numberGUDH0BTSW
Number of Individuals Covered23
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,622
Other welfare benefits providedVOL. ACCIDENT ONLY
Welfare Benefit Premiums Paid to CarrierUSD $8,112
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,622
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUDB0BTSW
Policy instance 8
Insurance contract or identification numberGUDB0BTSW
Number of Individuals Covered87
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $4,953
Dental Insurance Welfare BenefitYes
Other welfare benefits providedVOL DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $49,533
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,953
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberFG558
Policy instance 1
Insurance contract or identification numberFG558
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,788
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedHEART, CANCER, CRITICAL ILLINESS
Welfare Benefit Premiums Paid to CarrierUSD $18,046
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,079
Insurance broker organization code?3
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50017101
Policy instance 2
Insurance contract or identification number50017101
Number of Individuals Covered155
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,849
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $10,951
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,643
Insurance broker organization code?3
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50017101
Policy instance 3
Insurance contract or identification number50017101
Number of Individuals Covered48
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $176
Other welfare benefits providedVOL. ACCIDENTAL DEATH & DISMEMBERME
Welfare Benefit Premiums Paid to CarrierUSD $841
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $119
Insurance broker organization code?3
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50017101
Policy instance 4
Insurance contract or identification number50017101
Number of Individuals Covered73
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $2,798
Total amount of fees paid to insurance companyUSD $2
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,328
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,821
Insurance broker organization code?3
Amount paid for insurance broker fees2
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number857930G
Policy instance 5
Insurance contract or identification number857930G
Number of Individuals Covered19
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $598
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,947
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $598
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number02F8600
Policy instance 6
Insurance contract or identification number02F8600
Number of Individuals Covered114
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $43,129
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $839,063
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,256
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberFG558
Policy instance 1
Insurance contract or identification numberFG558
Number of Individuals Covered32
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $2,068
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedHEART, CANCER, CRITICAL ILLINESS
Welfare Benefit Premiums Paid to CarrierUSD $21,111
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,246
Insurance broker organization code?3
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50017101
Policy instance 2
Insurance contract or identification number50017101
Number of Individuals Covered157
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $2,850
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $17,298
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,525
Insurance broker organization code?3
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50017101
Policy instance 3
Insurance contract or identification number50017101
Number of Individuals Covered57
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $208
Other welfare benefits providedVOL. ACCIDENTAL DEATH & DISMEMBERME
Welfare Benefit Premiums Paid to CarrierUSD $986
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $89
Insurance broker organization code?3
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )
Policy contract number000006218
Policy instance 5
Insurance contract or identification number000006218
Number of Individuals Covered155
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $6,478
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,478
Insurance broker organization code?3
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50017101
Policy instance 4
Insurance contract or identification number50017101
Number of Individuals Covered64
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $2,887
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,688
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,266
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number857930G
Policy instance 6
Insurance contract or identification number857930G
Number of Individuals Covered26
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $590
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,802
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $590
Insurance broker organization code?3
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 47155 )
Policy contract number000006128V
Policy instance 7
Insurance contract or identification number000006128V
Number of Individuals Covered138
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $3,487
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,487
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number02F8600
Policy instance 8
Insurance contract or identification number02F8600
Number of Individuals Covered129
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $44,773
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $846,514
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,302
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberFG558
Policy instance 2
Insurance contract or identification numberFG558
Number of Individuals Covered35
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $3,329
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedHEART, CANCER, CRITICAL ILLINESS
Welfare Benefit Premiums Paid to CarrierUSD $31,117
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,031
Insurance broker organization code?3
ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
Policy contract number028664
Policy instance 1
Insurance contract or identification number028664
Number of Individuals Covered134
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $21,647
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,647
Insurance broker organization code?3
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50017101
Policy instance 3
Insurance contract or identification number50017101
