401k Plan data: K-M MACHINE COMPANY, INC. BENEFIT PLAN plan

K-M MACHINE COMPANY, INC. BENEFIT PLAN 401k Plan overview

Plan Name	K-M MACHINE COMPANY, INC. BENEFIT PLAN
Plan identification number	501

K-M MACHINE COMPANY, INC. BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness)

401k Sponsoring company profile

K-M MACHINE COMPANY, INC. BENEFIT PLAN has sponsored the creation of one or more 401k plans.

Company Name: K-M MACHINE COMPANY, INC. BENEFIT PLAN

Employer identification number (EIN): 562198285

NAIC Classification: 332700

Form 5500 Filing Information

Submission information for form 5500 for 401k plan K-M MACHINE COMPANY, INC. BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2019-08-01

Plan Statistics for K-M MACHINE COMPANY, INC. BENEFIT PLAN

401k plan membership statisitcs for K-M MACHINE COMPANY, INC. BENEFIT PLAN

Measure Date Value
2019: K-M MACHINE COMPANY, INC. BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-08-01 112
Total number of active participants reported on line 7a of the Form 5500 2019-08-01 110
Number of retired or separated participants receiving benefits 2019-08-01 1
Number of other retired or separated participants entitled to future benefits 2019-08-01 3
Total of all active and inactive participants 2019-08-01 114

Measure	Date	Value
2019: K-M MACHINE COMPANY, INC. BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-08-01	112
Total number of active participants reported on line 7a of the Form 5500	2019-08-01	110
Number of retired or separated participants receiving benefits	2019-08-01	1
Number of other retired or separated participants entitled to future benefits	2019-08-01	3
Total of all active and inactive participants	2019-08-01	114

Form 5500 Responses for K-M MACHINE COMPANY, INC. BENEFIT PLAN

2019: K-M MACHINE COMPANY, INC. BENEFIT PLAN 2019 form 5500 responses
2019-08-01	Type of plan entity	Single employer plan
2019-08-01	First time form 5500 has been submitted	Yes
2019-08-01	Submission has been amended	No
2019-08-01	This submission is the final filing	No
2019-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-08-01	Plan is a collectively bargained plan	No
2019-08-01	Plan funding arrangement – Insurance	Yes
2019-08-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )

Policy contract number

14158483-1001

Policy instance

Insurance contract or identification number	14158483-1001
Number of Individuals Covered	130
Insurance policy start date	2019-08-01
Insurance policy end date	2020-07-31
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	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 $786,412
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00426041

Policy instance

Insurance contract or identification number	00426041
Number of Individuals Covered	105
Insurance policy start date	2019-08-01
Insurance policy end date	2020-07-31
Total amount of commissions paid to insurance broker	USD $9,711
Total amount of fees paid to insurance company	USD $174
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	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE
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 $136,648
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,711
Insurance broker organization code?	3
Amount paid for insurance broker fees	174
Additional information about fees paid to insurance broker	ADDITIONAL COMMISSIONS

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Company Name:	K-M MACHINE COMPANY, INC. BENEFIT PLAN
Employer identification number (EIN):	562198285
NAIC Classification:	332700