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| Plan Name | SMOKERS OUTLET MANAGEMENT INC HEALTH AND WELFARE BENEFIT PLANS |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | SMOKERS OUTLET MANAGEMENT INC |
| Employer identification number (EIN): | 571158872 |
| NAIC Classification: | 551112 |
| NAIC Description: | Offices of Other Holding Companies |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-08-01 | DEREK PUTRUS | 2024-01-16 | ||
| 501 | 2021-08-01 | DEREK PUTRUS | 2023-05-10 |
| Measure | Date | Value |
|---|---|---|
| 2022: SMOKERS OUTLET MANAGEMENT INC HEALTH AND WELFARE BENEFIT PLANS 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-08-01 | 131 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-08-01 | 122 |
| Number of retired or separated participants receiving benefits | 2022-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-08-01 | 0 |
| Total of all active and inactive participants | 2022-08-01 | 122 |
| Number of employers contributing to the scheme | 2022-08-01 | 0 |
| 2021: SMOKERS OUTLET MANAGEMENT INC HEALTH AND WELFARE BENEFIT PLANS 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-08-01 | 135 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-08-01 | 131 |
| Number of retired or separated participants receiving benefits | 2021-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-08-01 | 0 |
| Total of all active and inactive participants | 2021-08-01 | 131 |
| Number of employers contributing to the scheme | 2021-08-01 | 0 |
| 2022: SMOKERS OUTLET MANAGEMENT INC HEALTH AND WELFARE BENEFIT PLANS 2022 form 5500 responses | ||
|---|---|---|
| 2022-08-01 | Type of plan entity | Single employer plan |
| 2022-08-01 | Plan funding arrangement – Insurance | Yes |
| 2022-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: SMOKERS OUTLET MANAGEMENT INC HEALTH AND WELFARE BENEFIT PLANS 2021 form 5500 responses | ||
| 2021-08-01 | Type of plan entity | Single employer plan |
| 2021-08-01 | First time form 5500 has been submitted | Yes |
| 2021-08-01 | Plan funding arrangement – Insurance | Yes |
| 2021-08-01 | Plan benefit arrangement – Insurance | Yes |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 402136 |
| Policy instance | 1 |
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) | |
| Policy contract number | 402136 |
| Policy instance | 2 |
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) | |
| Policy contract number | 10673 |
| Policy instance | 3 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |
| Policy contract number | GLUG0BXQX |
| Policy instance | 4 |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) | |
| Policy contract number | 402136 |
| Policy instance | 1 |
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) | |
| Policy contract number | 402136 |
| Policy instance | 2 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |
| Policy contract number | GLUG0BXQX |
| Policy instance | 3 |
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