Number of Individuals Covered161
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $3,176
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $19,404
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,911
Insurance broker organization code?3
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50017101
Policy instance 4
Insurance contract or identification number50017101
Number of Individuals Covered68
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $263
Other welfare benefits providedVOL. ACCIDENTAL DEATH & DISMEMBERME
Welfare Benefit Premiums Paid to CarrierUSD $1,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $50
Insurance broker organization code?3
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50017101
Policy instance 5
Insurance contract or identification number50017101
Number of Individuals Covered71
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $3,755
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,947
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,692
Insurance broker organization code?3
ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
Policy contract number027397
Policy instance 6
Insurance contract or identification number027397
Number of Individuals Covered161
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $2,796
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,796
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number857930G
Policy instance 7
Insurance contract or identification number857930G
Number of Individuals Covered26
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $836
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,727
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $836
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number90923
Policy instance 8
Insurance contract or identification number90923
Number of Individuals Covered83
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,700
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,335
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,020
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberFG558
Policy instance 2
Insurance contract or identification numberFG558
Number of Individuals Covered36
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,526
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedHEART, CANCER, CRITICAL ILLINESS
Welfare Benefit Premiums Paid to CarrierUSD $29,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,211
Insurance broker organization code?3
Insurance broker nameWILLIAM D. BARRY
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50017101
Policy instance 3
Insurance contract or identification number50017101
Number of Individuals Covered165
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,793
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $17,245
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,587
Insurance broker organization code?3
Insurance broker nameCHRISTOPHER SHUMAKE
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50017101
Policy instance 4
Insurance contract or identification number50017101
Number of Individuals Covered76
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $255
Total amount of fees paid to insurance companyUSD $1
Other welfare benefits providedVOL. ACCIDENTAL DEATH & DISMEMBERME
Welfare Benefit Premiums Paid to CarrierUSD $1,216
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $182
Insurance broker organization code?3
Amount paid for insurance broker fees1
Insurance broker nameCHRISTOPHER SHUMAKE
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50017101
Policy instance 5
Insurance contract or identification number50017101
Number of Individuals Covered89
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,820
Total amount of fees paid to insurance companyUSD $21
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,729
Insurance broker organization code?3
Amount paid for insurance broker fees21
Insurance broker nameCHRISTOPHER SHUMAKE
ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
Policy contract number027397
Policy instance 6
Insurance contract or identification number027397
Number of Individuals Covered169
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,912
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,912
Insurance broker organization code?3
Insurance broker nameWILLIAM D. BARRY
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number857930G
Policy instance 7
Insurance contract or identification number857930G
Number of Individuals Covered32
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $822
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,437
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $822
Insurance broker organization code?3
Insurance broker nameWILLIAM D. BARRY, LP
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number90923
Policy instance 8
Insurance contract or identification number90923
Number of Individuals Covered73
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,480
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,910
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $888
Insurance broker organization code?3
Insurance broker nameW D BARRY LP
ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
Policy contract number028664
Policy instance 1
Insurance contract or identification number028664
Number of Individuals Covered140
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $22,405
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,405
Insurance broker organization code?3
Insurance broker nameWILLIAM D. BARRY
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberFG558
Policy instance 3
Insurance contract or identification numberFG558
Number of Individuals Covered55
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $2,515
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,703
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,510
Insurance broker organization code?3
Insurance broker nameWILLIAM D. BARRY
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50017101
Policy instance 4
Insurance contract or identification number50017101
Number of Individuals Covered158
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $2,566
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $15,972
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,396
Insurance broker organization code?3
Insurance broker nameCHRISTOPHER SHUMAKE
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50017101
Policy instance 5
Insurance contract or identification number50017101
Number of Individuals Covered92
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $280
Other welfare benefits providedVOL. ACCIDENTAL DEATH & DISMEMBERME
Welfare Benefit Premiums Paid to CarrierUSD $1,403
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $210
Insurance broker organization code?3
Insurance broker nameCHRISTOPHER SHUMAKE
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50017101
Policy instance 6
Insurance contract or identification number50017101
Number of Individuals Covered102
