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SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 401k Plan overview

Plan NameSOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN
Plan identification number 501

SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN Benefits

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

401k Sponsoring company profile

SOUTHERN MILLS, INC. has sponsored the creation of one or more 401k plans.

Company Name:SOUTHERN MILLS, INC.
Employer identification number (EIN):580439110
NAIC Classification:313000
NAIC Description: Textile Mills

Additional information about SOUTHERN MILLS, INC.

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division
Incorporation Date: 2015-05-13
Company Identification Number: 111182093

More information about SOUTHERN MILLS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-01-01LYNN PERREAULT2024-10-14
5012022-01-01LYNN PERREAULT2023-10-16
5012021-01-01JEAN HARRIS2022-10-16
5012020-01-01JEAN HARRIS2021-10-15
5012019-01-01JEAN HARRIS2020-10-14
5012018-01-01JEAN HARRIS2019-10-14
5012018-01-01JEAN HARRIS2019-10-14
5012017-01-01
5012016-01-01
5012015-01-01
5012014-01-01
5012013-01-01GARY KITTS
5012012-01-01LYNN BLACK
5012011-01-01LYNN BLACK
5012010-01-01LYNN BLACK
5012009-01-01LYNN BLACK

Plan Statistics for SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN

401k plan membership statisitcs for SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN

Measure Date Value
2023: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-01556
Total number of active participants reported on line 7a of the Form 55002023-01-01556
Total of all active and inactive participants2023-01-01556
2022: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01647
Total number of active participants reported on line 7a of the Form 55002022-01-01556
Total of all active and inactive participants2022-01-01556
2021: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01678
Total number of active participants reported on line 7a of the Form 55002021-01-01647
Total of all active and inactive participants2021-01-01647
2020: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01839
Total number of active participants reported on line 7a of the Form 55002020-01-01678
Number of retired or separated participants receiving benefits2020-01-011
Total of all active and inactive participants2020-01-01679
2019: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01861
Total number of active participants reported on line 7a of the Form 55002019-01-01839
Number of retired or separated participants receiving benefits2019-01-012
Total of all active and inactive participants2019-01-01841
2018: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01517
Total number of active participants reported on line 7a of the Form 55002018-01-01861
Total of all active and inactive participants2018-01-01861
2017: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01483
Total number of active participants reported on line 7a of the Form 55002017-01-01517
Total of all active and inactive participants2017-01-01517
2016: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01530
Total number of active participants reported on line 7a of the Form 55002016-01-01483
Total of all active and inactive participants2016-01-01483
2015: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01567
Total number of active participants reported on line 7a of the Form 55002015-01-01530
Total of all active and inactive participants2015-01-01530
2014: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01533
Total number of active participants reported on line 7a of the Form 55002014-01-01567
Total of all active and inactive participants2014-01-01567
2013: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01552
Total number of active participants reported on line 7a of the Form 55002013-01-01527
Number of retired or separated participants receiving benefits2013-01-016
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01533
2012: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01551
Total number of active participants reported on line 7a of the Form 55002012-01-01547
Number of retired or separated participants receiving benefits2012-01-015
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01552
2011: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01513
Total number of active participants reported on line 7a of the Form 55002011-01-01549
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-012
Total of all active and inactive participants2011-01-01551
2010: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01449
Total number of active participants reported on line 7a of the Form 55002010-01-01505
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-018
Total of all active and inactive participants2010-01-01513
2009: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01525
Total number of active participants reported on line 7a of the Form 55002009-01-01441
Number of retired or separated participants receiving benefits2009-01-018
Total of all active and inactive participants2009-01-01449

