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COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN 401k Plan overview

Plan NameCOLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN
Plan identification number 502

COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN Benefits

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

401k Sponsoring company profile

COLLOM & CARNEY CLINIC ASSOCIATION has sponsored the creation of one or more 401k plans.

Company Name:COLLOM & CARNEY CLINIC ASSOCIATION
Employer identification number (EIN):751151440
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Additional information about COLLOM & CARNEY CLINIC ASSOCIATION

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 1983-01-31
Company Identification Number: 0080898303
Legal Registered Office Address: 5002 COWHORN CREEK RD

TEXARKANA
United States of America (USA)
75503

More information about COLLOM & CARNEY CLINIC ASSOCIATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-01-01
5022021-01-01
5022020-01-01
5022019-01-01
5022018-01-01
5022017-01-01TOM SIMMONS
5022016-01-01TOM SIMMONS
5022015-01-01TOM SIMMONS
5022014-01-01TOM SIMMONS
5022013-01-01TOM SIMMONS
5022012-01-01TOM SIMMONS
5022011-01-01TOM SIMMONS
5022009-01-01TOM SIMMONS TOM SIMMONS2010-10-12

Plan Statistics for COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN

401k plan membership statisitcs for COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN

Measure Date Value
2022: COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01435
Total number of active participants reported on line 7a of the Form 55002022-01-01444
Number of retired or separated participants receiving benefits2022-01-012
Total of all active and inactive participants2022-01-01446
Total participants2022-01-01446
2021: COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01451
Total number of active participants reported on line 7a of the Form 55002021-01-01434
Number of retired or separated participants receiving benefits2021-01-011
Total of all active and inactive participants2021-01-01435
Total participants2021-01-01435
2020: COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01450
Total number of active participants reported on line 7a of the Form 55002020-01-01449
Number of retired or separated participants receiving benefits2020-01-012
Total of all active and inactive participants2020-01-01451
Total participants2020-01-01451
2019: COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01478
Total number of active participants reported on line 7a of the Form 55002019-01-01447
Number of retired or separated participants receiving benefits2019-01-013
Total of all active and inactive participants2019-01-01450
Total participants2019-01-01450
2018: COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01507
Total number of active participants reported on line 7a of the Form 55002018-01-01476
Number of retired or separated participants receiving benefits2018-01-012
Total of all active and inactive participants2018-01-01478
Total participants2018-01-01478
2017: COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01523
Total number of active participants reported on line 7a of the Form 55002017-01-01505
Number of retired or separated participants receiving benefits2017-01-012
Total of all active and inactive participants2017-01-01507
Total participants2017-01-01507
2016: COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01492
Total number of active participants reported on line 7a of the Form 55002016-01-01521
Number of retired or separated participants receiving benefits2016-01-012
Total of all active and inactive participants2016-01-01523
Total participants2016-01-01523
2015: COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01559
Total number of active participants reported on line 7a of the Form 55002015-01-01489
Number of retired or separated participants receiving benefits2015-01-013
Total of all active and inactive participants2015-01-01492
Total participants2015-01-010
2014: COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01509
Total number of active participants reported on line 7a of the Form 55002014-01-01503
Number of retired or separated participants receiving benefits2014-01-0156
Total of all active and inactive participants2014-01-01559
Total participants2014-01-010
2013: COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01486
Total number of active participants reported on line 7a of the Form 55002013-01-01491
Number of other retired or separated participants entitled to future benefits2013-01-0118
Total of all active and inactive participants2013-01-01509
Total participants2013-01-010
2012: COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01458
Total number of active participants reported on line 7a of the Form 55002012-01-01462
Number of retired or separated participants receiving benefits2012-01-013
Number of other retired or separated participants entitled to future benefits2012-01-0121
Total of all active and inactive participants2012-01-01486
Total participants2012-01-010
2011: COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01539
Total number of active participants reported on line 7a of the Form 55002011-01-01445
Number of retired or separated participants receiving benefits2011-01-013
Number of other retired or separated participants entitled to future benefits2011-01-0110
Total of all active and inactive participants2011-01-01458
Total participants2011-01-01458
2009: COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01508
Total number of active participants reported on line 7a of the Form 55002009-01-01523
Number of retired or separated participants receiving benefits2009-01-0110
Number of other retired or separated participants entitled to future benefits2009-01-0111
Total of all active and inactive participants2009-01-01544
Total participants2009-01-01544