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $4,265
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,328
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,199
Insurance broker organization code?3
Insurance broker nameCHRISTOPHER SHUMAKE
ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
Policy contract number027397
Policy instance 7
Insurance contract or identification number027397
Number of Individuals Covered153
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $2,730
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,730
Insurance broker organization code?3
Insurance broker nameWILLIAM D. BARRY
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number857930G
Policy instance 8
Insurance contract or identification number857930G
Number of Individuals Covered35
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $859
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,169
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $859
Insurance broker organization code?3
Insurance broker nameWILLIAM D. BARRY
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7159189
Policy instance 2
Insurance contract or identification numberE7159189
Number of Individuals Covered39
Insurance policy start date2015-01-01
Insurance policy end date2015-05-01
Total amount of commissions paid to insurance brokerUSD $574
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,459
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $220
Insurance broker organization code?3
Insurance broker nameLAURA LENEE SELF
ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
Policy contract number028664
Policy instance 1
Insurance contract or identification number028664
Number of Individuals Covered126
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $22,374
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,374
Insurance broker organization code?3
Insurance broker nameWILLIAM D. BARRY
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number857930G
Policy instance 8
Insurance contract or identification number857930G
Number of Individuals Covered35
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $824
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,033
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $824
Insurance broker organization code?3
Insurance broker nameWD BARRY LP
ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
Policy contract number027397
Policy instance 7
Insurance contract or identification number027397
Number of Individuals Covered164
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $2,726
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,726
Insurance broker organization code?3
Insurance broker nameWILLIAM D. BARRY
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50017101
Policy instance 5
Insurance contract or identification number50017101
Number of Individuals Covered101
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $372
Other welfare benefits providedVOL. ACCIDENTAL DEATH & DISMEMBERME
Welfare Benefit Premiums Paid to CarrierUSD $1,716
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $257
Insurance broker organization code?3
Insurance broker nameCHRISTOPHER SHUMAKE
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50017101
Policy instance 4
Insurance contract or identification number50017101
Number of Individuals Covered164
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $3,040
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $18,237
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,736
Insurance broker organization code?3
Insurance broker nameCHRISTOPHER SHUMAKE
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7159189
Policy instance 2
Insurance contract or identification numberE7159189
Number of Individuals Covered42
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,582
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,488
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $593
Insurance broker organization code?3
Insurance broker nameLAURA LENEE SELF
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberFG558
Policy instance 3
Insurance contract or identification numberFG558
Number of Individuals Covered46
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $4,057
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,903
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,435
Insurance broker organization code?3
Insurance broker nameWILLIAM D BARRY LP
ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
Policy contract number028664
Policy instance 1
Insurance contract or identification number028664
Number of Individuals Covered132
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $24,405
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,405
Insurance broker organization code?3
Insurance broker nameWILLIAM D. BARRY
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50017101
Policy instance 6
Insurance contract or identification number50017101
Number of Individuals Covered112
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $4,869
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,494
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,374
Insurance broker organization code?3
Insurance broker nameCLIFFORD FARMER
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50017101
Policy instance 7
Insurance contract or identification number50017101
Number of Individuals Covered114
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $456
Other welfare benefits providedVOL. ACCIDENTAL DEATH & DISMEMBERME
Welfare Benefit Premiums Paid to CarrierUSD $2,278
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $342
Insurance broker nameCLIFFORD FARMER
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberFG558
Policy instance 5
Insurance contract or identification numberFG558
Number of Individuals Covered51
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $3,730
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,673
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,239
Insurance broker organization code?3
Insurance broker nameWILLIAM D BARRY LP
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50017101
Policy instance 8
Insurance contract or identification number50017101
Number of Individuals Covered121
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $5,796
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,983
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,347
Insurance broker nameCLIFFORD FARMER
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number857930G
Policy instance 4
Insurance contract or identification number857930G
Number of Individuals Covered37
Insurance policy start date2013-09-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $423
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,922
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $423
Insurance broker organization code?3
Insurance broker nameWILLIAM D. BARRY
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7159189
Policy instance 3