Financial Data on SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN

Measure Date Value
2023 : SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2023 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-12-31$579,920
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-12-31$546,158
Total income from all sources (including contributions)2023-12-31$5,736,217
Total of all expenses incurred2023-12-31$5,736,217
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2023-12-31$5,423,175
Total contributions o plan (from employers,participants, others, non cash contrinutions)2023-12-31$5,736,217
Value of total assets at end of year2023-12-31$579,920
Value of total assets at beginning of year2023-12-31$546,158
Total of administrative expenses incurred including professional, contract, advisory and management fees2023-12-31$313,042
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2023-12-31No
Was this plan covered by a fidelity bond2023-12-31Yes
Value of fidelity bond cover2023-12-31$500,000
If this is an individual account plan, was there a blackout period2023-12-31No
Were there any nonexempt tranactions with any party-in-interest2023-12-31No
Contributions received from participants2023-12-31$2,025,803
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2023-12-31$1,282
Administrative expenses (other) incurred2023-12-31$313,042
Liabilities. Value of operating payables at end of year2023-12-31$138,050
Liabilities. Value of operating payables at beginning of year2023-12-31$139,000
Total non interest bearing cash at end of year2023-12-31$89,264
Total non interest bearing cash at beginning of year2023-12-31$90,889
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2023-12-31No
Value of net income/loss2023-12-31$0
Value of net assets at end of year (total assets less liabilities)2023-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2023-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2023-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2023-12-31No
Were any leases to which the plan was party in default or uncollectible2023-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2023-12-31$872,588
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2023-12-31No
Was there a failure to transmit to the plan any participant contributions2023-12-31No
Has the plan failed to provide any benefit when due under the plan2023-12-31No
Contributions received in cash from employer2023-12-31$3,710,414
Employer contributions (assets) at end of year2023-12-31$490,656
Employer contributions (assets) at beginning of year2023-12-31$453,987
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2023-12-31$4,550,587
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32023-12-31No
Liabilities. Value of benefit claims payable at end of year2023-12-31$441,870
Liabilities. Value of benefit claims payable at beginning of year2023-12-31$407,158
Did the plan have assets held for investment2023-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2023-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2023-12-31No
Opinion of an independent qualified public accountant for this plan2023-12-31Unqualified
Accountancy firm name2023-12-31MERSEREAU, LAZENBY & ROCKAS, LLC
Accountancy firm EIN2023-12-31582115374
2022 : SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2022 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$546,158
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$830,139
Total income from all sources (including contributions)2022-12-31$4,753,308
Total of all expenses incurred2022-12-31$4,753,308
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$4,421,808
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$4,753,308
Value of total assets at end of year2022-12-31$546,158
Value of total assets at beginning of year2022-12-31$830,139
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$331,500
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$3,000,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$2,045,409
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$1,282
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$3,573
Administrative expenses (other) incurred2022-12-31$331,500
Liabilities. Value of operating payables at end of year2022-12-31$139,000
Liabilities. Value of operating payables at beginning of year2022-12-31$139,000
Total non interest bearing cash at end of year2022-12-31$90,889
Total non interest bearing cash at beginning of year2022-12-31$98,096
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$0
Value of net assets at end of year (total assets less liabilities)2022-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$675,731
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$2,707,899
Employer contributions (assets) at end of year2022-12-31$453,987
Employer contributions (assets) at beginning of year2022-12-31$728,470
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$3,746,077
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32022-12-31No
Liabilities. Value of benefit claims payable at end of year2022-12-31$407,158
Liabilities. Value of benefit claims payable at beginning of year2022-12-31$691,139
Did the plan have assets held for investment2022-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31MERSEREAU, LAZENBY & ROCKAS, LLC
Accountancy firm EIN2022-12-31582115374
2021 : SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2021 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$830,139
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$924,288
Total income from all sources (including contributions)2021-12-31$6,084,667
Total of all expenses incurred2021-12-31$6,084,667
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$5,855,941
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$6,084,667
Value of total assets at end of year2021-12-31$830,139
Value of total assets at beginning of year2021-12-31$924,288
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$228,726
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$1,875,296
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$3,573
Administrative expenses (other) incurred2021-12-31$228,726
Liabilities. Value of operating payables at end of year2021-12-31$139,000
Liabilities. Value of operating payables at beginning of year2021-12-31$139,000
Total non interest bearing cash at end of year2021-12-31$98,096
Total non interest bearing cash at beginning of year2021-12-31$69,794
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$0
Value of net assets at end of year (total assets less liabilities)2021-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$695,190
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$4,209,371
Employer contributions (assets) at end of year2021-12-31$728,470
Employer contributions (assets) at beginning of year2021-12-31$854,494
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$5,160,751
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32021-12-31No
Liabilities. Value of benefit claims payable at end of year2021-12-31$691,139
Liabilities. Value of benefit claims payable at beginning of year2021-12-31$785,288
Did the plan have assets held for investment2021-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31MERSEREAU, LAZENBY & ROCKAS, LLC
Accountancy firm EIN2021-12-31582115374
2020 : SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2020 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$924,288
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$367,635
Total income from all sources (including contributions)2020-12-31$5,639,793
Total of all expenses incurred2020-12-31$5,639,793
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$5,187,010
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$5,639,793
Value of total assets at end of year2020-12-31$924,288
Value of total assets at beginning of year2020-12-31$367,635
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$452,783
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$2,039,747
Administrative expenses (other) incurred2020-12-31$452,783
Liabilities. Value of operating payables at end of year2020-12-31$139,000
Liabilities. Value of operating payables at beginning of year2020-12-31$139,000
Total non interest bearing cash at end of year2020-12-31$69,794
Total non interest bearing cash at beginning of year2020-12-31$116,388
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$0
