Civic Intelligence

Smith Dairy Medical Plan Trust

990 • Fiscal year 2016 • EIN 23-7358097

Jul 01, 2016 to Dec 31, 2016 • Filed on Nov 06, 2017

Organization ProfileWWW.SMITHFOODS.COM
PO Box 87Orrville, OH 44667

(330) 683-8710

Siviq Scores

Scores are not available for this record yet.

Balance Sheet

Assets

Down

$0

Down $1,791,935 (-100%) from 2015

Net Assets

Down

$0

Down $1,791,935 (-100%) from 2015

Liabilities

Flat

$0

Flat from 2015

Revenue And Expenses

Revenue

Down

$1,566,470

Down $1,618,458 (-51%) from 2015

Expenses

Down

$1,667,876

Down $1,442,314 (-46%) from 2015

Net Income

Down

-$101,406

Down $176,144 (-236%) from 2015

Historical Trend

Balance Sheet Trend

The highlighted filing sits inside the broader history for assets, liabilities, and net assets.

$2.0M$1.5M$1.0M$500K$0Assets 2010: $1,164,279Liabilities 2010: $0Net Assets 2010: $1,164,2792010Assets 2011: $1,336,436Liabilities 2011: $0Net Assets 2011: $1,336,4362011Assets 2012: $1,361,311Liabilities 2012: $0Net Assets 2012: $1,361,3112012Assets 2013: $1,498,542Liabilities 2013: $0Net Assets 2013: $1,498,5422013Assets 2014: $1,717,197Liabilities 2014: $0Net Assets 2014: $1,717,1972014Assets 2015: $1,791,935Liabilities 2015: $0Net Assets 2015: $1,791,9352015Assets 2016: $0Liabilities 2016: $0Net Assets 2016: $02016Assets 2016: $101,406Liabilities 2016: $0Net Assets 2016: $101,4062016

Highlighted filing

2016

Assets$0
Liabilities$0
Net Assets$0
Open 2016 Filing

Operations Trend

Revenue, expenses, and net income across loaded years, with this filing highlighted.

$4.0M$2.0M$0-$2.0MExpenses 2010: $2,545,4212010Expenses 2011: $2,917,7512011Expenses 2012: $2,720,9492012Expenses 2013: $2,782,1572013Revenue 2014: $3,578,572Expenses 2014: $3,359,917Net Income 2014: $218,6552014Revenue 2015: $3,184,928Expenses 2015: $3,110,190Net Income 2015: $74,7382015Revenue 2016: $1,566,470Expenses 2016: $1,667,876Net Income 2016: -$101,4062016Revenue 2016: $1,424,196Expenses 2016: $3,114,725Net Income 2016: -$1,690,5292016

Highlighted filing

2016

Revenue$1,566,470
Expenses$1,667,876
Net Income-$101,406
Open 2016 Filing
Jump To
Filing Snapshot
Filing Period
Jul 1, 2016 to Dec 31, 2016
Signed
Nov 6, 2017
Return Version
2016v3.0
Gross Receipts
$1,566,470
Mission and Program Overview

Mission

To provide health benefits to eligible individuals and their families.

To provide health benefits to eligible individuals.

Balance Sheet Detail
LineBeginningEndChange
Assets
Rtn Earn Endowment Incm Other Fnds$101,406$0▼ $101,406
Investments in Publicly Traded Securities$99,875$0▼ $99,875
Savings and Temporary Cash Investments$1,531$0▼ $1,531
Cash and Non-Interest-Bearing Accounts-$0-
Accounts Receivable-$0-
Other Notes and Loans Receivable, Net-$0-
Pledges and Grants Receivable-$0-
Receivable From Disqualified Prsn-$0-
Receivables From Officers Etc-$0-
Investments Other Securities-$0-
Investments Program Related-$0-
Land, Buildings, and Equipment, Net-$0-
Pd in Cap Srpls Land Bldg Eqp Fund$0$0→ $0
Cap Stk Tr Prin Current Funds$0$0→ $0
Intangible Assets-$0-
Inventories for Sale or Use-$0-
Prepaid Expenses and Deferred Charges-$0-
Total Assets$101,406$0▼ $101,406
Other Assets Total-$0-
Liabilities
Total Liabilities$0$0→ $0
Net Assets / Fund Balance
Total Net Assets Fund Balance$101,406$0▼ $101,406
Total Liabilities and Net Assets / Fund Balance$101,406$0▼ $101,406
Compensation and Service Providers

