401k Plan data: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN plan

MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 401k Plan overview

Plan Name	MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN
Plan identification number	001

MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.

401k Sponsoring company profile

MID-SOUTH BUSINESS FURNITURE has sponsored the creation of one or more 401k plans.

Company Name: MID-SOUTH BUSINESS FURNITURE

Employer identification number (EIN): 620978688

NAIC Classification: 442110
NAIC Description: Furniture Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2018-01-01 TED TRAMMELL TED TRAMMELL 2019-07-01
001 2017-01-01 TED TRAMMELL TED TRAMMELL 2018-07-04
001 2016-01-01 TED TRAMMELL
001 2015-01-01 TED TRAMMELL TED TRAMMELL 2016-07-31
001 2014-01-01 TED TRAMMELL TED TRAMMELL 2015-07-31
001 2013-01-01 TED J. TRAMMELL
001 2012-01-01 TED J. TRAMMELL
001 2011-01-01 TED J. TRAMMELL
001 2009-01-01 TED J. TRAMMELL

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2018-01-01	TED TRAMMELL	TED TRAMMELL	2019-07-01
001	2017-01-01	TED TRAMMELL	TED TRAMMELL	2018-07-04
001	2016-01-01	TED TRAMMELL
001	2015-01-01	TED TRAMMELL	TED TRAMMELL	2016-07-31
001	2014-01-01	TED TRAMMELL	TED TRAMMELL	2015-07-31
001	2013-01-01	TED J. TRAMMELL
001	2012-01-01	TED J. TRAMMELL
001	2011-01-01	TED J. TRAMMELL
001	2009-01-01	TED J. TRAMMELL

Plan Statistics for MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN

401k plan membership statisitcs for MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN

Measure Date Value
2018: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 0
Total of all active and inactive participants 2018-01-01 0
Total participants 2018-01-01 0
Number of participants with account balances 2018-01-01 0
2017: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 0
Total of all active and inactive participants 2017-01-01 0
Total participants 2017-01-01 0
Number of participants with account balances 2017-01-01 0
2016: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Total of all active and inactive participants 2016-01-01 0
Total participants 2016-01-01 0
Number of participants with account balances 2016-01-01 0
2015: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 0
Total of all active and inactive participants 2015-01-01 0
Total participants 2015-01-01 0
Number of participants with account balances 2015-01-01 0
2014: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 0
Total of all active and inactive participants 2014-01-01 0
Total participants 2014-01-01 0
Number of participants with account balances 2014-01-01 0
2013: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 0
Total of all active and inactive participants 2013-01-01 0
Total participants 2013-01-01 0
Number of participants with account balances 2013-01-01 0
2012: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 0
Total of all active and inactive participants 2012-01-01 0
Total participants 2012-01-01 0
Number of participants with account balances 2012-01-01 2
2011: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 0
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 0
Number of participants with account balances 2011-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 2
2009: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 16
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 16
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 16
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 16
Number of participants with account balances 2009-01-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2018: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	0
Total of all active and inactive participants	2018-01-01	0
Total participants	2018-01-01	0
Number of participants with account balances	2018-01-01	0
2017: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	0
Total of all active and inactive participants	2017-01-01	0
Total participants	2017-01-01	0
Number of participants with account balances	2017-01-01	0
2016: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Total of all active and inactive participants	2016-01-01	0
Total participants	2016-01-01	0
Number of participants with account balances	2016-01-01	0
2015: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	0
Total of all active and inactive participants	2015-01-01	0
Total participants	2015-01-01	0
Number of participants with account balances	2015-01-01	0
2014: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	0
Total of all active and inactive participants	2014-01-01	0
Total participants	2014-01-01	0
Number of participants with account balances	2014-01-01	0
2013: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	0
Total of all active and inactive participants	2013-01-01	0
Total participants	2013-01-01	0
Number of participants with account balances	2013-01-01	0
2012: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	0
Total of all active and inactive participants	2012-01-01	0
Total participants	2012-01-01	0
Number of participants with account balances	2012-01-01	2
2011: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	0
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	0
Number of participants with account balances	2011-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	2
2009: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	16
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	16
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	16
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	16
Number of participants with account balances	2009-01-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN

Measure	Date	Value
2018 : MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2018 401k financial data
Total income from all sources	2018-12-31	$-2,234
Expenses. Total of all expenses incurred	2018-12-31	$18,491
Benefits paid (including direct rollovers)	2018-12-31	$18,255
Total plan assets at end of year	2018-12-31	$0
Total plan assets at beginning of year	2018-12-31	$20,725
Other income received	2018-12-31	$-2,234
Net income (gross income less expenses)	2018-12-31	$-20,725
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$20,725
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$236
2017 : MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2017 401k financial data
Total income from all sources	2017-12-31	$3,146
Expenses. Total of all expenses incurred	2017-12-31	$214
Total plan assets at end of year	2017-12-31	$20,725
Total plan assets at beginning of year	2017-12-31	$17,793
Other income received	2017-12-31	$3,146
Net income (gross income less expenses)	2017-12-31	$2,932
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$20,725
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$17,793
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$214
2016 : MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2016 401k financial data
Total income from all sources	2016-12-31	$1,327
Expenses. Total of all expenses incurred	2016-12-31	$187
Total plan assets at end of year	2016-12-31	$17,793
Total plan assets at beginning of year	2016-12-31	$16,653
Other income received	2016-12-31	$1,327
Net income (gross income less expenses)	2016-12-31	$1,140
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$17,793
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$16,653
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$187
2015 : MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$0
Expenses. Total of all expenses incurred	2015-12-31	$534
Total plan assets at end of year	2015-12-31	$16,653
Total plan assets at beginning of year	2015-12-31	$17,187
Expenses. Other expenses not covered elsewhere	2015-12-31	$344
Net income (gross income less expenses)	2015-12-31	$-534
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$16,653
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$17,187
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$190
2014 : MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$743
Expenses. Total of all expenses incurred	2014-12-31	$183
Total plan assets at end of year	2014-12-31	$17,187
Total plan assets at beginning of year	2014-12-31	$16,627
Other income received	2014-12-31	$743
Net income (gross income less expenses)	2014-12-31	$560
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$17,187
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$16,627
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$183
2013 : MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$4,932
Expenses. Total of all expenses incurred	2013-12-31	$41,410
Benefits paid (including direct rollovers)	2013-12-31	$41,228
Total plan assets at end of year	2013-12-31	$16,627
Total plan assets at beginning of year	2013-12-31	$53,105
Other income received	2013-12-31	$4,932
Net income (gross income less expenses)	2013-12-31	$-36,478
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$16,627
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$53,105
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$182
2012 : MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$7,338
Expenses. Total of all expenses incurred	2012-12-31	$523
Total plan assets at end of year	2012-12-31	$53,105
Total plan assets at beginning of year	2012-12-31	$46,290
Other income received	2012-12-31	$7,338
Net income (gross income less expenses)	2012-12-31	$6,815
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$53,105
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$46,290
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$523
2011 : MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$-3,847
Expenses. Total of all expenses incurred	2011-12-31	$578
Benefits paid (including direct rollovers)	2011-12-31	$40
Total plan assets at end of year	2011-12-31	$46,290
Total plan assets at beginning of year	2011-12-31	$50,715
Total contributions received or receivable from participants	2011-12-31	$0
Other income received	2011-12-31	$-3,847
Net income (gross income less expenses)	2011-12-31	$-4,425
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$46,290
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$50,715
Total contributions received or receivable from employer(s)	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$538
2010 : MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$35,887
Expenses. Total of all expenses incurred	2010-12-31	$465,781
Benefits paid (including direct rollovers)	2010-12-31	$463,297
Total plan assets at end of year	2010-12-31	$50,715
Total plan assets at beginning of year	2010-12-31	$480,609
Total contributions received or receivable from participants	2010-12-31	$993
Other income received	2010-12-31	$34,894
Net income (gross income less expenses)	2010-12-31	$-429,894
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$50,715
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$480,609
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$2,484
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN

2018: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	Yes
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: MID SOUTH BUSINESS FURNITURE RETIREMENT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

648253

Policy instance

Insurance contract or identification number	648253
Number of Individuals Covered	0
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $236
Are there contracts with allocated funds for individual policies?	0
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

648253

Policy instance

Insurance contract or identification number	648253
Number of Individuals Covered	1
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $214
Are there contracts with allocated funds for individual policies?	0
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	PAUL H CULBRETH, CFP

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Company Name:	MID-SOUTH BUSINESS FURNITURE
Employer identification number (EIN):	620978688
NAIC Classification:	442110
NAIC Description:	Furniture Stores