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401k Plan overview

Plan NameSMITH MOUNTAIN INDUSTRIES, INC. WELFARE BENEFIT PLAN
Plan identification number 501

SMITH MOUNTAIN INDUSTRIES, INC. WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

SMITH MOUNTAIN INDUSTRIES, INC. has sponsored the creation of one or more 401k plans.

Company Name:SMITH MOUNTAIN INDUSTRIES, INC.
Employer identification number (EIN):010581784
NAIC Classification:423990
NAIC Description:Other Miscellaneous Durable Goods Merchant Wholesalers

Additional information about SMITH MOUNTAIN INDUSTRIES, INC.

Jurisdiction of Incorporation: State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number: 3484991

More information about SMITH MOUNTAIN INDUSTRIES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SMITH MOUNTAIN INDUSTRIES, INC. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012015-01-01
5012014-05-01

Plan Statistics for SMITH MOUNTAIN INDUSTRIES, INC. WELFARE BENEFIT PLAN

401k plan membership statisitcs for SMITH MOUNTAIN INDUSTRIES, INC. WELFARE BENEFIT PLAN

Measure Date Value
Total participants, beginning-of-year2015-01-01161
Total number of active participants reported on line 7a of the Form 55002015-01-01166
Number of retired or separated participants receiving benefits2015-01-016
Total of all active and inactive participants2015-01-01172
Total participants, beginning-of-year2014-05-01161
Total number of active participants reported on line 7a of the Form 55002014-05-01161
Number of retired or separated participants receiving benefits2014-05-012
Number of other retired or separated participants entitled to future benefits2014-05-010
Total of all active and inactive participants2014-05-01163

Form 5500 Responses

2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number21453000V
Policy instance 1
Number of Individuals Covered194
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $23,733
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 )
Policy contract numberA2Y65
Policy instance 2
Number of Individuals Covered279
Total amount of commissions paid to insurance brokerUSD $30,200
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $988,578
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 )
Policy contract number265881
Policy instance 3
Number of Individuals Covered148
Total amount of commissions paid to insurance brokerUSD $3,363
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $67,253
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Dental Insurance Welfare BenefitYes
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number21453000V
Policy instance 1
Number of Individuals Covered182
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $28,297
Insurance policy start date2014-05-01
Insurance policy end date2014-12-31
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 )
Policy contract numberA2Y65
Policy instance 2
Number of Individuals Covered162
Total amount of commissions paid to insurance brokerUSD $21,657
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $700,531
Insurance policy start date2014-05-01
Insurance policy end date2014-12-31
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 )
Policy contract numberA2Y65
Policy instance 1
Number of Individuals Covered158
Total amount of commissions paid to insurance brokerUSD $32,705
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $874,494
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Life Insurance Welfare BenefitNo
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number21453000V
Policy instance 2
Number of Individuals Covered199
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $41,536
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Life Insurance Welfare BenefitYes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00348671
Policy instance 1
Number of Individuals Covered197
Total amount of commissions paid to insurance brokerUSD $9,991
Total amount of fees paid to insurance companyUSD $5,979
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $105,359
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Life Insurance Welfare BenefitYes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
ANTHEM BLUE CROSS AND BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 71835 )
Policy contract numberA2Y65
Policy instance 2
Number of Individuals Covered252
Total amount of commissions paid to insurance brokerUSD $24,033
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $726,423
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Life Insurance Welfare BenefitNo
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo

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