Form 5500 Responses for COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN

2022: COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: COLLOM & CARNEY CLINIC ASSOCIATION HEALTH INSURANCE PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUC 0BRFT
Policy instance 3
Insurance contract or identification numberGUC 0BRFT
Number of Individuals Covered293
Insurance policy start date2021-08-01
Insurance policy end date2022-08-01
Total amount of commissions paid to insurance brokerUSD $10,736
Total amount of fees paid to insurance companyUSD $5,129
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $71,573
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,736
Amount paid for insurance broker fees4245
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 )
Policy contract numberLGS01105-21
Policy instance 1
Insurance contract or identification numberLGS01105-21
Number of Individuals Covered429
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Welfare Benefit Premiums Paid to CarrierUSD $148,073
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BRFT
Policy instance 2
Insurance contract or identification numberGLUG0BRFT
Number of Individuals Covered476
Insurance policy start date2021-08-01
Insurance policy end date2022-08-01
Total amount of fees paid to insurance companyUSD $1,445
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1196
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-053920
Policy instance 8
Insurance contract or identification number010-053920
Number of Individuals Covered752
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $20,907
Total amount of fees paid to insurance companyUSD $1,113
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $209,065
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,907
Amount paid for insurance broker fees1113
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUDE0BRFT
Policy instance 4
Insurance contract or identification numberGUDE0BRFT
Number of Individuals Covered339
Insurance policy start date2021-08-01
Insurance policy end date2022-08-01
Total amount of commissions paid to insurance brokerUSD $12,468
Total amount of fees paid to insurance companyUSD $6,037
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $83,120
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,468
Amount paid for insurance broker fees4996
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUPR0BRFT
Policy instance 5
Insurance contract or identification numberGUPR0BRFT
Number of Individuals Covered293
Insurance policy start date2021-08-01
Insurance policy end date2022-08-01
Total amount of commissions paid to insurance brokerUSD $8,054
Total amount of fees paid to insurance companyUSD $3,863
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $53,695
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,054
Amount paid for insurance broker fees3197
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0BRFT
Policy instance 6
Insurance contract or identification numberGVTL0BRFT
Number of Individuals Covered307
Insurance policy start date2021-08-01
Insurance policy end date2022-08-01
Total amount of commissions paid to insurance brokerUSD $20,944
Total amount of fees paid to insurance companyUSD $9,766
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $139,629
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,944
Amount paid for insurance broker fees8082
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number27096
Policy instance 7
Insurance contract or identification number27096
Number of Individuals Covered280
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $14,021
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $53,969
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,021
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUC 0BRFT
Policy instance 3
Insurance contract or identification numberGUC 0BRFT
Number of Individuals Covered282
Insurance policy start date2020-08-01
Insurance policy end date2021-08-01
Total amount of commissions paid to insurance brokerUSD $10,789
Total amount of fees paid to insurance companyUSD $1,447
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $71,924
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,789
Amount paid for insurance broker fees1066
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BRFT
Policy instance 2
Insurance contract or identification numberGLUG0BRFT
Number of Individuals Covered459
Insurance policy start date2020-08-01
Insurance policy end date2021-08-01
Total amount of fees paid to insurance companyUSD $384
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees283
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 )
Policy contract numberLGS01105-20
Policy instance 1
Insurance contract or identification numberLGS01105-20
Number of Individuals Covered441
Insurance policy start date2020-08-01
Insurance policy end date2021-07-31
Welfare Benefit Premiums Paid to CarrierUSD $129,777
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUDE0BRFT
Policy instance 4
Insurance contract or identification numberGUDE0BRFT
Number of Individuals Covered212
Insurance policy start date2020-08-01
Insurance policy end date2021-08-01
Total amount of commissions paid to insurance brokerUSD $12,508
Total amount of fees paid to insurance companyUSD $1,546
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $83,385
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,508
Amount paid for insurance broker fees1139
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0BRFT
Policy instance 6
Insurance contract or identification numberGVTL0BRFT
Number of Individuals Covered294
Insurance policy start date2020-08-01
Insurance policy end date2021-08-01
Total amount of commissions paid to insurance brokerUSD $19,922
Total amount of fees paid to insurance companyUSD $2,717
