401k Plan data: SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN plan

SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN
Plan identification number	501

SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

SOUTHERN DEVELOPMENT MANAGEMENT CO., INC. has sponsored the creation of one or more 401k plans.

Company Name: SOUTHERN DEVELOPMENT MANAGEMENT CO., INC.

Employer identification number (EIN): 570884962

NAIC Classification: 531310

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-06-01 WILLIAM T. POUNCEY 2023-12-14
501 2021-06-01 CATHY WALKER 2022-12-12
501 2020-06-01 CATHY WALKER 2021-09-27
501 2019-06-01 CATHY WALKER 2020-08-13
501 2018-06-01 CATHY WALKER 2020-02-14
501 2017-06-01
501 2015-06-01
501 2014-06-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-06-01	WILLIAM T. POUNCEY	2023-12-14
501	2021-06-01	CATHY WALKER	2022-12-12
501	2020-06-01	CATHY WALKER	2021-09-27
501	2019-06-01	CATHY WALKER	2020-08-13
501	2018-06-01	CATHY WALKER	2020-02-14
501	2017-06-01
501	2015-06-01
501	2014-06-01

Plan Statistics for SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN

Measure Date Value
2022: SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-06-01 94
Total number of active participants reported on line 7a of the Form 5500 2022-06-01 106
Number of retired or separated participants receiving benefits 2022-06-01 0
Number of other retired or separated participants entitled to future benefits 2022-06-01 0
Total of all active and inactive participants 2022-06-01 106
2021: SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-06-01 100
Total number of active participants reported on line 7a of the Form 5500 2021-06-01 94
Total of all active and inactive participants 2021-06-01 94
2020: SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-06-01 106
Total number of active participants reported on line 7a of the Form 5500 2020-06-01 100
Total of all active and inactive participants 2020-06-01 100
2019: SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-06-01 109
Total number of active participants reported on line 7a of the Form 5500 2019-06-01 106
Total of all active and inactive participants 2019-06-01 106
2018: SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-06-01 103
Total number of active participants reported on line 7a of the Form 5500 2018-06-01 109
Total of all active and inactive participants 2018-06-01 109
2017: SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-06-01 108
Total number of active participants reported on line 7a of the Form 5500 2017-06-01 103
Total of all active and inactive participants 2017-06-01 103
2015: SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-06-01 117
Total number of active participants reported on line 7a of the Form 5500 2015-06-01 105
Total of all active and inactive participants 2015-06-01 105
2014: SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-06-01 0
Total number of active participants reported on line 7a of the Form 5500 2014-06-01 117
Total of all active and inactive participants 2014-06-01 117

Measure	Date	Value
2022: SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-06-01	94
Total number of active participants reported on line 7a of the Form 5500	2022-06-01	106
Number of retired or separated participants receiving benefits	2022-06-01	0
Number of other retired or separated participants entitled to future benefits	2022-06-01	0
Total of all active and inactive participants	2022-06-01	106
2021: SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-06-01	100
Total number of active participants reported on line 7a of the Form 5500	2021-06-01	94
Total of all active and inactive participants	2021-06-01	94
2020: SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-06-01	106
Total number of active participants reported on line 7a of the Form 5500	2020-06-01	100
Total of all active and inactive participants	2020-06-01	100
2019: SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-06-01	109
Total number of active participants reported on line 7a of the Form 5500	2019-06-01	106
Total of all active and inactive participants	2019-06-01	106
2018: SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-06-01	103
Total number of active participants reported on line 7a of the Form 5500	2018-06-01	109
Total of all active and inactive participants	2018-06-01	109
2017: SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-06-01	108
Total number of active participants reported on line 7a of the Form 5500	2017-06-01	103
Total of all active and inactive participants	2017-06-01	103
2015: SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-06-01	117
Total number of active participants reported on line 7a of the Form 5500	2015-06-01	105
Total of all active and inactive participants	2015-06-01	105
2014: SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-06-01	0
Total number of active participants reported on line 7a of the Form 5500	2014-06-01	117
Total of all active and inactive participants	2014-06-01	117

