Application To Self-Insure Workers' Compensation Liabilities - South Dakota Department Of Labor And Regulation Page 7

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6. EMPLOYEE AND PAYROLL DATA
(6.1) Total number of persons now employed in South Dakota.
(6.2) As of what date?
(6.3) Usual number of employees in South Dakota.
(6.4) Highest number of employees at one time in South Dakota during the last calendar year (2011).
(6.5) Total number of employees nationwide.
(6.6) As of what date?
(6.7) Actual payroll during each of the last three (3) calendar years. These figures must be from January 1 to December 31.
Please provide a best estimate of the total wages to be paid in 2014 and 2015.
Year
Payroll in South Dakota
Nationwide Payroll
2013
2014
2015
Projected 2016
Projected 2017
(6.8) Provide South Dakota payroll for the last (2) calendar years and projected for the current year and next year broken down
by class code. Please use class code numbers only.
Total South Dakota
Year
Class Code
Payroll by Code
Year
Class Code
Payroll by Code
2014
2015
Year
Class Code
Payroll by Code
Year
Class Code
Payroll by Code
Proj 2016
Proj 2017
Page 7 of 18

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