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $132,817
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,922
Amount paid for insurance broker fees2002
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-053920
Policy instance 8
Insurance contract or identification number010-053920
Number of Individuals Covered739
Insurance policy start date2020-08-01
Insurance policy end date2021-07-31
Total amount of commissions paid to insurance brokerUSD $21,254
Total amount of fees paid to insurance companyUSD $4,329
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $212,544
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,254
Amount paid for insurance broker fees4329
Insurance broker organization code?3
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number27096
Policy instance 7
Insurance contract or identification number27096
Number of Individuals Covered236
Insurance policy start date2020-08-01
Insurance policy end date2021-07-31
Total amount of commissions paid to insurance brokerUSD $10,044
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $68,708
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,044
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUPR0BRFT
Policy instance 5
Insurance contract or identification numberGUPR0BRFT
Number of Individuals Covered282
Insurance policy start date2020-08-01
Insurance policy end date2021-08-01
Total amount of commissions paid to insurance brokerUSD $8,147
Total amount of fees paid to insurance companyUSD $945
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $54,311
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,147
Amount paid for insurance broker fees696
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 )
Policy contract numberMS6 90MS6-I1.1
Policy instance 6
Insurance contract or identification numberMS6 90MS6-I1.1
Number of Individuals Covered315
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Total amount of commissions paid to insurance brokerUSD $22,504
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $225,031
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,252
Insurance broker organization code?3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number82-2723296
Policy instance 2
Insurance contract or identification number82-2723296
Number of Individuals Covered223
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Total amount of commissions paid to insurance brokerUSD $22,305
Total amount of fees paid to insurance companyUSD $665
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $145,950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,825
Amount paid for insurance broker fees475
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number468351
Policy instance 5
Insurance contract or identification number468351
Number of Individuals Covered431
Insurance policy start date2019-08-01
Insurance policy end date2020-08-01
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,354
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number467995
Policy instance 4
Insurance contract or identification number467995
Number of Individuals Covered233
Insurance policy start date2019-08-01
Insurance policy end date2020-08-01
Total amount of commissions paid to insurance brokerUSD $10,671
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $98,249
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,825
Insurance broker organization code?3
QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 )
Policy contract numberLGS01105-19
Policy instance 3
Insurance contract or identification numberLGS01105-19
Number of Individuals Covered445
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Welfare Benefit Premiums Paid to CarrierUSD $114,628
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number595879
Policy instance 1
Insurance contract or identification number595879
Number of Individuals Covered263
Insurance policy start date2019-08-01
Insurance policy end date2020-08-01
Total amount of commissions paid to insurance brokerUSD $8,107
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $107,561
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,876
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number467995
Policy instance 4
Insurance contract or identification number467995
Number of Individuals Covered270
Insurance policy start date2018-08-01
Insurance policy end date2019-08-01
Total amount of commissions paid to insurance brokerUSD $10,808
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $108,075
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,808
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number595879
Policy instance 1
Insurance contract or identification number595879
Number of Individuals Covered305
Insurance policy start date2018-08-01
Insurance policy end date2019-08-01
Total amount of commissions paid to insurance brokerUSD $8,147
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $119,657
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,147
Insurance broker organization code?3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number82-2723296
Policy instance 2
Insurance contract or identification number82-2723296
Number of Individuals Covered253
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $27,370
Total amount of fees paid to insurance companyUSD $728
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $162,444
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,848
Amount paid for insurance broker fees520
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number468351
Policy instance 5
Insurance contract or identification number468351
Number of Individuals Covered498
Insurance policy start date2018-08-01
Insurance policy end date2019-08-01
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,106
