401k Plan data: THE MOUNTAIN CORPORATION MEDICAL PLAN plan

THE MOUNTAIN CORPORATION MEDICAL PLAN 401k Plan overview

Plan Name	THE MOUNTAIN CORPORATION MEDICAL PLAN
Plan identification number	502

THE MOUNTAIN CORPORATION MEDICAL PLAN Benefits

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

401k Sponsoring company profile

THE MOUNTAIN CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: THE MOUNTAIN CORPORATION

Employer identification number (EIN): 141672906

NAIC Classification: 315990
NAIC Description: Apparel Accessories and Other Apparel Manufacturing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE MOUNTAIN CORPORATION MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2013-03-01 AUDRIE OSGOOD
502 2012-03-01 AUDRIE OSGOOD
502 2011-03-01 AUDRIE OSGOOD
502 2010-03-01 AUDRIE OSGOOD

Plan id#	Filing Submission Date	Name of Administrator
502	2013-03-01	AUDRIE OSGOOD
502	2012-03-01	AUDRIE OSGOOD
502	2011-03-01	AUDRIE OSGOOD
502	2010-03-01	AUDRIE OSGOOD

Plan Statistics for THE MOUNTAIN CORPORATION MEDICAL PLAN

401k plan membership statisitcs for THE MOUNTAIN CORPORATION MEDICAL PLAN

Measure Date Value
2013: THE MOUNTAIN CORPORATION MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year 2013-03-01 161
Total number of active participants reported on line 7a of the Form 5500 2013-03-01 0
Number of retired or separated participants receiving benefits 2013-03-01 0
Number of other retired or separated participants entitled to future benefits 2013-03-01 0
Total of all active and inactive participants 2013-03-01 0
2012: THE MOUNTAIN CORPORATION MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-03-01 160
Total number of active participants reported on line 7a of the Form 5500 2012-03-01 161
Number of retired or separated participants receiving benefits 2012-03-01 0
Number of other retired or separated participants entitled to future benefits 2012-03-01 0
Total of all active and inactive participants 2012-03-01 161
2011: THE MOUNTAIN CORPORATION MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year 2011-03-01 110
Total number of active participants reported on line 7a of the Form 5500 2011-03-01 159
Number of retired or separated participants receiving benefits 2011-03-01 1
Number of other retired or separated participants entitled to future benefits 2011-03-01 0
Total of all active and inactive participants 2011-03-01 160
2010: THE MOUNTAIN CORPORATION MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year 2010-03-01 110
Total number of active participants reported on line 7a of the Form 5500 2010-03-01 110
Number of retired or separated participants receiving benefits 2010-03-01 0
Number of other retired or separated participants entitled to future benefits 2010-03-01 0
Total of all active and inactive participants 2010-03-01 110

Measure	Date	Value
2013: THE MOUNTAIN CORPORATION MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year	2013-03-01	161
Total number of active participants reported on line 7a of the Form 5500	2013-03-01	0
Number of retired or separated participants receiving benefits	2013-03-01	0
Number of other retired or separated participants entitled to future benefits	2013-03-01	0
Total of all active and inactive participants	2013-03-01	0
2012: THE MOUNTAIN CORPORATION MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-03-01	160
Total number of active participants reported on line 7a of the Form 5500	2012-03-01	161
Number of retired or separated participants receiving benefits	2012-03-01	0
Number of other retired or separated participants entitled to future benefits	2012-03-01	0
Total of all active and inactive participants	2012-03-01	161
2011: THE MOUNTAIN CORPORATION MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year	2011-03-01	110
Total number of active participants reported on line 7a of the Form 5500	2011-03-01	159
Number of retired or separated participants receiving benefits	2011-03-01	1
Number of other retired or separated participants entitled to future benefits	2011-03-01	0
Total of all active and inactive participants	2011-03-01	160
2010: THE MOUNTAIN CORPORATION MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year	2010-03-01	110
Total number of active participants reported on line 7a of the Form 5500	2010-03-01	110
Number of retired or separated participants receiving benefits	2010-03-01	0
Number of other retired or separated participants entitled to future benefits	2010-03-01	0
Total of all active and inactive participants	2010-03-01	110