Board Members and Trustees

NameTitle
Heather ZimmerlyTrustee
Karl KelblyTrustee
Nathan SchmidTrustee
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$1,552,180
Investment Income
$0
Other Revenue
$14,290
Change in Net Assets
$-101,406

Audited Revenue Reconciliation

Revenue per Audited Statements
$1,566,470
Revenue Not Reported on Financial Statements
$0
Revenue Not Reported on Form 990
$0
Total Revenue per Audited Statements
$1,566,470
Total Revenue per Form 990
$1,566,470
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$105,552
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Benefits to Members---$1,562,324
Other Expenses---$91,167
Insurance---$14,385
Total Functional Expenses$0$0$0$1,667,876

Audited Expense Reconciliation

Line ItemAmount
Expenses per Audited Statements$1,667,876
Total Expenses per Audited Statements$1,667,876
Total Expenses per Form 990$1,667,876
Expenses Not Reported on Financial Statements$0
Expenses Not Reported on Form 990$0
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Subject to proxy tax
No
Insider Transactions and Loans

Loans and Receivables

Line ItemBeginningEndChange
Receivables from Disqualified Persons-$0-
Receivables from Officers, Directors, Trustees, and Key Employees-$0-
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
Yes
Audit committee
Yes
Business relationship with family members
No
Business relationship with organization members
No
Material changes to governing documents
No
Compensation from other sources disclosed
No
CEO compensation reviewed
No
Other officer compensation reviewed
No
Conflict-of-interest policy
Yes
Audited financial statements prepared
No
Key decisions subject to board approval
No
Management duties delegated
No

Governance Explanations

Form 990, Part VI, Section A, Line 2

“A trustee of the smith dairy medical plan trust, nathan schmid is also a shareholder of the plan sponsor, smithfoods orrville, inc., employer identification number 34-0536210 (fka the smith dairy products company). Smith dairy medical plan trust is the health and welfare plan for smithfoods orrville, inc.”

Form 990, Part VI, Section A, Line 8B

“The organization does not have committees.”

Form 990, Part VI, Section B, Line 11B

“The trustees are provided with a copy of the form 990 for review and approval prior to filing.”

Form 990, Part VI, Section B, Line 12C

“Conflicts of interest are detailed in prohibited transaction regulations under erisa. In addition to the written policy and annual distribution, the plan's erisa attorney continually monitors the plan and its trustees for possible conflicts of interest.”

Form 990, Part VI, Section C, Line 18

“The plan's form 990 is available through various websites, such as guidestar, and the form 5500 is available to the public through freeerisa.com. The governing documents are not provided to the public.”

Form 990, Part VI, Section C, Line 19

“The organization generally does not make its governing documents and financial statements available to the public.”

Filing and Contact Details

Filer

Filer Name
Smith Dairy Medical Plan Trust
EIN
23-7358097
Phone
3306838710
Address
PO BOX 87, ORRVILLE, OH 44667

Signing Officer

Name
Nathan Schmid
Title
President
Phone
3306838710
Signed
2017-11-06
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Nathan Schmid
Formed
1974
Legal Domicile
Oh
Voting Board Members
3
Independent Board Members
0
Employees
0
Volunteers
0

Preparer

Firm
Cliftonlarsonallen Llp
Address
4505 STEPHEN CIRCLE NW STE 200, CANTON, OH 44718
Preparer
Steven O Pittman
Phone
3304972000
Supplemental Narrative

Additional Explanations

FORM 990, PART XII, LINE 2C:

“There has been no change in the organization's process of oversight of the audit of the financial statements or in the selection process of an independent accountant.”

