401k Plan data: SOUTHERN DOMINION HEALTH HEALTH SYSTEMS INC plan

SOUTHERN DOMINION HEALTH HEALTH SYSTEMS INC 401k Plan overview

Plan Name	SOUTHERN DOMINION HEALTH HEALTH SYSTEMS INC
Plan identification number	002

SOUTHERN DOMINION HEALTH HEALTH SYSTEMS INC 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.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

SOUTHERN DOMINION HEALTH SYSTEM, INC. has sponsored the creation of one or more 401k plans.

Company Name: SOUTHERN DOMINION HEALTH SYSTEM, INC.

Employer identification number (EIN): 541282624

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SOUTHERN DOMINION HEALTH HEALTH SYSTEMS INC

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2022-01-01
002 2021-01-01
002 2021-01-01
002 2020-01-01
002 2020-01-01
002 2019-01-01 JILL SEAMANS 2020-07-15
002 2018-01-01 JILL SEAMANS 2019-07-01
002 2017-01-01 JILL SEAMANS 2018-10-11
002 2017-01-01 JILL SEAMANS 2019-05-30
002 2016-01-01 JILL SEAMANS 2017-07-20
002 2015-01-01 JILL SEAMANS 2016-08-04
002 2014-01-01 JILL SEAMANS 2015-07-08
002 2013-01-01 JILL SEAMANS 2014-07-18
002 2012-01-01 JILL SEAMANS 2013-07-23 JOSEPH A SABATINI II 2013-07-23
002 2011-01-01 JILL SEAMANS
002 2010-01-01 JILL SEAMANS 2011-06-17

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2022-01-01
002	2021-01-01
002	2021-01-01
002	2020-01-01
002	2020-01-01
002	2019-01-01	JILL SEAMANS	2020-07-15
002	2018-01-01	JILL SEAMANS	2019-07-01
002	2017-01-01	JILL SEAMANS	2018-10-11
002	2017-01-01	JILL SEAMANS	2019-05-30
002	2016-01-01	JILL SEAMANS	2017-07-20
002	2015-01-01	JILL SEAMANS	2016-08-04
002	2014-01-01	JILL SEAMANS	2015-07-08
002	2013-01-01	JILL SEAMANS	2014-07-18
002	2012-01-01	JILL SEAMANS	2013-07-23	JOSEPH A SABATINI II	2013-07-23
002	2011-01-01	JILL SEAMANS
002	2010-01-01	JILL SEAMANS	2011-06-17

Plan Statistics for SOUTHERN DOMINION HEALTH HEALTH SYSTEMS INC

401k plan membership statisitcs for SOUTHERN DOMINION HEALTH HEALTH SYSTEMS INC

Measure Date Value
2022: SOUTHERN DOMINION HEALTH HEALTH SYSTEMS INC 2022 401k membership
Total participants, beginning-of-year 2022-01-01 136
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 79
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 15
Total of all active and inactive participants 2022-01-01 94
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 94
Number of participants with account balances 2022-01-01 86
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: SOUTHERN DOMINION HEALTH HEALTH SYSTEMS INC 2021 401k membership
Total participants, beginning-of-year 2021-01-01 132
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 78
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 58
Total of all active and inactive participants 2021-01-01 136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 136
Number of participants with account balances 2021-01-01 127
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 10
2020: SOUTHERN DOMINION HEALTH HEALTH SYSTEMS INC 2020 401k membership
Total participants, beginning-of-year 2020-01-01 144
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 76
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 69
Total of all active and inactive participants 2020-01-01 145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 145
Number of participants with account balances 2020-01-01 132
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 10
2011: SOUTHERN DOMINION HEALTH HEALTH SYSTEMS INC 2011 401k membership
Total participants, beginning-of-year 2011-01-01 74
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 90
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 90
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 90
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0

Measure	Date	Value
2022: SOUTHERN DOMINION HEALTH HEALTH SYSTEMS INC 2022 401k membership
Total participants, beginning-of-year	2022-01-01	136
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	79
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	15
Total of all active and inactive participants	2022-01-01	94
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	94
Number of participants with account balances	2022-01-01	86
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: SOUTHERN DOMINION HEALTH HEALTH SYSTEMS INC 2021 401k membership
Total participants, beginning-of-year	2021-01-01	132
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	78
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	58
Total of all active and inactive participants	2021-01-01	136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	136
Number of participants with account balances	2021-01-01	127
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	10
2020: SOUTHERN DOMINION HEALTH HEALTH SYSTEMS INC 2020 401k membership
Total participants, beginning-of-year	2020-01-01	144
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	76
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	69
Total of all active and inactive participants	2020-01-01	145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	145
Number of participants with account balances	2020-01-01	132
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	10
2011: SOUTHERN DOMINION HEALTH HEALTH SYSTEMS INC 2011 401k membership
Total participants, beginning-of-year	2011-01-01	74
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	90
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	90
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	90
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0