Value of net assets at end of year (total assets less liabilities)2020-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$701,422
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$3,600,046
Employer contributions (assets) at end of year2020-12-31$854,494
Employer contributions (assets) at beginning of year2020-12-31$251,247
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$4,485,588
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-12-31No
Liabilities. Value of benefit claims payable at end of year2020-12-31$785,288
Liabilities. Value of benefit claims payable at beginning of year2020-12-31$228,635
Did the plan have assets held for investment2020-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31MERSEREAU, LAZENBY & ROCKAS LLC
Accountancy firm EIN2020-12-31582115374
2019 : SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$367,635
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$367,635
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$413,244
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$413,244
Total income from all sources (including contributions)2019-12-31$5,393,971
Total income from all sources (including contributions)2019-12-31$5,393,971
Total of all expenses incurred2019-12-31$5,393,971
Total of all expenses incurred2019-12-31$5,393,971
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$5,004,196
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$5,393,971
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$5,393,971
Value of total assets at end of year2019-12-31$367,635
Value of total assets at end of year2019-12-31$367,635
Value of total assets at beginning of year2019-12-31$413,244
Value of total assets at beginning of year2019-12-31$413,244
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$389,775
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$389,775
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31Yes
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
Value of fidelity bond cover2019-12-31$500,000
If this is an individual account plan, was there a blackout period2019-12-31No
If this is an individual account plan, was there a blackout period2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$2,024,331
Contributions received from participants2019-12-31$2,024,331
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$276,482
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$276,482
Administrative expenses (other) incurred2019-12-31$389,775
Administrative expenses (other) incurred2019-12-31$389,775
Liabilities. Value of operating payables at end of year2019-12-31$139,000
Liabilities. Value of operating payables at end of year2019-12-31$139,000
Liabilities. Value of operating payables at beginning of year2019-12-31$139,000
Liabilities. Value of operating payables at beginning of year2019-12-31$139,000
Total non interest bearing cash at end of year2019-12-31$116,388
Total non interest bearing cash at end of year2019-12-31$116,388
Total non interest bearing cash at beginning of year2019-12-31$136,762
Total non interest bearing cash at beginning of year2019-12-31$136,762
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$0
Value of net income/loss2019-12-31$0
Value of net assets at end of year (total assets less liabilities)2019-12-31$0
Value of net assets at end of year (total assets less liabilities)2019-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$703,228
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$703,228
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$3,369,640
Contributions received in cash from employer2019-12-31$3,369,640
Employer contributions (assets) at end of year2019-12-31$251,247
Employer contributions (assets) at end of year2019-12-31$251,247
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$4,300,968
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$4,300,968
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-12-31No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-12-31No
Liabilities. Value of benefit claims payable at end of year2019-12-31$228,635
Liabilities. Value of benefit claims payable at end of year2019-12-31$228,635
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$274,244
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$274,244
Did the plan have assets held for investment2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Accountancy firm name2019-12-31MERSEREAU, LAZENBY & ROCKAS LLC
Accountancy firm name2019-12-31MERSEREAU, LAZENBY & ROCKAS LLC
Accountancy firm EIN2019-12-31582115374
Accountancy firm EIN2019-12-31582115374
2018 : SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$413,244
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$620,748
Total income from all sources (including contributions)2018-12-31$5,675,370
Total of all expenses incurred2018-12-31$5,675,370
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$4,915,605
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$5,675,370
Value of total assets at end of year2018-12-31$413,244
Value of total assets at beginning of year2018-12-31$620,748
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$759,765
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$500,000
If this is an individual account plan, was there a blackout period2018-12-31No
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$1,873,941
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-12-31$276,482
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-12-31$443,128
Administrative expenses (other) incurred2018-12-31$759,765
Liabilities. Value of operating payables at end of year2018-12-31$139,000
Liabilities. Value of operating payables at beginning of year2018-12-31$139,000
Total non interest bearing cash at end of year2018-12-31$136,762
Total non interest bearing cash at beginning of year2018-12-31$69,350
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$0
Value of net assets at end of year (total assets less liabilities)2018-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$646,758
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$3,801,429
Employer contributions (assets) at beginning of year2018-12-31$108,270
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$4,268,847
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-12-31No
Liabilities. Value of benefit claims payable at end of year2018-12-31$274,244
Liabilities. Value of benefit claims payable at beginning of year2018-12-31$481,748
Did the plan have assets held for investment2018-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31No
Opinion of an independent qualified public accountant for this plan2018-12-31Unqualified
Accountancy firm name2018-12-31MERSEREAU, LAZENBY & ROCKAS LLC
Accountancy firm EIN2018-12-31582115374
2017 : SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2017 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$620,748
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$465,827
Total income from all sources (including contributions)2017-12-31$6,414,619
Total of all expenses incurred2017-12-31$6,414,619
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$5,946,171
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$6,414,619
Value of total assets at end of year2017-12-31$620,748
Value of total assets at beginning of year2017-12-31$465,827
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$468,448
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$500,000
If this is an individual account plan, was there a blackout period2017-12-31No
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$1,889,004
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-12-31$443,128
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-12-31$186,373
Administrative expenses (other) incurred2017-12-31$468,448
Liabilities. Value of operating payables at end of year2017-12-31$139,000
Liabilities. Value of operating payables at beginning of year2017-12-31$139,000
Total non interest bearing cash at end of year2017-12-31$69,350
Total non interest bearing cash at beginning of year2017-12-31$8,308
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$0
Value of net assets at end of year (total assets less liabilities)2017-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$653,414
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$4,525,615
Employer contributions (assets) at end of year2017-12-31$108,270