Form 5500 Responses for SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN

2022: SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN 2022 form 5500 responses
2022-06-01	Type of plan entity	Single employer plan
2022-06-01	Plan funding arrangement – Insurance	Yes
2022-06-01	Plan benefit arrangement – Insurance	Yes
2021: SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN 2021 form 5500 responses
2021-06-01	Type of plan entity	Single employer plan
2021-06-01	Plan funding arrangement – Insurance	Yes
2021-06-01	Plan benefit arrangement – Insurance	Yes
2020: SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN 2020 form 5500 responses
2020-06-01	Type of plan entity	Single employer plan
2020-06-01	Plan funding arrangement – Insurance	Yes
2020-06-01	Plan benefit arrangement – Insurance	Yes
2019: SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN 2019 form 5500 responses
2019-06-01	Type of plan entity	Single employer plan
2019-06-01	Plan funding arrangement – Insurance	Yes
2019-06-01	Plan benefit arrangement – Insurance	Yes
2018: SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN 2018 form 5500 responses
2018-06-01	Type of plan entity	Single employer plan
2018-06-01	Plan funding arrangement – Insurance	Yes
2018-06-01	Plan benefit arrangement – Insurance	Yes
2017: SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-06-01	Type of plan entity	Single employer plan
2017-06-01	Plan funding arrangement – Insurance	Yes
2017-06-01	Plan benefit arrangement – Insurance	Yes
2015: SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-06-01	Type of plan entity	Single employer plan
2015-06-01	Plan funding arrangement – Insurance	Yes
2015-06-01	Plan benefit arrangement – Insurance	Yes
2014: SOUTHERN DEVELOPMENT MANAGEMENT COMPANY EMPLOYEE BENEFIT PLAN 2014 form 5500 responses
2014-06-01	Type of plan entity	Single employer plan
2014-06-01	First time form 5500 has been submitted	Yes
2014-06-01	Plan funding arrangement – Insurance	Yes
2014-06-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

GVTL0B69R

Policy instance

Insurance contract or identification number	GVTL0B69R
Number of Individuals Covered	44
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $4,180
Total amount of fees paid to insurance company	USD $1,456
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $19,905
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,180
Amount paid for insurance broker fees	1456
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 )

Policy contract number

06584

Policy instance

Insurance contract or identification number	06584
Number of Individuals Covered	72
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Health Insurance Welfare Benefit	Yes
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 number

E3078433

Policy instance

Insurance contract or identification number	E3078433
Number of Individuals Covered	42
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $6,765
Total amount of fees paid to insurance company	USD $1,161
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,467
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,532
Amount paid for insurance broker fees	348
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

96757601001

Policy instance

Insurance contract or identification number	96757601001
Number of Individuals Covered	36
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $130
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,216
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $130
Insurance broker organization code?	3

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

Policy contract number

GUDS0B69R

Policy instance

Insurance contract or identification number	GUDS0B69R
Number of Individuals Covered	106
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $1,748
Total amount of fees paid to insurance company	USD $1,507
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $43,700
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,748
Amount paid for insurance broker fees	1507
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GUG 0B69R

Policy instance

Insurance contract or identification number	GUG 0B69R
Number of Individuals Covered	80
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $1,855
Total amount of fees paid to insurance company	USD $1,301
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,546
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,855
Amount paid for insurance broker fees	1301
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GLUG0B69R

Policy instance

Insurance contract or identification number	GLUG0B69R
Number of Individuals Covered	105
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $2,865
Total amount of fees paid to insurance company	USD $1,964
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $28,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,865
Amount paid for insurance broker fees	1964
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GLTD0B69R

Policy instance

Insurance contract or identification number	GLTD0B69R
Number of Individuals Covered	73
Insurance policy start date	2022-06-01
Insurance policy end date	2023-05-31
Total amount of commissions paid to insurance broker	USD $2,613
Total amount of fees paid to insurance company	USD $1,847
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,129
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,613
Amount paid for insurance broker fees	1847
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GUDS0B69R

Policy instance

Insurance contract or identification number	GUDS0B69R
Number of Individuals Covered	94
Insurance policy start date	2021-06-01
Insurance policy end date	2022-06-01
Total amount of commissions paid to insurance broker	USD $1,744
Total amount of fees paid to insurance company	USD $1,590
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $43,596
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,306
Amount paid for insurance broker fees	1590
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GUG0B69R

Policy instance

Insurance contract or identification number	GUG0B69R
Number of Individuals Covered	74
Insurance policy start date	2021-06-01
Insurance policy end date	2022-06-01
Total amount of commissions paid to insurance broker	USD $1,947
Total amount of fees paid to insurance company	USD $1,427
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,473
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,453
Amount paid for insurance broker fees	1427
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GLUG0B69R

