WALTER E. SMITHE FURNITURE, INC. LONG TERM DISABILITY PLAN
|
2021
|
363195096
|
2023-04-11
|
WALTER E. SMITHE FURNITURE, INC.
|
248
|
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1997-09-01
|
Business code |
442110
|
Sponsor’s telephone number |
6302858000
|
Plan sponsor’s mailing address |
1251 W THORNDALE AVE, ITASCA, IL, 601431149
|
Plan sponsor’s
address |
1251 W THORNDALE AVE, ITASCA, IL, 601431149
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2023-04-11 |
Name of individual signing |
PHIL ZACHARSKI |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2023-04-11 |
Name of individual signing |
PHIL ZACHARSKI |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
WALTER E. SMITHE FURNITURE LIFE & ACCIDENTAL DEATH/DISMEMBERMENT PLAN
|
2021
|
363195096
|
2023-04-11
|
WALTER E. SMITHE FURNITURE, INC.
|
248
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1997-09-01
|
Business code |
442110
|
Sponsor’s telephone number |
6302858000
|
Plan sponsor’s mailing address |
1251 W THORNDALE AVE, ITASCA, IL, 601431149
|
Plan sponsor’s
address |
1251 W THORNDALE AVE, ITASCA, IL, 601431149
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2023-04-11 |
Name of individual signing |
PHIL ZACHARSKI |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2023-04-11 |
Name of individual signing |
PHIL ZACHARSKI |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
WALTER E SMITHE FURNITURE VISION PLAN
|
2021
|
363195096
|
2022-10-24
|
WALTER E SMITHE FURNITURE INC.
|
185
|
|
File |
View Page
|
Three-digit plan number (PN) |
506
|
Effective date of plan |
2016-04-01
|
Business code |
442110
|
Sponsor’s telephone number |
6302858000
|
Plan sponsor’s mailing address |
1251 W THORNDALE AVE, ITASCA, IL, 601431149
|
Plan sponsor’s
address |
1251 W THORNDALE AVE, ITASCA, IL, 601431149
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-10-24 |
Name of individual signing |
PHIL ZACHARSKI |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-10-24 |
Name of individual signing |
PHIL ZACHARSKI |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
WALTER E. SMITHE FURNITURE, INC. DENTAL INSURANCE PLAN
|
2021
|
363195096
|
2022-10-03
|
WALTER E. SMITHE FURNITURE, INC.
|
153
|
|
File |
View Page
|
Three-digit plan number (PN) |
505
|
Effective date of plan |
1992-01-01
|
Business code |
442110
|
Sponsor’s telephone number |
6302858000
|
Plan sponsor’s mailing address |
1251 W THORNDALE AVE, ITASCA, IL, 601431149
|
Plan sponsor’s
address |
1251 W THORNDALE AVE, ITASCA, IL, 601431149
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-10-03 |
Name of individual signing |
PHIL ZACHARSKI |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-10-03 |
Name of individual signing |
PHIL ZACHARSKI |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
WALTER E SMITHE FURNITURE HMO MEDICAL INSURANCE PLAN
|
2021
|
363195096
|
2022-10-03
|
WALTER E. SMITHE FURNITURE, INC.
|
341
|
|
File |
View Page
|
Three-digit plan number (PN) |
504
|
Effective date of plan |
1992-01-01
|
Business code |
442110
|
Sponsor’s telephone number |
6302858000
|
Plan sponsor’s mailing address |
1251 W THORNDALE AVE, ITASCA, IL, 601431149
|
Plan sponsor’s
address |
1251 W THORNDALE AVE, ITASCA, IL, 601431149
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-10-03 |
Name of individual signing |
PHIL ZACHARSKI |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-10-03 |
Name of individual signing |
PHIL ZACHARSKI |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
WALTER E. SMITHE FURNITURE, INC. LONG TERM DISABILITY PLAN
|
2020
|
363195096
|
2022-03-11
|
WALTER E. SMITHE FURNITURE, INC.