Employer contributions (assets) at beginning of year2017-12-31$271,146
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$5,292,757
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-12-31No
Liabilities. Value of benefit claims payable at end of year2017-12-31$481,748
Liabilities. Value of benefit claims payable at beginning of year2017-12-31$326,827
Did the plan have assets held for investment2017-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31No
Opinion of an independent qualified public accountant for this plan2017-12-31Unqualified
Accountancy firm name2017-12-31MERSEREAU, LAZENBY & ROCKAS
Accountancy firm EIN2017-12-31582115374
2016 : SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2016 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$465,827
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$1,055,887
Total income from all sources (including contributions)2016-12-31$6,326,650
Total of all expenses incurred2016-12-31$6,326,650
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$5,866,481
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$6,326,650
Value of total assets at end of year2016-12-31$465,827
Value of total assets at beginning of year2016-12-31$1,055,887
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$460,169
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$500,000
If this is an individual account plan, was there a blackout period2016-12-31No
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$1,804,540
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$186,373
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$537,565
Administrative expenses (other) incurred2016-12-31$460,169
Liabilities. Value of operating payables at end of year2016-12-31$139,000
Liabilities. Value of operating payables at beginning of year2016-12-31$139,000
Total non interest bearing cash at end of year2016-12-31$8,308
Total non interest bearing cash at beginning of year2016-12-31$34,279
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$0
Value of net assets at end of year (total assets less liabilities)2016-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$621,922
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$4,522,110
Employer contributions (assets) at end of year2016-12-31$271,146
Employer contributions (assets) at beginning of year2016-12-31$484,043
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$5,244,559
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-12-31No
Liabilities. Value of benefit claims payable at end of year2016-12-31$326,827
Liabilities. Value of benefit claims payable at beginning of year2016-12-31$916,887
Did the plan have assets held for investment2016-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31No
Opinion of an independent qualified public accountant for this plan2016-12-31Unqualified
Accountancy firm name2016-12-31MERSEREAU, LAZENBY & ROCKAS LLC
Accountancy firm EIN2016-12-31582115374
2015 : SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2015 401k financial data
Total transfer of assets from this plan2015-12-31$301,031
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$1,055,887
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$733,856
Total income from all sources (including contributions)2015-12-31$7,252,772
Total of all expenses incurred2015-12-31$6,951,741
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$6,582,977
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$7,252,772
Value of total assets at end of year2015-12-31$1,055,887
Value of total assets at beginning of year2015-12-31$733,856
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$368,764
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$500,000
If this is an individual account plan, was there a blackout period2015-12-31No
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$1,847,728
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-12-31$537,565
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-12-31$270,838
Administrative expenses (other) incurred2015-12-31$368,764
Liabilities. Value of operating payables at end of year2015-12-31$139,000
Liabilities. Value of operating payables at beginning of year2015-12-31$118,000
Total non interest bearing cash at end of year2015-12-31$34,279
Total non interest bearing cash at beginning of year2015-12-31$32,901
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$301,031
Value of net assets at end of year (total assets less liabilities)2015-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$703,024
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$5,405,044
Employer contributions (assets) at end of year2015-12-31$484,043
Employer contributions (assets) at beginning of year2015-12-31$430,117
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$5,879,953
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32015-12-31No
Liabilities. Value of benefit claims payable at end of year2015-12-31$916,887
Liabilities. Value of benefit claims payable at beginning of year2015-12-31$615,856
Did the plan have assets held for investment2015-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31No
Opinion of an independent qualified public accountant for this plan2015-12-31Unqualified
Accountancy firm name2015-12-31MERSEREAU, LAZENBY & ROCKAS LLC
Accountancy firm EIN2015-12-31582115374
2014 : SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2014 401k financial data
Total transfer of assets to this plan2014-12-31$3,161
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$463,018
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$436,179
Total income from all sources (including contributions)2014-12-31$6,216,293
Total of all expenses incurred2014-12-31$6,219,454
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$6,219,454
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$6,216,293
Value of total assets at end of year2014-12-31$463,018
Value of total assets at beginning of year2014-12-31$436,179
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$500,000
If this is an individual account plan, was there a blackout period2014-12-31No
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$1,463,911
Liabilities. Value of operating payables at end of year2014-12-31$118,000
Liabilities. Value of operating payables at beginning of year2014-12-31$88,000
Total non interest bearing cash at end of year2014-12-31$32,901
Total non interest bearing cash at beginning of year2014-12-31$21,227
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$-3,161
Value of net assets at end of year (total assets less liabilities)2014-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$4,752,382
Employer contributions (assets) at end of year2014-12-31$430,117
Employer contributions (assets) at beginning of year2014-12-31$414,952
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$6,219,454
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32014-12-31No
Liabilities. Value of benefit claims payable at end of year2014-12-31$345,018
Liabilities. Value of benefit claims payable at beginning of year2014-12-31$348,179
Did the plan have assets held for investment2014-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31No
Opinion of an independent qualified public accountant for this plan2014-12-31Unqualified
Accountancy firm name2014-12-31MERSEREAU, LAZENBY & ROCKAS LLC
Accountancy firm EIN2014-12-31582115374
2013 : SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2013 401k financial data
Unrealized appreciation/depreciation of real estate assets2013-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2013-12-31$0
Total unrealized appreciation/depreciation of assets2013-12-31$0
Total transfer of assets to this plan2013-12-31$0
Total transfer of assets from this plan2013-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$436,179
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$458,487
Expenses. Interest paid2013-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022013-12-31$0
Total income from all sources (including contributions)2013-12-31$5,392,842
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$5,392,842
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$5,392,842
Expenses. Certain deemed distributions of participant loans2013-12-31$0
Value of total corrective distributions2013-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$5,392,842
Value of total assets at end of year2013-12-31$436,179
