401k Plan data: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN plan

SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN
Plan identification number	501

SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance

401k Sponsoring company profile

SOUTHWEST MISSISSIPPI MENTAL HEALTH MENTAL RETARDATION COMMISSION has sponsored the creation of one or more 401k plans.

Company Name: SOUTHWEST MISSISSIPPI MENTAL HEALTH MENTAL RETARDATION COMMISSION

Employer identification number (EIN): 640536181

NAIC Classification: 621112
NAIC Description: Offices of Physicians, Mental Health Specialists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2018-01-01
501 2017-01-01 WALLACE POPE 2018-10-01 WALLACE POPE 2018-10-01
501 2016-01-01 WALLACE POPE 2017-07-31 WALLACE POPE 2017-07-31
501 2015-01-01 WALLACE POPE WALLACE POPE 2016-07-27
501 2014-01-01 WALLACE POPE WALLACE POPE 2015-07-06
501 2013-01-01 WALLACE POPE WALLACE POPE 2014-07-15
501 2012-01-01 MICKEY LAMPTON MICKEY LAMPTON 2013-07-13
501 2011-01-01 MICKEY LAMPTON MICKEY LAMPTON 2012-07-13
501 2010-01-01 MICKEY LAMPTON MICKEY LAMPTON 2011-07-11
501 2009-01-01 DR. STEVE ELLIS DR. STEVE ELLIS 2010-07-21
501 2009-01-01 MICKEY LAMPTON MICKEY LAMPTON 2010-07-21
501 2009-01-01 DR. STEVE ELLIS DR. STEVE ELLIS 2010-07-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2018-01-01
501	2017-01-01	WALLACE POPE	2018-10-01	WALLACE POPE	2018-10-01
501	2016-01-01	WALLACE POPE	2017-07-31	WALLACE POPE	2017-07-31
501	2015-01-01	WALLACE POPE		WALLACE POPE	2016-07-27
501	2014-01-01	WALLACE POPE		WALLACE POPE	2015-07-06
501	2013-01-01	WALLACE POPE		WALLACE POPE	2014-07-15
501	2012-01-01	MICKEY LAMPTON		MICKEY LAMPTON	2013-07-13
501	2011-01-01	MICKEY LAMPTON		MICKEY LAMPTON	2012-07-13
501	2010-01-01	MICKEY LAMPTON		MICKEY LAMPTON	2011-07-11
501	2009-01-01	DR. STEVE ELLIS		DR. STEVE ELLIS	2010-07-21
501	2009-01-01	MICKEY LAMPTON		MICKEY LAMPTON	2010-07-21
501	2009-01-01	DR. STEVE ELLIS		DR. STEVE ELLIS	2010-07-14

Plan Statistics for SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN

Measure Date Value
2018: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 62
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
2017: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 85
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 62
Total of all active and inactive participants 2017-01-01 62
2016: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 80
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 85
Total of all active and inactive participants 2016-01-01 85
2015: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 92
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 80
Total of all active and inactive participants 2015-01-01 80
2014: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 84
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 92
Total of all active and inactive participants 2014-01-01 92
2013: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 72
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 84
Total of all active and inactive participants 2013-01-01 84
2012: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 91
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 72
Total of all active and inactive participants 2012-01-01 72
2011: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 87
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 91
Total of all active and inactive participants 2011-01-01 91
2010: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 85
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 87
Total of all active and inactive participants 2010-01-01 87
2009: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 82
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 85
Total of all active and inactive participants 2009-01-01 85

Measure	Date	Value
2018: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	62
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
2017: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	85
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	62
Total of all active and inactive participants	2017-01-01	62
2016: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	80
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	85
Total of all active and inactive participants	2016-01-01	85
2015: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	92
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	80
Total of all active and inactive participants	2015-01-01	80
2014: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	84
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	92
Total of all active and inactive participants	2014-01-01	92
2013: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	72
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	84
Total of all active and inactive participants	2013-01-01	84
2012: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	91
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	72
Total of all active and inactive participants	2012-01-01	72
2011: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	87
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	91
Total of all active and inactive participants	2011-01-01	91
2010: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	85
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	87
Total of all active and inactive participants	2010-01-01	87
2009: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	82
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	85
Total of all active and inactive participants	2009-01-01	85