Policy instance

Insurance contract or identification number	GLUG0B69R
Number of Individuals Covered	93
Insurance policy start date	2021-06-01
Insurance policy end date	2022-06-01
Total amount of commissions paid to insurance broker	USD $2,856
Total amount of fees paid to insurance company	USD $1,981
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $28,559
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,153
Amount paid for insurance broker fees	1981
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GLTD0B69R

Policy instance

Insurance contract or identification number	GLTD0B69R
Number of Individuals Covered	70
Insurance policy start date	2021-06-01
Insurance policy end date	2022-06-01
Total amount of commissions paid to insurance broker	USD $2,745
Total amount of fees paid to insurance company	USD $1,875
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,458
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,053
Amount paid for insurance broker fees	1875
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

GVTL0B69R

Policy instance

Insurance contract or identification number	GVTL0B69R
Number of Individuals Covered	39
Insurance policy start date	2021-06-01
Insurance policy end date	2022-06-01
Total amount of commissions paid to insurance broker	USD $4,749
Total amount of fees paid to insurance company	USD $1,602
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $22,615
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,559
Amount paid for insurance broker fees	1602
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 )

Policy contract number

06584

Policy instance

Insurance contract or identification number	06584
Number of Individuals Covered	67
Insurance policy start date	2021-06-01
Insurance policy end date	2022-05-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10117921001

Policy instance

Insurance contract or identification number	10117921001
Number of Individuals Covered	83
Insurance policy start date	2021-06-01
Insurance policy end date	2022-05-31
Total amount of commissions paid to insurance broker	USD $842
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,782
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $842
Insurance broker organization code?	3

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

Policy contract number

E3078433

Policy instance

Insurance contract or identification number	E3078433
Number of Individuals Covered	43
Insurance policy start date	2021-06-01
Insurance policy end date	2022-05-31
Total amount of commissions paid to insurance broker	USD $3,091
Total amount of fees paid to insurance company	USD $166
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,792
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,149
Amount paid for insurance broker fees	67
Insurance broker organization code?	3

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

Policy contract number

GUDS0B69R

Policy instance

Insurance contract or identification number	GUDS0B69R
Number of Individuals Covered	100
Insurance policy start date	2020-06-01
Insurance policy end date	2021-06-01
Total amount of commissions paid to insurance broker	USD $1,902
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,559
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,902
Insurance broker organization code?	3

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

Policy contract number

GUG0B69R

Policy instance

Insurance contract or identification number	GUG0B69R
Number of Individuals Covered	82
Insurance policy start date	2020-06-01
Insurance policy end date	2021-06-01
Total amount of commissions paid to insurance broker	USD $2,058
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,576
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,058
Insurance broker organization code?	3

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

Policy contract number

GLUG0B69R

Policy instance

Insurance contract or identification number	GLUG0B69R
Number of Individuals Covered	100
Insurance policy start date	2020-06-01
Insurance policy end date	2021-06-01
Total amount of commissions paid to insurance broker	USD $2,761
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $27,606
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,761
Insurance broker organization code?	3

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

Policy contract number

GLTD0B69R

Policy instance

Insurance contract or identification number	GLTD0B69R
Number of Individuals Covered	75
Insurance policy start date	2020-06-01
Insurance policy end date	2021-06-01
Total amount of commissions paid to insurance broker	USD $2,491
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,910
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,491
Insurance broker organization code?	3

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

Policy contract number

GVTL0B69R

Policy instance

Insurance contract or identification number	GVTL0B69R
Number of Individuals Covered	47
Insurance policy start date	2020-06-01
Insurance policy end date	2021-06-01
Total amount of commissions paid to insurance broker	USD $4,665
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $22,214
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,665
Insurance broker organization code?	3

BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 )

Policy contract number

06584

Policy instance

Insurance contract or identification number	06584
Number of Individuals Covered	70
Insurance policy start date	2020-06-01
Insurance policy end date	2021-05-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10117921001

Policy instance

Insurance contract or identification number	10117921001
Number of Individuals Covered	90
Insurance policy start date	2020-06-01
Insurance policy end date	2021-05-31
Total amount of commissions paid to insurance broker	USD $968
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,601
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $968
Insurance broker organization code?	3

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

Policy contract number

E3078433

Policy instance

Insurance contract or identification number	E3078433
Number of Individuals Covered	46
Insurance policy start date	2020-06-01
Insurance policy end date	2021-05-31
Total amount of commissions paid to insurance broker	USD $4,867
Total amount of fees paid to insurance company	USD $860
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,660
Amount paid for insurance broker fees	474
Additional information about fees paid to insurance broker	BONUSES
Insurance broker organization code?	3