Value of total assets at beginning of year2013-12-31$458,487
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$0
Total income from rents2013-12-31$0
Total interest from all sources2013-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2013-12-31$0
Assets. Real estate other than employer real property at end of year2013-12-31$0
Assets. Real estate other than employer real property at beginning of year2013-12-31$0
Administrative expenses professional fees incurred2013-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2013-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2013-12-31$0
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$1,020,432
Participant contributions at end of year2013-12-31$0
Participant contributions at beginning of year2013-12-31$0
Participant contributions at end of year2013-12-31$0
Participant contributions at beginning of year2013-12-31$0
Assets. Other investments not covered elsewhere at end of year2013-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2013-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2013-12-31$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2013-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-12-31$0
Assets. Loans (other than to participants) at end of year2013-12-31$0
Assets. Loans (other than to participants) at beginning of year2013-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-12-31$84,497
Other income not declared elsewhere2013-12-31$0
Administrative expenses (other) incurred2013-12-31$0
Liabilities. Value of operating payables at end of year2013-12-31$88,000
Liabilities. Value of operating payables at beginning of year2013-12-31$88,000
Total non interest bearing cash at end of year2013-12-31$21,227
Total non interest bearing cash at beginning of year2013-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Income. Non cash contributions2013-12-31$0
Value of net income/loss2013-12-31$0
Value of net assets at end of year (total assets less liabilities)2013-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Assets. partnership/joint venture interests at end of year2013-12-31$0
Assets. partnership/joint venture interests at beginning of year2013-12-31$0
Investment advisory and management fees2013-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$0
Value of interest in pooled separate accounts at end of year2013-12-31$0
Value of interest in pooled separate accounts at beginning of year2013-12-31$0
Interest on participant loans2013-12-31$0
Income. Interest from loans (other than to participants)2013-12-31$0
Interest earned on other investments2013-12-31$0
Income. Interest from US Government securities2013-12-31$0
Income. Interest from corporate debt instruments2013-12-31$0
Value of interest in master investment trust accounts at end of year2013-12-31$0
Value of interest in master investment trust accounts at beginning of year2013-12-31$0
Value of interest in common/collective trusts at end of year2013-12-31$0
Value of interest in common/collective trusts at beginning of year2013-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2013-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2013-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2013-12-31$0
Asset value of US Government securities at end of year2013-12-31$0
Asset value of US Government securities at beginning of year2013-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-12-31$0
Net investment gain/loss from pooled separate accounts2013-12-31$0
Net investment gain or loss from common/collective trusts2013-12-31$0
Net gain/loss from 103.12 investment entities2013-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Assets. Invements in employer securities at end of year2013-12-31$0
Assets. Invements in employer securities at beginning of year2013-12-31$0
Assets. Value of employer real property at end of year2013-12-31$0
Assets. Value of employer real property at beginning of year2013-12-31$0
Contributions received in cash from employer2013-12-31$4,372,410
Employer contributions (assets) at end of year2013-12-31$414,952
Employer contributions (assets) at beginning of year2013-12-31$458,487
Income. Dividends from preferred stock2013-12-31$0
Income. Dividends from common stock2013-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$5,392,842
Asset. Corporate debt instrument preferred debt at end of year2013-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2013-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2013-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2013-12-31$0
Contract administrator fees2013-12-31$0
Assets. Corporate common stocks other than exployer securities at end of year2013-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2013-12-31$0
Liabilities. Value of benefit claims payable at end of year2013-12-31$348,179
Liabilities. Value of benefit claims payable at beginning of year2013-12-31$285,990
Assets. Value of buildings and other operty used in plan operation at end of year2013-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2013-12-31$0
Did the plan have assets held for investment2013-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Aggregate proceeds on sale of assets2013-12-31$0
Aggregate carrying amount (costs) on sale of assets2013-12-31$0
Liabilities. Value of acquisition indebtedness at end of year2013-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2013-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31No
Opinion of an independent qualified public accountant for this plan2013-12-31Unqualified
Accountancy firm name2013-12-31DIXON HUGHES GOODMAN LLP
Accountancy firm EIN2013-12-31560747981
2012 : SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2012 401k financial data
Unrealized appreciation/depreciation of real estate assets2012-12-31$0
Total unrealized appreciation/depreciation of assets2012-12-31$0
Total transfer of assets to this plan2012-12-31$0
Total transfer of assets from this plan2012-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$458,487
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$272,572
Expenses. Interest paid2012-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022012-12-31$0
Total income from all sources (including contributions)2012-12-31$4,499,145
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$4,293,146
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$4,293,146
Expenses. Certain deemed distributions of participant loans2012-12-31$0
Value of total corrective distributions2012-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$4,499,145
Value of total assets at end of year2012-12-31$458,487
Value of total assets at beginning of year2012-12-31$66,573
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$0
Total income from rents2012-12-31$0
Total interest from all sources2012-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2012-12-31$0
Assets. Real estate other than employer real property at end of year2012-12-31$0
Assets. Real estate other than employer real property at beginning of year2012-12-31$0
Administrative expenses professional fees incurred2012-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2012-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2012-12-31$0
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$500,000
If this is an individual account plan, was there a blackout period2012-12-31No
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$1,058,433
Participant contributions at end of year2012-12-31$0
Participant contributions at beginning of year2012-12-31$0
Participant contributions at end of year2012-12-31$0
Participant contributions at beginning of year2012-12-31$0
Assets. Other investments not covered elsewhere at end of year2012-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2012-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2012-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-12-31$56,697
Assets. Loans (other than to participants) at end of year2012-12-31$0
Assets. Loans (other than to participants) at beginning of year2012-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-12-31$84,497
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-12-31$0
Other income not declared elsewhere2012-12-31$0
Administrative expenses (other) incurred2012-12-31$0
Liabilities. Value of operating payables at end of year2012-12-31$88,000
Liabilities. Value of operating payables at beginning of year2012-12-31$0