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This appendix keeps the raw XML leaves available for debugging and edge-case review. The human report above is the primary experience.

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IRS990ScheduleN/SupplementalInformationDetail/ExplanationTxt0ON JUNE 20, 2016, THE BOARD OF TRUSTEES OF THE PLAN VOTED TO TERMINATE THE PLAN AND THE RELATED TRUST. A RESOLUTION WAS FILED TO TERMINATE THE PLAN EFFECTIVE DECEMBER 31, 2016 AND TO TRANSFER ALL THE ASSETS OF THE TRUST TO THE PLAN SPONSOR (SMITHFOODS ORRVILLE, INC., EIN 34-0536210) AS SOON AS ADMINISTRATIVELY FEASIBLE. THE PLAN COMPLETED THE FINAL TRANSFER OF THE ASSETS ON AUGUST 1, 2016 AND DISSOLUTION OF THE PLAN ON DECEMBER 31, 2016.
IRS990ScheduleN/SupplementalInformationDetail/FormAndLineReferenceDesc0FORM 990, PART IV, LINE 31
IRS990/ScheduleORequiredInd01
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0A TRUSTEE OF THE SMITH DAIRY MEDICAL PLAN TRUST, NATHAN SCHMID IS ALSO A SHAREHOLDER OF THE PLAN SPONSOR, SMITHFOODS ORRVILLE, INC., EMPLOYER IDENTIFICATION NUMBER 34-0536210 (FKA THE SMITH DAIRY PRODUCTS COMPANY). SMITH DAIRY MEDICAL PLAN TRUST IS THE HEALTH AND WELFARE PLAN FOR SMITHFOODS ORRVILLE, INC.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1THE ORGANIZATION DOES NOT HAVE COMMITTEES.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2THE TRUSTEES ARE PROVIDED WITH A COPY OF THE FORM 990 FOR REVIEW AND APPROVAL PRIOR TO FILING.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3CONFLICTS OF INTEREST ARE DETAILED IN PROHIBITED TRANSACTION REGULATIONS UNDER ERISA. IN ADDITION TO THE WRITTEN POLICY AND ANNUAL DISTRIBUTION, THE PLAN'S ERISA ATTORNEY CONTINUALLY MONITORS THE PLAN AND ITS TRUSTEES FOR POSSIBLE CONFLICTS OF INTEREST.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt4THE PLAN'S FORM 990 IS AVAILABLE THROUGH VARIOUS WEBSITES, SUCH AS GUIDESTAR, AND THE FORM 5500 IS AVAILABLE TO THE PUBLIC THROUGH FREEERISA.COM. THE GOVERNING DOCUMENTS ARE NOT PROVIDED TO THE PUBLIC.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt5THE ORGANIZATION GENERALLY DOES NOT MAKE ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt6THERE HAS BEEN NO CHANGE IN THE ORGANIZATION'S PROCESS OF OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS OR IN THE SELECTION PROCESS OF AN INDEPENDENT ACCOUNTANT.
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0FORM 990, PART VI, SECTION A, LINE 2
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1FORM 990, PART VI, SECTION A, LINE 8B
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2FORM 990, PART VI, SECTION B, LINE 11B
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc3FORM 990, PART VI, SECTION B, LINE 12C
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc4FORM 990, PART VI, SECTION C, LINE 18
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc5FORM 990, PART VI, SECTION C, LINE 19
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc6FORM 990, PART XII, LINE 2C:
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ReturnHeader/BuildTS02017-02-10 21:41:12Z
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ReturnHeader/BusinessOfficerGrp/PersonNm0NATHAN SCHMID
ReturnHeader/BusinessOfficerGrp/PersonTitleTxt0PRESIDENT
ReturnHeader/BusinessOfficerGrp/PhoneNum03306838710
ReturnHeader/BusinessOfficerGrp/SignatureDt02017-11-06
ReturnHeader/Filer/BusinessName/BusinessNameLine1Txt0SMITH DAIRY MEDICAL PLAN TRUST
ReturnHeader/Filer/BusinessNameControlTxt0SMIT
ReturnHeader/Filer/EIN0237358097
ReturnHeader/Filer/PhoneNum03306838710
ReturnHeader/Filer/USAddress/AddressLine1Txt0PO BOX 87
ReturnHeader/Filer/USAddress/CityNm0ORRVILLE
ReturnHeader/Filer/USAddress/StateAbbreviationCd0OH
ReturnHeader/Filer/USAddress/ZIPCd044667
ReturnHeader/FilingSecurityInformation/AtSubmissionCreationDeviceId0F904662D9C5EBFCCB898FADF2250354DEA1F5A7F
ReturnHeader/FilingSecurityInformation/AtSubmissionFilingDeviceId0664F263084F6F8606BAF619F06C61B8C161659E7
ReturnHeader/FilingSecurityInformation/FilingLicenseTypeCd0P
ReturnHeader/FilingSecurityInformation/IPAddress/IPv4AddressTxt067.137.57.251
ReturnHeader/FilingSecurityInformation/IPDt02017-11-06
ReturnHeader/FilingSecurityInformation/IPTimezoneCd0ES
ReturnHeader/FilingSecurityInformation/IPTm010:52:37
ReturnHeader/PreparerFirmGrp/PreparerFirmEIN0410746749
ReturnHeader/PreparerFirmGrp/PreparerFirmName/BusinessNameLine1Txt0CLIFTONLARSONALLEN LLP
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/AddressLine1Txt04505 STEPHEN CIRCLE NW STE 200
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/CityNm0CANTON
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/StateAbbreviationCd0OH
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/ZIPCd044718
ReturnHeader/PreparerPersonGrp/PhoneNum03304972000
ReturnHeader/PreparerPersonGrp/PreparerPersonNm0STEVEN O PITTMAN
ReturnHeader/ReturnTs02017-11-09T15:42:55-06:00
ReturnHeader/ReturnTypeCd0990
ReturnHeader/TaxPeriodBeginDt02016-07-01
ReturnHeader/TaxPeriodEndDt02016-12-31
ReturnHeader/TaxYr02016

