401k Plan data: SIGNATURE HOMES LONG TERM DISABILITY PLAN plan

SIGNATURE HOMES LONG TERM DISABILITY PLAN 401k Plan overview

Plan Name	SIGNATURE HOMES LONG TERM DISABILITY PLAN
Plan identification number	503

SIGNATURE HOMES LONG TERM DISABILITY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Long-term disability cover

401k Sponsoring company profile

SB HOLDING COMPANY has sponsored the creation of one or more 401k plans.

Company Name: SB HOLDING COMPANY

Employer identification number (EIN): 631214233

NAIC Classification: 236110

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SIGNATURE HOMES LONG TERM DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2015-05-01
503 2014-05-01

Plan Statistics for SIGNATURE HOMES LONG TERM DISABILITY PLAN

401k plan membership statisitcs for SIGNATURE HOMES LONG TERM DISABILITY PLAN

Measure Date Value
2015: SIGNATURE HOMES LONG TERM DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year 2015-05-01 121
Total number of active participants reported on line 7a of the Form 5500 2015-05-01 128
Total of all active and inactive participants 2015-05-01 128
2014: SIGNATURE HOMES LONG TERM DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year 2014-05-01 109
Total number of active participants reported on line 7a of the Form 5500 2014-05-01 121
Total of all active and inactive participants 2014-05-01 121

Measure	Date	Value
2015: SIGNATURE HOMES LONG TERM DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year	2015-05-01	121
Total number of active participants reported on line 7a of the Form 5500	2015-05-01	128
Total of all active and inactive participants	2015-05-01	128
2014: SIGNATURE HOMES LONG TERM DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-05-01	109
Total number of active participants reported on line 7a of the Form 5500	2014-05-01	121
Total of all active and inactive participants	2014-05-01	121

Form 5500 Responses for SIGNATURE HOMES LONG TERM DISABILITY PLAN

2015: SIGNATURE HOMES LONG TERM DISABILITY PLAN 2015 form 5500 responses
2015-05-01	Type of plan entity	Single employer plan
2015-05-01	Plan funding arrangement – Insurance	Yes
2015-05-01	Plan benefit arrangement – Insurance	Yes
2014: SIGNATURE HOMES LONG TERM DISABILITY PLAN 2014 form 5500 responses
2014-05-01	Type of plan entity	Single employer plan
2014-05-01	First time form 5500 has been submitted	Yes
2014-05-01	Plan funding arrangement – Insurance	Yes
2014-05-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

GLTD0ALDX

Policy instance

Insurance contract or identification number	GLTD0ALDX
Number of Individuals Covered	128
Insurance policy start date	2015-05-01
Insurance policy end date	2016-04-30
Total amount of commissions paid to insurance broker	USD $3,721
Total amount of fees paid to insurance company	USD $1,456
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,721
Amount paid for insurance broker fees	1456
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	SS NESBITT & CO INC.

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

Policy contract number

GLTD0ALDX

Policy instance

Insurance contract or identification number	GLTD0ALDX
Number of Individuals Covered	121
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $3,435
Total amount of fees paid to insurance company	USD $985
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $22,902
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,435
Amount paid for insurance broker fees	985
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	SS NESBITT & CO INC.

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Company Name:	SB HOLDING COMPANY
Employer identification number (EIN):	631214233
NAIC Classification:	236110