Total non interest bearing cash at end of year2012-12-31$0
Total non interest bearing cash at beginning of year2012-12-31$9,876
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Income. Non cash contributions2012-12-31$0
Value of net income/loss2012-12-31$205,999
Value of net assets at end of year (total assets less liabilities)2012-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$-205,999
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Assets. partnership/joint venture interests at end of year2012-12-31$0
Assets. partnership/joint venture interests at beginning of year2012-12-31$0
Investment advisory and management fees2012-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$0
Value of interest in pooled separate accounts at end of year2012-12-31$0
Value of interest in pooled separate accounts at beginning of year2012-12-31$0
Interest on participant loans2012-12-31$0
Income. Interest from loans (other than to participants)2012-12-31$0
Interest earned on other investments2012-12-31$0
Income. Interest from US Government securities2012-12-31$0
Income. Interest from corporate debt instruments2012-12-31$0
Value of interest in master investment trust accounts at end of year2012-12-31$0
Value of interest in master investment trust accounts at beginning of year2012-12-31$0
Value of interest in common/collective trusts at end of year2012-12-31$0
Value of interest in common/collective trusts at beginning of year2012-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2012-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2012-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2012-12-31$4,293,146
Asset value of US Government securities at end of year2012-12-31$0
Asset value of US Government securities at beginning of year2012-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-12-31$0
Net investment gain/loss from pooled separate accounts2012-12-31$0
Net investment gain or loss from common/collective trusts2012-12-31$0
Net gain/loss from 103.12 investment entities2012-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Assets. Invements in employer securities at end of year2012-12-31$0
Assets. Invements in employer securities at beginning of year2012-12-31$0
Assets. Value of employer real property at end of year2012-12-31$0
Assets. Value of employer real property at beginning of year2012-12-31$0
Contributions received in cash from employer2012-12-31$3,440,712
Employer contributions (assets) at end of year2012-12-31$458,487
Employer contributions (assets) at beginning of year2012-12-31$0
Income. Dividends from preferred stock2012-12-31$0
Income. Dividends from common stock2012-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$0
Asset. Corporate debt instrument preferred debt at end of year2012-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2012-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2012-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2012-12-31$0
Contract administrator fees2012-12-31$0
Assets. Corporate common stocks other than exployer securities at end of year2012-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2012-12-31$0
Liabilities. Value of benefit claims payable at end of year2012-12-31$285,990
Liabilities. Value of benefit claims payable at beginning of year2012-12-31$190,572
Assets. Value of buildings and other operty used in plan operation at end of year2012-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2012-12-31$0
Did the plan have assets held for investment2012-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Aggregate proceeds on sale of assets2012-12-31$0
Aggregate carrying amount (costs) on sale of assets2012-12-31$0
Liabilities. Value of acquisition indebtedness at end of year2012-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2012-12-31$82,000
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31No
Opinion of an independent qualified public accountant for this plan2012-12-31Unqualified
Accountancy firm name2012-12-31DIXON HUGHES GOODMAN LLP
Accountancy firm EIN2012-12-31560747981
2011 : SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$272,572
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$447,308
Total income from all sources (including contributions)2011-12-31$3,906,139
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$3,762,745
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$3,762,745
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$3,906,139
Value of total assets at end of year2011-12-31$66,573
Value of total assets at beginning of year2011-12-31$97,915
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$0
Total interest from all sources2011-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$0
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$1,000,000
If this is an individual account plan, was there a blackout period2011-12-31No
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$930,920
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-12-31$56,697
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-12-31$77,820
Total non interest bearing cash at end of year2011-12-31$9,876
Total non interest bearing cash at beginning of year2011-12-31$20,095
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$143,394
Value of net assets at end of year (total assets less liabilities)2011-12-31$-205,999
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$-349,393
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2011-12-31$3,762,745
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$2,975,219
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-12-31No
Liabilities. Value of benefit claims payable at end of year2011-12-31$190,572
Liabilities. Value of benefit claims payable at beginning of year2011-12-31$386,308
Did the plan have assets held for investment2011-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Liabilities. Value of acquisition indebtedness at end of year2011-12-31$82,000
Liabilities. Value of acquisition indebtedness at beginning of year2011-12-31$61,000
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31No
Opinion of an independent qualified public accountant for this plan2011-12-31Unqualified
Accountancy firm name2011-12-31DIXON HUGHES GOODMAN, LLP
Accountancy firm EIN2011-12-31560747981
2010 : SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets2010-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$447,308
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$576,643
Total income from all sources (including contributions)2010-12-31$2,926,346
Total loss/gain on sale of assets2010-12-31$0
Total of all expenses incurred2010-12-31$2,858,871
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$2,858,871
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$2,926,346
Value of total assets at end of year2010-12-31$97,915
Value of total assets at beginning of year2010-12-31$30,440
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$0
Total interest from all sources2010-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$0
Was this plan covered by a fidelity bond2010-12-31No
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$736,022
Value of other receiveables (less allowance for doubtful accounts) at end of year2010-12-31$77,820
Total non interest bearing cash at end of year2010-12-31$20,095
Total non interest bearing cash at beginning of year2010-12-31$30,440
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$67,475
Value of net assets at end of year (total assets less liabilities)2010-12-31$-349,393
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$-546,203
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2010-12-31$2,858,871
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$2,190,324
Liabilities. Value of benefit claims payable at end of year2010-12-31$386,308
Liabilities. Value of benefit claims payable at beginning of year2010-12-31$515,643
Did the plan have assets held for investment2010-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Liabilities. Value of acquisition indebtedness at end of year2010-12-31$61,000
Liabilities. Value of acquisition indebtedness at beginning of year2010-12-31$61,000
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31No
Opinion of an independent qualified public accountant for this plan2010-12-31Unqualified
Accountancy firm name2010-12-31DIXON HUGHES GOODMAN, LLP
Accountancy firm EIN2010-12-31560747981