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 )
Policy contract numberLGS01105-18
Policy instance 3
Insurance contract or identification numberLGS01105-18
Number of Individuals Covered5606
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Welfare Benefit Premiums Paid to CarrierUSD $102,253
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number468351
Policy instance 5
Insurance contract or identification number468351
Number of Individuals Covered540
Insurance policy start date2017-08-01
Insurance policy end date2018-08-01
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,634
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 )
Policy contract numberLGS01105-17
Policy instance 3
Insurance contract or identification numberLGS01105-17
Number of Individuals Covered498
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $11,253
Welfare Benefit Premiums Paid to CarrierUSD $112,528
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,253
Insurance broker organization code?3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number82-2723296
Policy instance 2
Insurance contract or identification number82-2723296
Number of Individuals Covered253
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $52,843
Total amount of fees paid to insurance companyUSD $999
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $320,850
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,818
Amount paid for insurance broker fees693
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number595879
Policy instance 1
Insurance contract or identification number595879
Number of Individuals Covered336
Insurance policy start date2017-08-01
Insurance policy end date2018-08-01
Total amount of commissions paid to insurance brokerUSD $8,203
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $114,593
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,203
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number467995
Policy instance 4
Insurance contract or identification number467995
Number of Individuals Covered294
Insurance policy start date2017-08-01
Insurance policy end date2018-08-01
Total amount of commissions paid to insurance brokerUSD $11,239
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $102,062
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,239
Insurance broker organization code?3
QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 )
Policy contract numberLGS01105-16
Policy instance 3
Insurance contract or identification numberLGS01105-16
Number of Individuals Covered516
Insurance policy start date2016-08-01
Insurance policy end date2017-07-31
Total amount of commissions paid to insurance brokerUSD $11,468
Welfare Benefit Premiums Paid to CarrierUSD $114,682
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,468
Insurance broker nameBLUEADVANTAGE ADMINISTRATORS OF ARK
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number467995
Policy instance 4
Insurance contract or identification number467995
Number of Individuals Covered299
Insurance policy start date2016-08-01
Insurance policy end date2017-08-01
Total amount of commissions paid to insurance brokerUSD $11,903
Total amount of fees paid to insurance companyUSD $621
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $129,355
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,936
Insurance broker organization code?3
Amount paid for insurance broker fees621
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker namePERRY HALL
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number82-2723296
Policy instance 2
Insurance contract or identification number82-2723296
Number of Individuals Covered281
Insurance policy start date2016-08-01
Insurance policy end date2017-07-31
Total amount of commissions paid to insurance brokerUSD $27,380
Total amount of fees paid to insurance companyUSD $820
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $177,674
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,095
Amount paid for insurance broker fees559
Insurance broker organization code?3
Insurance broker nameVICKIE HENDERSON
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number595879
Policy instance 1
Insurance contract or identification number595879
Number of Individuals Covered339
Insurance policy start date2016-08-01
Insurance policy end date2017-08-01
Total amount of commissions paid to insurance brokerUSD $8,234
Total amount of fees paid to insurance companyUSD $661
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $139,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,321
Insurance broker organization code?3
Amount paid for insurance broker fees661
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker namePERRY HALL
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number468351
Policy instance 5
Insurance contract or identification number468351
Number of Individuals Covered558
Insurance policy start date2016-08-01
Insurance policy end date2017-08-01
Total amount of fees paid to insurance companyUSD $147
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,560
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees147
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Insurance broker namePERRY B HALL
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE9173626
Policy instance 1
Insurance contract or identification numberE9173626
Number of Individuals Covered2
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $49
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,421
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24
Insurance broker organization code?3
Insurance broker nameTAMMIE PEARSON
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number595879
Policy instance 2
Insurance contract or identification number595879
Number of Individuals Covered301
