401k Plan data: SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE plan

SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE 401k Plan overview

Plan Name	SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE
Plan identification number	504

SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

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

Company Name: SOUTHERN IMPERIAL, INC.

Employer identification number (EIN): 640407668

NAIC Classification: 332610

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2016-01-01 TIMOTHY SELLKE TIMOTHY SELLKE 2017-10-16
504 2015-01-01 NIKKI SCHIRO NIKKI SCHIRO 2016-10-17
504 2014-01-01 CHRISTINE DOYLE
504 2013-01-01 DALE S. THOMAS
504 2012-01-01 DALE S. THOMAS
504 2011-01-01 DALE S. THOMAS
504 2009-01-01 DALE S. THOMAS
504 2009-01-01 DALE S. THOMAS

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
504	2016-01-01	TIMOTHY SELLKE	TIMOTHY SELLKE	2017-10-16
504	2015-01-01	NIKKI SCHIRO	NIKKI SCHIRO	2016-10-17
504	2014-01-01	CHRISTINE DOYLE
504	2013-01-01	DALE S. THOMAS
504	2012-01-01	DALE S. THOMAS
504	2011-01-01	DALE S. THOMAS
504	2009-01-01	DALE S. THOMAS
504	2009-01-01	DALE S. THOMAS

Plan Statistics for SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE

401k plan membership statisitcs for SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE

Measure Date Value
2016: SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE 2016 401k membership
Total participants, beginning-of-year 2016-01-01 247
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 240
Total of all active and inactive participants 2016-01-01 240
Total participants 2016-01-01 240
2015: SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE 2015 401k membership
Total participants, beginning-of-year 2015-01-01 294
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 247
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 247
Total participants 2015-01-01 247
2014: SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE 2014 401k membership
Total participants, beginning-of-year 2014-01-01 279
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 294
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 294
2013: SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE 2013 401k membership
Total participants, beginning-of-year 2013-01-01 268
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 279
Total of all active and inactive participants 2013-01-01 279
2012: SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE 2012 401k membership
Total participants, beginning-of-year 2012-01-01 189
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 268
Total of all active and inactive participants 2012-01-01 268
2011: SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE 2011 401k membership
Total participants, beginning-of-year 2011-01-01 181
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 189
Total of all active and inactive participants 2011-01-01 189
2009: SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE 2009 401k membership
Total participants, beginning-of-year 2009-01-01 173
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 172
Total of all active and inactive participants 2009-01-01 172

Measure	Date	Value
2016: SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE 2016 401k membership
Total participants, beginning-of-year	2016-01-01	247
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	240
Total of all active and inactive participants	2016-01-01	240
Total participants	2016-01-01	240
2015: SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE 2015 401k membership
Total participants, beginning-of-year	2015-01-01	294
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	247
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	247
Total participants	2015-01-01	247
2014: SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE 2014 401k membership
Total participants, beginning-of-year	2014-01-01	279
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	294
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	294
2013: SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE 2013 401k membership
Total participants, beginning-of-year	2013-01-01	268
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	279
Total of all active and inactive participants	2013-01-01	279
2012: SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE 2012 401k membership
Total participants, beginning-of-year	2012-01-01	189
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	268
Total of all active and inactive participants	2012-01-01	268
2011: SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE 2011 401k membership
Total participants, beginning-of-year	2011-01-01	181
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	189
Total of all active and inactive participants	2011-01-01	189
2009: SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE 2009 401k membership
Total participants, beginning-of-year	2009-01-01	173
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	172
Total of all active and inactive participants	2009-01-01	172

Form 5500 Responses for SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE

2016: SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE 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: SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE 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: SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE 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: SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE 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: SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE 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: SOUTHERN IMPERIAL INC ACCIDENTAL DEATH AND DISMEMBERMENT GROUP TERM LIFE 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Potentially related plans

SOUTHERN IMPERIAL LLC MEDICAL PLAN [EIN = 821889187]

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Company Name:	SOUTHERN IMPERIAL, INC.
Employer identification number (EIN):	640407668
NAIC Classification:	332610