Insurance contract or identification numberE7159189
Number of Individuals Covered50
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,897
Total amount of fees paid to insurance companyUSD $110
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $33,167
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $695
Amount paid for insurance broker fees50
Insurance broker organization code?3
Insurance broker nameSTEPHEN FAWCETT
ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
Policy contract number027397
Policy instance 2
Insurance contract or identification number027397
Number of Individuals Covered158
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $2,563
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,563
Insurance broker nameWILLIAM D BARRY
ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )
Policy contract number028664
Policy instance 1
Insurance contract or identification number028664
Number of Individuals Covered134
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $39,448
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,448
Insurance broker organization code?3
Insurance broker nameWILLIAM D. BARRY
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50017101
Policy instance 6
Insurance contract or identification number50017101
Number of Individuals Covered168
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $3,497
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $20,109
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,016
Insurance broker nameCLIFFORD FARMER
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-376313
Policy instance 5
Insurance contract or identification number010-376313
Number of Individuals Covered233
Insurance policy start date2012-03-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,845
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $46,493
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,845
Insurance broker organization code?3
Insurance broker nameWILLIAM D. BARRY
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberFG558
Policy instance 1
Insurance contract or identification numberFG558
Number of Individuals Covered51
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $3,759
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,251
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,502
Insurance broker organization code?3
Insurance broker nameNOLAN R. SMITH
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number055982
Policy instance 4
Insurance contract or identification number055982
Number of Individuals Covered147
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $42,830
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $785,360
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,830
Insurance broker organization code?3
Insurance broker nameWILLIAM D. BARRY
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7159189
Policy instance 3
Insurance contract or identification numberE7159189
Number of Individuals Covered54
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $1,925
Total amount of fees paid to insurance companyUSD $144
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $32,795
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15
Insurance broker organization code?3
Amount paid for insurance broker fees3
Insurance broker nameRONALD FISCHER
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number857930G
Policy instance 2
Insurance contract or identification number857930G
Number of Individuals Covered180
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $5,317
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $48,667
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,317
Insurance broker organization code?3
Insurance broker nameWILLIAM D. BARRY
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-376313
Policy instance 5
Insurance contract or identification number010-376313
Number of Individuals Covered242
Insurance policy start date2011-03-01
Insurance policy end date2012-02-28
Total amount of commissions paid to insurance brokerUSD $3,043
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $56,166
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number055982
Policy instance 4
Insurance contract or identification number055982
Number of Individuals Covered148
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $43,954
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $861,391
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7159189
Policy instance 3
Insurance contract or identification numberE7159189
Number of Individuals Covered63
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $2,387
Total amount of fees paid to insurance companyUSD $126
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $39,217
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number857930G
Policy instance 2
Insurance contract or identification number857930G
Number of Individuals Covered172
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of commissions paid to insurance brokerUSD $5,707
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $53,049
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberFG558
Policy instance 1
Insurance contract or identification numberFG558
Number of Individuals Covered53
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $6,573
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $37,419
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberFG558
Policy instance 1
Insurance contract or identification numberFG558
Number of Individuals Covered73
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $24,055
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $40,298
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7159189
Policy instance 3
Insurance contract or identification numberE7159189
Number of Individuals Covered78
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $4,518
Total amount of fees paid to insurance companyUSD $242
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $51,976
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number055982
Policy instance 4
Insurance contract or identification number055982
Number of Individuals Covered165
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $36,056
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $759,986
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-376313
Policy instance 5
Insurance contract or identification number010-376313
Number of Individuals Covered264
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $3,033
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $55,519
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number857930G
Policy instance 2
Insurance contract or identification number857930G
Number of Individuals Covered184
Insurance policy start date2009-09-01
Insurance policy end date2010-08-31
Total amount of commissions paid to insurance brokerUSD $5,668
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $57,644
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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