Financial Data on SOUTHERN DOMINION HEALTH HEALTH SYSTEMS INC

Measure	Date	Value
2022 : SOUTHERN DOMINION HEALTH HEALTH SYSTEMS INC 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-259,799
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$543,479
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$536,818
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$604,201
Value of total assets at end of year	2022-12-31	$3,764,440
Value of total assets at beginning of year	2022-12-31	$4,567,718
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$6,661
Total interest from all sources	2022-12-31	$2,719
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$350,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$311,344
Participant contributions at end of year	2022-12-31	$12,107
Participant contributions at beginning of year	2022-12-31	$11,738
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$130,477
Other income not declared elsewhere	2022-12-31	$697
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-803,278
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$3,764,440
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$4,567,718
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$2,306,552
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$2,570,668
Value of interest in pooled separate accounts at end of year	2022-12-31	$1,033,999
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$1,697,517
Interest on participant loans	2022-12-31	$2,719
Value of interest in master investment trust accounts at end of year	2022-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2022-12-31	$0
Value of interest in common/collective trusts at end of year	2022-12-31	$0
Value of interest in common/collective trusts at beginning of year	2022-12-31	$0
Assets. Value of investments in 103.12 investment entities at end of year	2022-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2022-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$411,782
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$287,795
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-594,101
Net investment gain/loss from pooled separate accounts	2022-12-31	$-273,315
Net investment gain or loss from common/collective trusts	2022-12-31	$0
Net gain/loss from 103.12 investment entities	2022-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$162,380
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$536,818
Contract administrator fees	2022-12-31	$6,661
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Disclaimer
Accountancy firm name	2022-12-31	ROBINSON, FAMRMER, COX, ASSC
Accountancy firm EIN	2022-12-31	541896113
2021 : SOUTHERN DOMINION HEALTH HEALTH SYSTEMS INC 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$965,694
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$279,476
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$272,880
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$518,652
Value of total assets at end of year	2021-12-31	$4,567,718
Value of total assets at beginning of year	2021-12-31	$3,881,500
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$6,596
Total interest from all sources	2021-12-31	$2,351
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$240,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$312,777
Participant contributions at end of year	2021-12-31	$11,738
Participant contributions at beginning of year	2021-12-31	$11,396
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$52,751
Other income not declared elsewhere	2021-12-31	$434
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$686,218
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$4,567,718
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$3,881,500
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$4,268,185
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$2,021,374
Value of interest in pooled separate accounts at end of year	2021-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$1,563,945
Interest on participant loans	2021-12-31	$2,351
Value of interest in common/collective trusts at end of year	2021-12-31	$0
Value of interest in common/collective trusts at beginning of year	2021-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$287,795
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$284,785
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$444,257
Net investment gain/loss from pooled separate accounts	2021-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$153,124
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$272,880
Contract administrator fees	2021-12-31	$6,596
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Disclaimer
Accountancy firm name	2021-12-31	ROBINSON, FAMRMER, COX, ASSC
Accountancy firm EIN	2021-12-31	541896113
2020 : SOUTHERN DOMINION HEALTH HEALTH SYSTEMS INC 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$1,055,336
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$469,011
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$464,423
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$484,711
Value of total assets at end of year	2020-12-31	$3,881,500
Value of total assets at beginning of year	2020-12-31	$3,295,175
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$4,588
Total interest from all sources	2020-12-31	$2,009
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$240,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$294,401
Participant contributions at end of year	2020-12-31	$11,396
Participant contributions at beginning of year	2020-12-31	$11,166
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$46,808
Other income not declared elsewhere	2020-12-31	$430
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$586,325
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$3,881,500
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$3,295,175
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$2,021,374
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$1,298,326
Value of interest in pooled separate accounts at end of year	2020-12-31	$1,563,945
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$1,592,443
Interest on participant loans	2020-12-31	$2,009
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$284,785
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$393,240
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$382,420
Net investment gain/loss from pooled separate accounts	2020-12-31	$185,766
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$143,502
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$464,423
Contract administrator fees	2020-12-31	$4,588
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	ROBINSON, FAMRMER, COX, ASSC
Accountancy firm EIN	2020-12-31	541896113

Form 5500 Responses for SOUTHERN DOMINION HEALTH HEALTH SYSTEMS INC

2022: SOUTHERN DOMINION HEALTH HEALTH SYSTEMS INC 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	Yes
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: SOUTHERN DOMINION HEALTH HEALTH SYSTEMS INC 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: SOUTHERN DOMINION HEALTH HEALTH SYSTEMS INC 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	Yes
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2011: SOUTHERN DOMINION HEALTH HEALTH SYSTEMS INC 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	First time form 5500 has been submitted	Yes
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

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

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	79
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $298
Total amount of fees paid to insurance company	USD $31
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?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $298
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER
Insurance broker organization code?	3

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

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	99
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $224
Total amount of fees paid to insurance company	USD $23
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?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $224
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER
Insurance broker organization code?	3

C.M. LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93432 )

Policy contract number

ART0127621EE

Policy instance

Insurance contract or identification number	ART0127621EE
Number of Individuals Covered	55
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
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?	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	92
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $177
Total amount of fees paid to insurance company	USD $18
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?	Yes
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?	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Other information about contract	CUSTODIAL GUARANTEED INTEREST CONTRACT
Commission paid to Insurance Broker	USD $177
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER
Insurance broker organization code?	3

C.M. LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93432 )

Policy contract number

ART0127621EE

Policy instance

Insurance contract or identification number	ART0127621EE
Number of Individuals Covered	60
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Are there contracts with allocated funds for individual policies?	1
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?	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

C.M. LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93432 )

Policy contract number

ART0127615EE

Policy instance

Insurance contract or identification number	ART0127615EE
Number of Individuals Covered	90
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $14,224
Total amount of fees paid to insurance company	USD $634
Are there contracts with allocated funds for individual policies?	Yes

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Company Name:	SOUTHERN DOMINION HEALTH SYSTEM, INC.
Employer identification number (EIN):	541282624
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)