Form 5500 Responses for SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN

2023: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan funding arrangement – General assets of the sponsorYes
2023-01-01Plan benefit arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – General assets of the sponsorYes
2022: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS 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: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS 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: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS 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: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS 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: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedYes
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: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS 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: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS 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: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS 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: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
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
2010: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: SOUTHERN MILL, INC. HEALTH AND DENTAL BENEFITS PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
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

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number10275114
Policy instance 6
Insurance contract or identification number10275114
Number of Individuals Covered177
Insurance policy start date2023-04-01
Insurance policy end date2024-03-31
Total amount of commissions paid to insurance brokerUSD $12,076
Total amount of fees paid to insurance companyUSD $4,026
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $80,507
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number10275115
Policy instance 5
Insurance contract or identification number10275115
Number of Individuals Covered276
Insurance policy start date2023-04-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $4,780
Total amount of fees paid to insurance companyUSD $1,593
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $31,867
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number711421
Policy instance 4
Insurance contract or identification number711421
Number of Individuals Covered594
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $559,887
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 number96797051003
Policy instance 3
Insurance contract or identification number96797051003
Number of Individuals Covered622
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,140
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010267730
Policy instance 2
Insurance contract or identification number000010267730
Number of Individuals Covered404
Insurance policy start date2023-04-01
Insurance policy end date2024-03-31
Total amount of commissions paid to insurance brokerUSD $8,291
Total amount of fees paid to insurance companyUSD $4,145
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D DEPENDENT LIFE LIFE
Welfare Benefit Premiums Paid to CarrierUSD $82,909
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number26886
Policy instance 1
Insurance contract or identification number26886
Number of Individuals Covered275
Insurance policy start date2023-04-01
Insurance policy end date2024-03-31
Total amount of commissions paid to insurance brokerUSD $16,496
Total amount of fees paid to insurance companyUSD $5,499
Other welfare benefits providedVOL CHILD/SPOUSE LIFE VOL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $109,973
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number26886
Policy instance 1
Insurance contract or identification number26886
Number of Individuals Covered306
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $17,910
Total amount of fees paid to insurance companyUSD $5,970
Other welfare benefits providedVOL CHILD/SPOUSE LIFE VOL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $119,401
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,910
Insurance broker organization code?3
Amount paid for insurance broker fees5970
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010267730
Policy instance 2
Insurance contract or identification number000010267730
Number of Individuals Covered439
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $7,509
Total amount of fees paid to insurance companyUSD $3,755
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $75,089
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,509
Insurance broker organization code?3
Amount paid for insurance broker fees3755
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number96797051003
Policy instance 3
Insurance contract or identification number96797051003
Number of Individuals Covered639
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,513
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number711421
Policy instance 4
Insurance contract or identification number711421
Number of Individuals Covered613
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $477,071
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number26886
Policy instance 1
Insurance contract or identification number26886
Number of Individuals Covered322
Insurance policy start date2021-09-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $3,931
Total amount of fees paid to insurance companyUSD $1,310
Other welfare benefits providedVOL CHILD/SPOUSE LIFE VOL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $26,209
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,931
Insurance broker organization code?3
Amount paid for insurance broker fees1310
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010267730
Policy instance 2
Insurance contract or identification number000010267730
Number of Individuals Covered1188
Insurance policy start date2021-09-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,871
Total amount of fees paid to insurance companyUSD $936
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $18,713
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,871
Insurance broker organization code?3
Amount paid for insurance broker fees936
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number96797051003
Policy instance 3
Insurance contract or identification number96797051003
Number of Individuals Covered665
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,521
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number711421
Policy instance 4
Insurance contract or identification number711421
Number of Individuals Covered647
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $503,062
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10186414
Policy instance 5
Insurance contract or identification number10186414
Number of Individuals Covered1214
Insurance policy start date2021-01-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $5,396
Total amount of fees paid to insurance companyUSD $2,698
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $53,957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,396
Insurance broker organization code?3
Amount paid for insurance broker fees2698
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number711421
Policy instance 4
Insurance contract or identification number711421
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $523,367
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 number96797051003
Policy instance 3
Insurance contract or identification number96797051003
Number of Individuals Covered684
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $32,780
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010186414
Policy instance 2
Insurance contract or identification number000010186414
Number of Individuals Covered779
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $6,274
Total amount of fees paid to insurance companyUSD $11,719
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $62,744
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees11719
Additional information about fees paid to insurance brokerBROKER BONUS AND CONSULTING
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $6,274
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number18022
Policy instance 1
Insurance contract or identification number18022
Number of Individuals Covered344
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $16,898
Total amount of fees paid to insurance companyUSD $22,527
Other welfare benefits providedVOL CHILD/SPOUSE LIFE VOL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $112,653
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees22527
Additional information about fees paid to insurance brokerBROKER BONUS AND CONSULTING
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $16,898
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9679705
Policy instance 3
Insurance contract or identification number9679705
Number of Individuals Covered746
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,757
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number711421
Policy instance 4
Insurance contract or identification number711421
Number of Individuals Covered522
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $494,640
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )
Policy contract number000010234743
Policy instance 5
Insurance contract or identification number000010234743
Number of Individuals Covered4
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedNY DISABILITY/NY FAMILY LEAVE
Welfare Benefit Premiums Paid to CarrierUSD $470
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010186414
Policy instance 2
Insurance contract or identification number000010186414
Number of Individuals Covered1469
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $5,739
Total amount of fees paid to insurance companyUSD $2,870
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $57,392
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,739
Insurance broker organization code?3
Amount paid for insurance broker fees2870
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number18022
Policy instance 1
Insurance contract or identification number18022
Number of Individuals Covered336
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $15,806
Total amount of fees paid to insurance companyUSD $5,269
Other welfare benefits providedVOL CHILD/SPOUSE LIFE VOL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $105,372
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,806
Insurance broker organization code?3
Amount paid for insurance broker fees5269
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number18022
Policy instance 1
Insurance contract or identification number18022
Number of Individuals Covered475
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $17,751
Total amount of fees paid to insurance companyUSD $2,419