Insurance policy start date2014-08-01
Insurance policy end date2015-08-01
Total amount of commissions paid to insurance brokerUSD $8,082
Total amount of fees paid to insurance companyUSD $469
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $134,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,041
Amount paid for insurance broker fees469
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Insurance broker nameLINDA ROGERS
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberF8265
Policy instance 3
Insurance contract or identification numberF8265
Number of Individuals Covered288
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $37,877
Total amount of fees paid to insurance companyUSD $1,192
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $202,788
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,095
Amount paid for insurance broker fees643
Insurance broker organization code?3
Insurance broker nameMARK LEE
QBE A&H (National Association of Insurance Commissioners NAIC id number: 39217 )
Policy contract numberLGS01105-14
Policy instance 4
Insurance contract or identification numberLGS01105-14
Number of Individuals Covered495
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $12,688
Welfare Benefit Premiums Paid to CarrierUSD $126,883
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,688
Insurance broker organization code?3
Insurance broker nameBLUEADVANTAGE ADMINISTRATORS OF AR
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number467995
Policy instance 5
Insurance contract or identification number467995
Number of Individuals Covered275
Insurance policy start date2014-12-01
Insurance policy end date2015-08-01
Total amount of commissions paid to insurance brokerUSD $6,708
Total amount of fees paid to insurance companyUSD $671
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $76,103
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,354
Amount paid for insurance broker fees671
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Insurance broker nameLINDA ROGERS
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number468351
Policy instance 6
Insurance contract or identification number468351
Number of Individuals Covered518
Insurance policy start date2014-12-01
Insurance policy end date2015-08-01
Total amount of fees paid to insurance companyUSD $177
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,994
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees177
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Insurance broker namePERRY HALL
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number595879
Policy instance 2
Insurance contract or identification number595879
Number of Individuals Covered235
Insurance policy start date2013-08-01
Insurance policy end date2014-08-01
Total amount of commissions paid to insurance brokerUSD $8,266
Total amount of fees paid to insurance companyUSD $561
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $138,459
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,133
Amount paid for insurance broker fees561
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Insurance broker nameLINDA ROGERS
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE9173626
Policy instance 1
Insurance contract or identification numberE9173626
Number of Individuals Covered3
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $57
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,618
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23
Insurance broker organization code?3
Insurance broker nameTAMMIE PEARSON
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberSL10000059-121
Policy instance 5
Insurance contract or identification numberSL10000059-121
Number of Individuals Covered489
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $11,307
Welfare Benefit Premiums Paid to CarrierUSD $113,068
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,307
Insurance broker organization code?3
Insurance broker nameGROUP SERVICE UNDERWRITERS INC
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50006029
Policy instance 3
Insurance contract or identification number50006029
Number of Individuals Covered520
Insurance policy start date2014-01-01
Insurance policy end date2014-11-30
Total amount of commissions paid to insurance brokerUSD $4,212
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $36,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,685
Insurance broker organization code?3
Insurance broker nameCHRISTOPHER SHUMAKE
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberF8265
Policy instance 4
Insurance contract or identification numberF8265
Number of Individuals Covered305
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $34,821
Total amount of fees paid to insurance companyUSD $330
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $193,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,716
Amount paid for insurance broker fees177
Insurance broker organization code?3
Insurance broker nameMARK LEE
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50006029
Policy instance 7
Insurance contract or identification number50006029
Number of Individuals Covered467
Insurance policy start date2014-01-01
Insurance policy end date2014-11-30
Total amount of commissions paid to insurance brokerUSD $17,921
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOL GROUP LIFE
Welfare Benefit Premiums Paid to CarrierUSD $75,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,338
Insurance broker organization code?3
Insurance broker nameCHRISTOPHER SHUMAKE
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50006029
Policy instance 6
Insurance contract or identification number50006029
Number of Individuals Covered336
Insurance policy start date2014-01-01
Insurance policy end date2014-11-30