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

Policy contract number

E3078433

Policy instance

Insurance contract or identification number	E3078433
Number of Individuals Covered	49
Insurance policy start date	2019-06-01
Insurance policy end date	2020-05-31
Total amount of commissions paid to insurance broker	USD $4,789
Total amount of fees paid to insurance company	USD $257
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $48,116
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,065
Amount paid for insurance broker fees	19
Insurance broker organization code?	3

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

Policy contract number

GUDS0B69R

Policy instance

Insurance contract or identification number	GUDS0B69R
Number of Individuals Covered	106
Insurance policy start date	2019-06-01
Insurance policy end date	2020-05-31
Total amount of commissions paid to insurance broker	USD $1,990
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,740
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,990
Insurance broker organization code?	3

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

Policy contract number

GUG0B69R

Policy instance

Insurance contract or identification number	GUG0B69R
Number of Individuals Covered	81
Insurance policy start date	2019-06-01
Insurance policy end date	2020-05-31
Total amount of commissions paid to insurance broker	USD $1,947
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,474
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,947
Insurance broker organization code?	3

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

Policy contract number

GLUG0B69R

Policy instance

Insurance contract or identification number	GLUG0B69R
Number of Individuals Covered	105
Insurance policy start date	2019-06-01
Insurance policy end date	2020-05-31
Total amount of commissions paid to insurance broker	USD $2,632
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $26,321
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,632
Insurance broker organization code?	3

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

Policy contract number

GLTD0B69R

Policy instance

Insurance contract or identification number	GLTD0B69R
Number of Individuals Covered	75
Insurance policy start date	2019-06-01
Insurance policy end date	2020-05-31
Total amount of commissions paid to insurance broker	USD $2,406
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,063
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,406
Insurance broker organization code?	3

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

Policy contract number

GVTL0B69R

Policy instance

Insurance contract or identification number	GVTL0B69R
Number of Individuals Covered	50
Insurance policy start date	2019-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $4,898
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $23,325
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,898
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 )

Policy contract number

15-84662-00

Policy instance

Insurance contract or identification number	15-84662-00
Number of Individuals Covered	71
Insurance policy start date	2019-06-01
Insurance policy end date	2020-06-01
Total amount of commissions paid to insurance broker	USD $22,356
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $558,820
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,356
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10117921001

Policy instance

Insurance contract or identification number	10117921001
Number of Individuals Covered	93
Insurance policy start date	2019-06-01
Insurance policy end date	2020-05-31
Total amount of commissions paid to insurance broker	USD $870
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,628
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $870
Insurance broker organization code?	3

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

Policy contract number

GVTL0B69R

Policy instance

Insurance contract or identification number	GVTL0B69R
Number of Individuals Covered	57
Insurance policy start date	2018-06-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $5,386
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $25,648
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,386
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 )

Policy contract number

15-84662-00

Policy instance

Insurance contract or identification number	15-84662-00
Number of Individuals Covered	71
Insurance policy start date	2018-06-01
Insurance policy end date	2019-06-01
Total amount of commissions paid to insurance broker	USD $21,203
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $530,071
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,457
Insurance broker organization code?	3

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

Policy contract number

GLTD0B69R

Policy instance

Insurance contract or identification number	GLTD0B69R
Number of Individuals Covered	81
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $2,297
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $22,966
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,297
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10117921001

Policy instance

Insurance contract or identification number	10117921001
Number of Individuals Covered	100
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $880
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $880
Insurance broker organization code?	3

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

Policy contract number

E3078433

Policy instance

Insurance contract or identification number	E3078433
Number of Individuals Covered	53
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $10,812
Total amount of fees paid to insurance company	USD $3,688
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,592
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,459
Amount paid for insurance broker fees	2726
Insurance broker organization code?	3

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

Policy contract number

GLUG0B69R

Policy instance

Insurance contract or identification number	GLUG0B69R
Number of Individuals Covered	106
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $2,200
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $22,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,200
Insurance broker organization code?	3

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

Policy contract number

GUG0B69R

Policy instance

Insurance contract or identification number	GUG0B69R
Number of Individuals Covered	85
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $1,875
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,751
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,875
Insurance broker organization code?	3

