Schedule A
- Row 1
- Filing Id
- 84037347326278
- Form Id
- 93408385
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 7020378347326020004
- Ins Broker 01 Name
- THE THORNE CORPORATION
- Ins Broker 01 Street Addr
- 3103 DEVINE STREET
- Ins Broker 01 City
- COLUMBIA
- Ins Broker 01 State
- SC
- Ins Broker 01 ZIP Code
- 292051881
- Ins Broker Comm Pd 01 Amount
- $949
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 2
- Filing Id
- 84037347326278
- Form Id
- 93408383
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 7020378347326020002
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 3
- Filing Id
- 84037347326278
- Form Id
- 93408386
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 7020378347326020005
- Ins Broker 01 Name
- SC BANKERS EMPLOYEE BENEFIT TRUST
- Ins Broker 01 Street Addr
- PO BOX 1483
- Ins Broker 01 City
- COLUMBIA
- Ins Broker 01 State
- SC
- Ins Broker 01 ZIP Code
- 29202
- Ins Broker Comm Pd 01 Amount
- $394
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 4
- Filing Id
- 84037347326278
- Form Id
- 93408384
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 7020378347326020003
- Ins Broker 01 Name
- THE THORNE CORPORATION
- Ins Broker 01 Street Addr
- 3103 DEVINE STREET
- Ins Broker 01 City
- COLUMBIA
- Ins Broker 01 State
- SC
- Ins Broker 01 ZIP Code
- 292051881
- Ins Broker Comm Pd 01 Amount
- $1,246
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 5
- Ins Carrier Name: UNUM LIFE INSURANCE COMPANY
- Filing Id
- 84037347326278
- Form Id
- 93408384
- Schedule A EIN
- 58-1111076
- Schedule A Plan Num
- 511
- Schedule A Plan Year Begin Date
- 2007-01-01
- Schedule A Tax Period
- 20071231
- Ins Carrier Name
- UNUM LIFE INSURANCE COMPANY
- Ins Carrier EIN
- 01-0278678
- Ins Carrier Naic Code
- 62235
- Ins Contract Num
- 348118-0051
- Ins Prsn Covered End of year Count
- 45
- Ins Policy From Date
- 2007-01-01
- Ins Policy To Date
- 2007-12-31
- Ins Broker Comm Total Amount
- $1,246
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- No
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $7,806
- Wlfr Acquis Cost Amount
- $0
- Row 6
- Ins Carrier Name: BLUE CROSS / BLUE SHIELD
- Filing Id
- 84037347326278
- Form Id
- 93408383
- Schedule A EIN
- 58-1111076
- Schedule A Plan Num
- 511
- Schedule A Plan Year Begin Date
- 2007-01-01
- Schedule A Tax Period
- 20071231
- Ins Carrier Name
- BLUE CROSS / BLUE SHIELD
- Ins Carrier EIN
- 57-0287419
- Ins Carrier Naic Code
- 38520
- Ins Contract Num
- 03-51236-77-7
- Ins Prsn Covered End of year Count
- 36
- Ins Policy From Date
- 2007-01-01
- Ins Policy To Date
- 2007-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- AIK
- Wlfr Premium Rcvd Amount
- $159,668
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $159,668
- Wlfr Claims Paid Amount
- $90,038
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $90,038
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $6,241
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $6,241
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $0
- Wlfr Acquis Cost Amount
- $0
- Row 7
- Ins Carrier Name: UNUM LIFE INSURANCE COMPANY
- Filing Id
- 84037347326278
- Form Id
- 93408385
- Schedule A EIN
- 58-1111076
- Schedule A Plan Num
- 511
- Schedule A Plan Year Begin Date
- 2007-01-01
- Schedule A Tax Period
- 20071231
- Ins Carrier Name
- UNUM LIFE INSURANCE COMPANY
- Ins Carrier EIN
- 01-0278678
- Ins Carrier Naic Code
- 62235
- Ins Contract Num
- 105531-00551
- Ins Prsn Covered End of year Count
- 43
- Ins Policy From Date
- 2007-01-01
- Ins Policy To Date
- 2007-12-31
- Ins Broker Comm Total Amount
- $949
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- D
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $12,058
- Wlfr Acquis Cost Amount
- $0
- Row 8
- Ins Carrier Name: METROPOLITAN LIFE INSURANCE COMPANY
- Filing Id
- 84037347326278
- Form Id
- 93408386
- Schedule A EIN
- 58-1111076
- Schedule A Plan Num
- 511
- Schedule A Plan Year Begin Date
- 2007-01-01
- Schedule A Tax Period
- 20071231
- Ins Carrier Name
- METROPOLITAN LIFE INSURANCE COMPANY
- Ins Carrier EIN
- 13-5581829
- Ins Carrier Naic Code
- 65978
- Ins Contract Num
- TS05469906
- Ins Prsn Covered End of year Count
- 17
- Ins Policy From Date
- 2007-01-01
- Ins Policy To Date
- 2007-12-31
- Ins Broker Comm Total Amount
- $394
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $11,247
- Wlfr Acquis Cost Amount
- $0