Total amount of commissions paid to insurance brokerUSD $1,928
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOL AD&D
Welfare Benefit Premiums Paid to CarrierUSD $8,065
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,220
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 numberE9173626
Policy instance 1
Insurance contract or identification numberE9173626
Number of Individuals Covered3
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $59
Life Insurance Welfare BenefitYes
Temporary Disability 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
Insurance broker organization code?3
Insurance broker nameTAMMIE PEARSON
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50006029
Policy instance 7
Insurance contract or identification number50006029
Number of Individuals Covered409
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $18,159
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOL GROUP LIFE
Welfare Benefit Premiums Paid to CarrierUSD $86,470
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,971
Insurance broker organization code?3
Insurance broker nameCLIFFORD FARMER
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberF8265
Policy instance 4
Insurance contract or identification numberF8265
Number of Individuals Covered292
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $37,741
Total amount of fees paid to insurance companyUSD $1,376
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $186,889
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,090
Amount paid for insurance broker fees740
Insurance broker organization code?3
Insurance broker nameDAVID GORDON WALKER
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50006029
Policy instance 6
Insurance contract or identification number50006029
Number of Individuals Covered293
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,474
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOL AD&D
Welfare Benefit Premiums Paid to CarrierUSD $7,017
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,053
Insurance broker organization code?3
Insurance broker nameCLIFFORD FARMER
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberSL10000059-121
Policy instance 5
Insurance contract or identification numberSL10000059-121
Number of Individuals Covered443
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $9,532
Welfare Benefit Premiums Paid to CarrierUSD $95,318
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,532
Insurance broker organization code?3
Insurance broker nameGROUP SERVICE UNDERWRITERS INC
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50006029
Policy instance 3
Insurance contract or identification number50006029
Number of Individuals Covered455
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $4,793
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $44,465
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,446
Insurance broker organization code?3
Insurance broker nameCLIFFORD FARMER
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number595879
Policy instance 2
Insurance contract or identification number595879
Number of Individuals Covered235
Insurance policy start date2012-09-01
Insurance policy end date2013-09-01
Total amount of commissions paid to insurance brokerUSD $7,924
Total amount of fees paid to insurance companyUSD $502
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $133,976
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,962
Amount paid for insurance broker fees502
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Insurance broker nameLINDA ROGERS
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50006029
Policy instance 2
Insurance contract or identification number50006029
Number of Individuals Covered307
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,317
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOL AD&D
Welfare Benefit Premiums Paid to CarrierUSD $10,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $44
Insurance broker organization code?3
Insurance broker nameDAINES INSURANCE AGENCY
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE9173626
Policy instance 7
Insurance contract or identification numberE9173626
Number of Individuals Covered3
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $225
Life Insurance Welfare BenefitYes
Temporary Disability 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 $1
Insurance broker organization code?3
Insurance broker nameDAVID BARNETTE
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number595879
Policy instance 6
Insurance contract or identification number595879
Number of Individuals Covered210
Insurance policy start date2011-08-01
Insurance policy end date2012-08-01
Total amount of commissions paid to insurance brokerUSD $6,686
Total amount of fees paid to insurance companyUSD $500
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $145,097
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,343
Insurance broker organization code?3
Amount paid for insurance broker fees500
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker namePERRY HALL
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50006029
Policy instance 5
Insurance contract or identification number50006029
Number of Individuals Covered448
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $3,444
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $31,466
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $297
Insurance broker organization code?3
Insurance broker nameDAINES INSURANCE AGENCY
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberF8265
Policy instance 4
Insurance contract or identification numberF8265
Number of Individuals Covered282
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $46,979
Total amount of fees paid to insurance companyUSD $1,352
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $207,759