|
231
|
|
File |
View Page
|
Three-digit plan number (PN) |
503
|
Effective date of plan |
1997-09-01
|
Business code |
442110
|
Sponsor’s telephone number |
6302858000
|
Plan sponsor’s mailing address |
1251 W THORNDALE AVE, ITASCA, IL, 601431149
|
Plan sponsor’s
address |
1251 W THORNDALE AVE, ITASCA, IL, 601431149
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-03-11 |
Name of individual signing |
PHIL ZACHARSKI |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-03-11 |
Name of individual signing |
PHIL ZACHARSKI |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
WALTER E. SMITHE FURNITURE LIFE & ACCIDENTAL DEATH/DISMEMBERMENT PLAN
|
2020
|
363195096
|
2022-03-11
|
WALTER E. SMITHE FURNITURE, INC.
|
231
|
|
File |
View Page
|
Three-digit plan number (PN) |
502
|
Effective date of plan |
1997-09-01
|
Business code |
442110
|
Sponsor’s telephone number |
6302858000
|
Plan sponsor’s mailing address |
1251 W THORNDALE AVE, ITASCA, IL, 601431149
|
Plan sponsor’s
address |
1251 W THORNDALE AVE, ITASCA, IL, 601431149
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2022-03-11 |
Name of individual signing |
PHIL ZACHARSKI |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2022-03-11 |
Name of individual signing |
PHIL ZACHARSKI |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
WALTER E SMITHE FURNITURE HMO MEDICAL INSURANCE PLAN
|
2020
|
363195096
|
2021-09-21
|
WALTER E. SMITHE FURNITURE, INC.
|
294
|
|
File |
View Page
|
Three-digit plan number (PN) |
504
|
Effective date of plan |
1992-01-01
|
Business code |
442110
|
Sponsor’s telephone number |
6302858000
|
Plan sponsor’s mailing address |
1251 W THORNDALE AVE, ITASCA, IL, 601431149
|
Plan sponsor’s
address |
1251 W THORNDALE AVE, ITASCA, IL, 601431149
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2021-09-21 |
Name of individual signing |
PHIL ZACHARSKI |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2021-09-21 |
Name of individual signing |
PHIL ZACHARSKI |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
WALTER E. SMITHE FURNITURE, INC. DENTAL INSURANCE PLAN
|
2020
|
363195096
|
2021-09-21
|
WALTER E. SMITHE FURNITURE, INC.
|
135
|
|
File |
View Page
|
Three-digit plan number (PN) |
505
|
Effective date of plan |
1992-01-01
|
Business code |
442110
|
Sponsor’s telephone number |
6302858000
|
Plan sponsor’s mailing address |
1251 W THORNDALE AVE, ITASCA, IL, 601431149
|
Plan sponsor’s
address |
1251 W THORNDALE AVE, ITASCA, IL, 601431149
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2021-09-21 |
Name of individual signing |
PHIL ZACHARSKI |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2021-09-21 |
Name of individual signing |
PHIL ZACHARSKI |
Valid signature |
Filed with authorized/valid electronic signature |
|
|
WALTER E SMITHE FURNITURE VISION PLAN
|
2020
|
363195096
|
2021-09-28
|
WALTER E SMITHE FURNITURE INC.
|
152
|
|
File |
View Page
|
Three-digit plan number (PN) |
506
|
Effective date of plan |
2016-04-01
|
Business code |
442110
|
Sponsor’s telephone number |
6302858000
|
Plan sponsor’s mailing address |
1251 W THORNDALE AVE, ITASCA, IL, 601431149
|
Plan sponsor’s
address |
1251 W THORNDALE AVE, ITASCA, IL, 601431149
|
Number of participants as of the end of the plan year
Signature of
Role |
Plan administrator |
Date |
2021-09-28 |
Name of individual signing |
PHIL ZACHARSKI |
Valid signature |
Filed with authorized/valid electronic signature |
|
Role |
Employer/plan sponsor |
Date |
2021-09-28 |
Name of individual signing |
PHIL ZACHARSKI |
Valid signature |
Filed with authorized/valid electronic signature |
|
|