Form 5500 Responses for SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN

2018: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	This submission is the final filing	Yes
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	This submission is the final filing	Yes
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 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: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT 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: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT 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: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT 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
2010: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: SOUTHWEST MISSISSIPPI MENTAL HEALTH EMPLOYEE BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 )

Policy contract number

AH27244-008

Policy instance

Insurance contract or identification number	AH27244-008
Number of Individuals Covered	62
Insurance policy start date	2017-01-01
Insurance policy end date	2017-11-30
Total amount of commissions paid to insurance broker	USD $545
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ORGAN & TISSUE TRANSPLANT POLICY
Welfare Benefit Premiums Paid to Carrier	USD $3,631
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $545
Insurance broker organization code?	3
Insurance broker name	FOX/EVERETT A DIVISION OF HUB INTER

HCC LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL32447

Policy instance

Insurance contract or identification number	HCL32447
Number of Individuals Covered	62
Insurance policy start date	2017-01-01
Insurance policy end date	2017-11-30
Total amount of commissions paid to insurance broker	USD $24,875
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $165,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,875
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	FOX/EVERETT A DIVISION OF HUB INTER

UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 )

Policy contract number

UNI-201777

Policy instance

Insurance contract or identification number	UNI-201777
Number of Individuals Covered	80
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,617
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $174,315
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,147
Insurance broker organization code?	3
Insurance broker name	FOX EVERETT, INC.

US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 )

Policy contract number

AH27244-008

Policy instance

Insurance contract or identification number	AH27244-008
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ORGAN AND TISSUE TRANSPLANT POLICY
Welfare Benefit Premiums Paid to Carrier	USD $6,022
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 name	FOX EVERETT, INC.

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00610095

Policy instance

Insurance contract or identification number	G00610095
Number of Individuals Covered	80
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
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 name	FOX EVERETT, INC.

US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 )

Policy contract number

US000234

Policy instance

Insurance contract or identification number	US000234
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $903
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $903
Insurance broker organization code?	3
Insurance broker name	FOX EVERETT, INC.

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL14837

Policy instance

Insurance contract or identification number	HCL14837
Insurance policy start date	2015-01-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
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 name	FOX EVERETT, INC.

US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 )

Policy contract number

AH27244-008

Policy instance

Insurance contract or identification number	AH27244-008
Number of Individuals Covered	84
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $710
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ORGAN AND TISSUE TRANSPLANT POLICY
Welfare Benefit Premiums Paid to Carrier	USD $4,730
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $710
Insurance broker organization code?	3
Insurance broker name	FOX EVERETT, INC.

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL14837

Policy instance

Insurance contract or identification number	HCL14837
Insurance policy start date	2014-01-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
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 name	FOX EVERETT, INC.

US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 )

Policy contract number

US000234

Policy instance

Insurance contract or identification number	US000234
Insurance policy start date	2014-01-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 name	FOX EVERETT, INC.

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00610095

Policy instance

Insurance contract or identification number	G00610095
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
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 name	FOX EVERETT, INC.

UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 )

Policy contract number

UNI-201777

Policy instance

Insurance contract or identification number	UNI-201777
Number of Individuals Covered	84
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $15,733
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $104,888
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,733
Insurance broker organization code?	3
Insurance broker name	FOX EVERETT, INC.

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL14837

Policy instance

Insurance contract or identification number	HCL14837
Insurance policy start date	2013-01-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
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 name	FOX EVERETT, INC.

US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 )

Policy contract number

US000234

Policy instance

Insurance contract or identification number	US000234
Number of Individuals Covered	72
Insurance policy start date	2013-01-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $10,090
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $67,268
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,090
Insurance broker organization code?	3
Insurance broker name	FOX EVERETT, INC.

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00610095

Policy instance

Insurance contract or identification number	G00610095
Number of Individuals Covered	84
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,959
Total amount of fees paid to insurance company	USD $1,480
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,959
Amount paid for insurance broker fees	1480
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	FOX EVERETT, INC.