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5
Insurance broker organization code?3
Amount paid for insurance broker fees60
Insurance broker nameLINDA ROGERS
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberSL10000059-111
Policy instance 3
Insurance contract or identification numberSL10000059-111
Number of Individuals Covered462
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $11,132
Welfare Benefit Premiums Paid to CarrierUSD $111,317
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,132
Insurance broker organization code?3
Insurance broker nameGROUP SERVICE UNDERWRITERS INC
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50006029
Policy instance 1
Insurance contract or identification number50006029
Number of Individuals Covered420
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $12,795
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOL GROUP LIFE
Welfare Benefit Premiums Paid to CarrierUSD $60,929
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $316
Insurance broker organization code?3
Insurance broker nameDAINES INSURANCE AGENCY
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50006029
Policy instance 2
Insurance contract or identification number50006029
Number of Individuals Covered500
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $178
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOL AD&D
Welfare Benefit Premiums Paid to CarrierUSD $848
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 numberE9173626
Policy instance 8
Insurance contract or identification numberE9173626
Number of Individuals Covered8
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $386
Total amount of fees paid to insurance companyUSD $1
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number101054401
Policy instance 6
Insurance contract or identification number101054401
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $382
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50006029
Policy instance 5
Insurance contract or identification number50006029
Number of Individuals Covered458
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $4,838
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $44,136
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number595879
Policy instance 7
Insurance contract or identification number595879
Number of Individuals Covered226
Insurance policy start date2010-08-01
Insurance policy end date2011-08-01
Total amount of commissions paid to insurance brokerUSD $9,908
Total amount of fees paid to insurance companyUSD $641
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $170,935
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberF8265
Policy instance 4
Insurance contract or identification numberF8265
Number of Individuals Covered320
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $36,857
Total amount of fees paid to insurance companyUSD $1,775
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $173,221
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50006029
Policy instance 1
Insurance contract or identification number50006029
Number of Individuals Covered500
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $16,962
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOL GROUP LIFE
Welfare Benefit Premiums Paid to CarrierUSD $84,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract number3738596
Policy instance 3
Insurance contract or identification number3738596
Number of Individuals Covered514
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $12,867
Welfare Benefit Premiums Paid to CarrierUSD $128,671
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract number3738596
Policy instance 1
Insurance contract or identification number3738596
Number of Individuals Covered517
Insurance policy start date2009-08-01
Insurance policy end date2010-08-01
Total amount of commissions paid to insurance brokerUSD $15,194
Welfare Benefit Premiums Paid to CarrierUSD $126,614
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 numberE9173626
Policy instance 6
Insurance contract or identification numberE9173626
Number of Individuals Covered8
Insurance policy start date2009-08-01
Insurance policy end date2010-07-31
Total amount of commissions paid to insurance brokerUSD $394
Total amount of fees paid to insurance companyUSD $2
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number595879
Policy instance 5
Insurance contract or identification number595879
Number of Individuals Covered246
Insurance policy start date2009-08-01
Insurance policy end date2010-08-01
Total amount of commissions paid to insurance brokerUSD $8,943
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $155,595
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number54401
Policy instance 3
Insurance contract or identification number54401
Number of Individuals Covered505
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $14,766
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $80,575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberF8265
Policy instance 2
Insurance contract or identification numberF8265
Number of Individuals Covered308
Insurance policy start date2009-08-01
Insurance policy end date2010-07-31
Total amount of commissions paid to insurance brokerUSD $43,093
Total amount of fees paid to insurance companyUSD $2,170
Welfare Benefit Premiums Paid to CarrierUSD $184,228
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number54401
Policy instance 4
Insurance contract or identification number54401
Number of Individuals Covered520
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $4,303
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $43,406
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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