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

Policy contract number

GUDS0B69R

Policy instance

Insurance contract or identification number	GUDS0B69R
Number of Individuals Covered	109
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $1,970
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,259
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,970
Insurance broker organization code?	3

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

Policy contract number

GUDS0B69R

Policy instance

Insurance contract or identification number	GUDS0B69R
Number of Individuals Covered	103
Insurance policy start date	2017-06-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $2,002
Total amount of fees paid to insurance company	USD $335
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,055
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 number

GUG0B69R

Policy instance

Insurance contract or identification number	GUG0B69R
Number of Individuals Covered	86
Insurance policy start date	2017-06-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $1,995
Total amount of fees paid to insurance company	USD $269
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,953
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 number

GLUG0B69R

Policy instance

Insurance contract or identification number	GLUG0B69R
Number of Individuals Covered	102
Insurance policy start date	2017-06-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $2,270
Total amount of fees paid to insurance company	USD $299
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $22,695
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 number

GLTD0B69R

Policy instance

Insurance contract or identification number	GLTD0B69R
Number of Individuals Covered	82
Insurance policy start date	2017-06-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $2,491
Total amount of fees paid to insurance company	USD $338
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,908
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 number

GVTL0B69R

Policy instance

Insurance contract or identification number	GVTL0B69R
Number of Individuals Covered	61
Insurance policy start date	2017-06-01
Insurance policy end date	2017-05-31
Total amount of commissions paid to insurance broker	USD $5,572
Total amount of fees paid to insurance company	USD $334
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $26,535
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 )

Policy contract number

15-84662-00

Policy instance

Insurance contract or identification number	15-84662-00
Number of Individuals Covered	72
Insurance policy start date	2017-06-01
Insurance policy end date	2018-06-01
Total amount of commissions paid to insurance broker	USD $23,371
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $579,918
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 number

E3078433

Policy instance

Insurance contract or identification number	E3078433
Number of Individuals Covered	49
Insurance policy start date	2017-06-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $8,208
Total amount of fees paid to insurance company	USD $5,197
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $43,374
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10117921001

Policy instance

Insurance contract or identification number	10117921001
Number of Individuals Covered	111
Insurance policy start date	2017-06-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $888
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,695
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 number

E3078433

Policy instance

Insurance contract or identification number	E3078433
Number of Individuals Covered	54
Insurance policy start date	2015-06-01
Insurance policy end date	2016-05-31
Total amount of commissions paid to insurance broker	USD $1,034
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,459
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $522
Insurance broker organization code?	3
Insurance broker name	INNOVATIVE PARTNERS, LLC

BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 )

Policy contract number

15-84662-00

Policy instance

Insurance contract or identification number	15-84662-00
Number of Individuals Covered	72
Insurance policy start date	2015-06-01
Insurance policy end date	2016-05-31
Total amount of commissions paid to insurance broker	USD $22,129
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,129
Insurance broker organization code?	3
Insurance broker name	KEY INSURANCE CONSULTANTS

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00488091

Policy instance

Insurance contract or identification number	00488091
Number of Individuals Covered	105
Insurance policy start date	2015-06-01
Insurance policy end date	2016-05-31
Total amount of commissions paid to insurance broker	USD $13,909
Total amount of fees paid to insurance company	USD $7,484
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $139,093
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,909
Amount paid for insurance broker fees	7484
Additional information about fees paid to insurance broker	PRODUCER
Insurance broker organization code?	3
Insurance broker name	SOUTHEASTERN INS CONSULTANTS

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00488091

Policy instance

Insurance contract or identification number	00488091
Number of Individuals Covered	117
Insurance policy start date	2014-06-01
Insurance policy end date	2015-05-31
Total amount of commissions paid to insurance broker	USD $15,523
Total amount of fees paid to insurance company	USD $3,138
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $155,226
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,523
Insurance broker organization code?	3
Amount paid for insurance broker fees	3138
Insurance broker name	KEY INSURANCE CONSULTANTS

BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 )

Policy contract number

15-84662-00

Policy instance

Insurance contract or identification number	15-84662-00
Number of Individuals Covered	80
Insurance policy start date	2014-06-01
Insurance policy end date	2015-05-31
Total amount of commissions paid to insurance broker	USD $23,041
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,041
Insurance broker organization code?	3
Insurance broker name	KEY INSURANCE CONSULTANTS

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Company Name:	SOUTHERN DEVELOPMENT MANAGEMENT CO., INC.
Employer identification number (EIN):	570884962
NAIC Classification:	531310