Other welfare benefits providedVOL CHILD & SPOUSE LIFE VOL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $118,339
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,751
Insurance broker organization code?3
Amount paid for insurance broker fees2419
Additional information about fees paid to insurance brokerCONSULTING
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number711421
Policy instance 4
Insurance contract or identification number711421
Number of Individuals Covered715
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $436,360
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010186414
Policy instance 2
Insurance contract or identification number000010186414
Number of Individuals Covered1395
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $6,248
Total amount of fees paid to insurance companyUSD $1,190
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $62,477
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,248
Insurance broker organization code?3
Amount paid for insurance broker fees1190
Additional information about fees paid to insurance brokerCONSULTING
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9679705
Policy instance 3
Insurance contract or identification number9679705
Number of Individuals Covered739
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,582
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number711421
Policy instance 4
Insurance contract or identification number711421
Number of Individuals Covered908
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $440,480
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 number9679705
Policy instance 3
Insurance contract or identification number9679705
Number of Individuals Covered895
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $37,127
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameDANIEL H. PATTERSON
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010186414
Policy instance 2
Insurance contract or identification number000010186414
Number of Individuals Covered1326
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $6,041
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $60,414
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,041
Insurance broker nameDANIEL H. PATTERSON
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number18022
Policy instance 1
Insurance contract or identification number18022
Number of Individuals Covered440
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $18,457
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedVOL CHILD & SPOUSE LIFE VOL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $123,046
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,457
Insurance broker organization code?3
Insurance broker nameDANIEL H. PATTERSON
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number68771-5
Policy instance 4
Insurance contract or identification number68771-5
Number of Individuals Covered530
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $495,387
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 number9679705
Policy instance 3
Insurance contract or identification number9679705
Number of Individuals Covered1762
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $63,515
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameDANIEL H. PATTERSON
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010186414
Policy instance 2
Insurance contract or identification number000010186414
Number of Individuals Covered519
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $5,861
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $58,607
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,861
Insurance broker nameDANIEL H. PATTERSON
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number00040000100018
Policy instance 1
Insurance contract or identification number00040000100018
Number of Individuals Covered253
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $17,164
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedVOL CHILD & SPOUSE LIFE VOL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $114,428
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,164
Insurance broker organization code?3
Insurance broker nameDANIEL H. PATTERSON
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number4040000020SSLS
Policy instance 4
Insurance contract or identification number4040000020SSLS
Number of Individuals Covered543
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $371,628
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
Insurance broker nameGALLAGHER BFT SVC INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number000010186414
Policy instance 2
Insurance contract or identification number000010186414
Number of Individuals Covered1604
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $6,315
Total amount of fees paid to insurance companyUSD $2,533
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $63,154
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,315
Amount paid for insurance broker fees2533
Additional information about fees paid to insurance brokerADMINISTRATIVE & OTHER FEES
Insurance broker organization code?3
Insurance broker nameDANIEL H. PATTERSON
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract number00040000100018
Policy instance 1
Insurance contract or identification number00040000100018
Number of Individuals Covered269
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $17,396
Total amount of fees paid to insurance companyUSD $4,078
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedVOL CHILD & SPOUSE LIFE VOL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $115,972
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,396
Amount paid for insurance broker fees4078
Additional information about fees paid to insurance brokerADMINISTRATIVE & OTHER FEES
Insurance broker organization code?3
Insurance broker nameDANIEL H. PATTERSON
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9679705
Policy instance 3
Insurance contract or identification number9679705
Number of Individuals Covered1866
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $65,805
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL143495
Policy instance 1
Insurance contract or identification numberGL143495
Number of Individuals Covered438
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $35,972
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $239,813
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,972
Insurance broker organization code?3
Insurance broker namePATTERSON & JOHNSON
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL143494
Policy instance 2
Insurance contract or identification numberGL143494
Number of Individuals Covered527
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $17,884
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $179,642
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,884
Insurance broker organization code?3
Insurance broker namePATTERSON & JOHNSON
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL143494
Policy instance 1
Insurance contract or identification numberGL143494
Number of Individuals Covered1190
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $19,333
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $193,487
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,333
Insurance broker organization code?3
Insurance broker namePATTERSON & JOHNSON
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL143494
Policy instance 4
Insurance contract or identification numberGL143494
Number of Individuals Covered1180
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $17,240
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $172,397
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number711421
Policy instance 5
Insurance contract or identification number711421
Number of Individuals Covered504
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $305,414
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 numberXM570
Policy instance 1
Insurance contract or identification numberXM570
Number of Individuals Covered28
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $4,305
Total amount of fees paid to insurance companyUSD $322
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedCANCER
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $242,334
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 numberXK178
Policy instance 2
Insurance contract or identification numberXK178
Number of Individuals Covered255
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $47,282
Total amount of fees paid to insurance companyUSD $604
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedCANCER
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $226,032
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 number9679705
Policy instance 3
Insurance contract or identification number9679705
Number of Individuals Covered549
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $28,123
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 number9679705
Policy instance 4
Insurance contract or identification number9679705
Number of Individuals Covered491
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $27,137
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number711421
Policy instance 7
Insurance contract or identification number711421
Number of Individuals Covered505
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $188,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL143495
Policy instance 6
Insurance contract or identification numberGL143495
Number of Individuals Covered407
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $25,135
Total amount of fees paid to insurance companyUSD $407
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $167,567
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 numberXM570
Policy instance 1
Insurance contract or identification numberXM570
Number of Individuals Covered28
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $4,335
Total amount of fees paid to insurance companyUSD $70
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedCANCER
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $20,592
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL143494
Policy instance 5
Insurance contract or identification numberGL143494
Number of Individuals Covered1110
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $14,645
Total amount of fees paid to insurance companyUSD $245
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $146,907
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 numberXK178
Policy instance 2
Insurance contract or identification numberXK178
Number of Individuals Covered254
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $23,676
Total amount of fees paid to insurance companyUSD $2,267
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedCANCER
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $182,635
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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