US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 )

Policy contract number

AH27244-008

Policy instance

Insurance contract or identification number	AH27244-008
Number of Individuals Covered	72
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $908
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ORGAN AND TISSUE TRANSPLANT POLICY
Welfare Benefit Premiums Paid to Carrier	USD $6,053
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $908
Insurance broker organization code?	3
Insurance broker name	FOX EVERETT, INC.

UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 )

Policy contract number

UNI-201777

Policy instance

Insurance contract or identification number	UNI-201777
Number of Individuals Covered	72
Insurance policy start date	2013-09-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $6,462
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $43,077
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,462
Insurance broker organization code?	3
Insurance broker name	FOX EVERETT, INC.

US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 )

Policy contract number

US000234

Policy instance

Insurance contract or identification number	US000234
Number of Individuals Covered	72
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $19,441
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $129,606
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,441
Insurance broker organization code?	3
Insurance broker name	FOX EVERETT, INC.

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00610095

Policy instance

Insurance contract or identification number	G00610095
Number of Individuals Covered	74
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,897
Total amount of fees paid to insurance company	USD $1,449
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,897
Amount paid for insurance broker fees	1449
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	FOX EVERETT, INC.

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL14837

Policy instance

Insurance contract or identification number	HCL14837
Insurance policy start date	2012-01-01
Insurance policy end date	2012-08-31
Total amount of commissions paid to insurance broker	USD $702
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $702
Insurance broker organization code?	3
Insurance broker name	FOX EVERETT, INC.

US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 )

Policy contract number

AH27244-008

Policy instance

Insurance contract or identification number	AH27244-008
Number of Individuals Covered	72
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,001
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ORGAN AND TISSUE TRANSPLANT POLICY
Welfare Benefit Premiums Paid to Carrier	USD $1,001
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,001
Insurance broker organization code?	3
Insurance broker name	FOX EVERETT, INC.

US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 )

Policy contract number

US000234

Policy instance

Insurance contract or identification number	US000234
Number of Individuals Covered	104
Insurance policy start date	2011-09-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $7,493
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $49,950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

JY806

Policy instance

Insurance contract or identification number	JY806
Number of Individuals Covered	95
Insurance policy start date	2011-01-01
Insurance policy end date	2011-08-31
Total amount of commissions paid to insurance broker	USD $15,261
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $101,737
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )

Policy contract number

3756895

Policy instance

Insurance contract or identification number	3756895
Number of Individuals Covered	95
Insurance policy start date	2011-01-01
Insurance policy end date	2011-08-31
Total amount of commissions paid to insurance broker	USD $514
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ORGAN AND TISSUE TRANSPLANT
Welfare Benefit Premiums Paid to Carrier	USD $3,425
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL14837

Policy instance

Insurance contract or identification number	HCL14837
Number of Individuals Covered	101
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,172
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

JY806

Policy instance

Insurance contract or identification number	JY806
Number of Individuals Covered	87
Insurance policy start date	2010-09-01
Insurance policy end date	2010-12-01
Total amount of commissions paid to insurance broker	USD $7,444
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,627
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,444
Insurance broker organization code?	3
Insurance broker name

ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )

Policy contract number

3756895

Policy instance

Insurance contract or identification number	3756895
Number of Individuals Covered	87
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $760
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	ORGAN AND TISSUE TRANSPLANT
Welfare Benefit Premiums Paid to Carrier	USD $5,067
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $760
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	FOX EVERETT, INC.

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

CL20153

Policy instance

Insurance contract or identification number	CL20153
Number of Individuals Covered	87
Insurance policy start date	2010-01-01
Insurance policy end date	2010-08-31
Total amount of commissions paid to insurance broker	USD $14,740
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $98,264
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,740
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	FOX EVERETT, INC.

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL14837

Policy instance

Insurance contract or identification number	HCL14837
Number of Individuals Covered	87
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,193
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,193
Insurance broker organization code?	3
Insurance broker name	FOX-EVERETT, INC.

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Company Name:	SOUTHWEST MISSISSIPPI MENTAL HEALTH MENTAL RETARDATION COMMISSION
Employer identification number (EIN):	640536181
NAIC Classification:	621112
NAIC Description:	Offices of Physicians, Mental Health Specialists