Form 5500 Responses for THE MOUNTAIN CORPORATION MEDICAL PLAN

2013: THE MOUNTAIN CORPORATION MEDICAL PLAN 2013 form 5500 responses
2013-03-01	Type of plan entity	Single employer plan
2013-03-01	Submission has been amended	No
2013-03-01	This submission is the final filing	Yes
2013-03-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2013-03-01	Plan is a collectively bargained plan	No
2013-03-01	Plan funding arrangement – Insurance	Yes
2013-03-01	Plan benefit arrangement – Insurance	Yes
2012: THE MOUNTAIN CORPORATION MEDICAL PLAN 2012 form 5500 responses
2012-03-01	Type of plan entity	Single employer plan
2012-03-01	Submission has been amended	No
2012-03-01	This submission is the final filing	No
2012-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-03-01	Plan is a collectively bargained plan	No
2012-03-01	Plan funding arrangement – Insurance	Yes
2012-03-01	Plan benefit arrangement – Insurance	Yes
2011: THE MOUNTAIN CORPORATION MEDICAL PLAN 2011 form 5500 responses
2011-03-01	Type of plan entity	Single employer plan
2011-03-01	Submission has been amended	No
2011-03-01	This submission is the final filing	No
2011-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-03-01	Plan is a collectively bargained plan	No
2011-03-01	Plan funding arrangement – Insurance	Yes
2011-03-01	Plan benefit arrangement – Insurance	Yes
2010: THE MOUNTAIN CORPORATION MEDICAL PLAN 2010 form 5500 responses
2010-03-01	Type of plan entity	Single employer plan
2010-03-01	First time form 5500 has been submitted	Yes
2010-03-01	Submission has been amended	Yes
2010-03-01	This submission is the final filing	No
2010-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-03-01	Plan is a collectively bargained plan	No
2010-03-01	Plan funding arrangement – Insurance	Yes
2010-03-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MATTHEW THORNTON HEALTH PLAN INC. (National Association of Insurance Commissioners NAIC id number: 95527 )

Policy contract number

358240

Policy instance

Insurance contract or identification number	358240
Number of Individuals Covered	228
Insurance policy start date	2013-03-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $46,352
Total amount of fees paid to insurance company	USD $8,736
Are there contracts with allocated funds for individual policies?	No
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	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $624,323
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $46,352
Amount paid for insurance broker fees	8736
Additional information about fees paid to insurance broker	BONUS, OVERRIDE AND NON MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	CRONIN GERVINO & WARLICK INC

MATTHEW THORNTON HEALTH PLAN INC. (National Association of Insurance Commissioners NAIC id number: 95527 )

Policy contract number

358240

Policy instance

Insurance contract or identification number	358240
Number of Individuals Covered	197
Insurance policy start date	2012-03-01
Insurance policy end date	2013-02-28
Total amount of commissions paid to insurance broker	USD $50,425
Total amount of fees paid to insurance company	USD $16,004
Are there contracts with allocated funds for individual policies?	No
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	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $652,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $50,425
Amount paid for insurance broker fees	16004
Additional information about fees paid to insurance broker	BONUS, OVERRIDE AND NON MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	CRONIN GERVINO & WARLICK INC

MATTHEW THORNTON HEALTH PLAN INC. (National Association of Insurance Commissioners NAIC id number: 95527 )

Policy contract number

358240

Policy instance

Insurance contract or identification number	358240
Number of Individuals Covered	186
Insurance policy start date	2011-03-01
Insurance policy end date	2012-02-29
Total amount of commissions paid to insurance broker	USD $20,365
Total amount of fees paid to insurance company	USD $2,939
Are there contracts with allocated funds for individual policies?	No
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	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $450,183
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,365
Amount paid for insurance broker fees	2939
Additional information about fees paid to insurance broker	BONUS, OVERRIDE AND NON MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	CRONIN GERVINO & WARLICK INC

MATTHEW THORNTON HEALTH PLAN INC. (National Association of Insurance Commissioners NAIC id number: 95527 )

Policy contract number

358240

Policy instance

Insurance contract or identification number	358240
Number of Individuals Covered	130
Insurance policy start date	2010-03-01
Insurance policy end date	2011-02-28
Total amount of commissions paid to insurance broker	USD $18,682
Total amount of fees paid to insurance company	USD $8,426
Are there contracts with allocated funds for individual policies?	No
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	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $429,211
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,558
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	CRONIN GERVINO & WARLICK INC

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Company Name:	THE MOUNTAIN CORPORATION
Employer identification number (EIN):	141672906
NAIC Classification:	315990
NAIC Description:	Apparel Accessories and Other Apparel Manufacturing