Document Assets

No mirrored PDF or thumbnail assets are attached yet.

Filings

Displayed year

2016 • Form 990Detailed filing. Detailed filing data is available for this year.

Open filing
Assets
$0
Liabilities
$0
Net assets
$0
Revenue
$1,566,470
Expenses
$1,667,876
Net income
-$101,406
Balance SheetOperations
YearAssetsLiabilitiesNet AssetsRevenueExpensesNet Income
2016Detailed filing. Detailed filing data is available for this year.$0.10$0.00$0.10$1.42$3.11$1.69
2016Detailed filing. Detailed filing data is available for this year.$0.00$0.00$0.00$1.57$1.67$0.10
2015Detailed filing. Detailed filing data is available for this year.$1.79$0.00$1.79$3.18$3.11$0.07
2014Detailed filing. Detailed filing data is available for this year.$1.72$0.00$1.72$3.58$3.36$0.22
2013Facts available. Structured filing facts are available, but richer extracted sections are limited.$1.50$0.00$1.50$2.78
2012Facts available. Structured filing facts are available, but richer extracted sections are limited.$1.36$0.00$1.36$2.72
2011Facts available. Structured filing facts are available, but richer extracted sections are limited.$1.34$0.00$1.34$2.92
2010Facts available. Structured filing facts are available, but richer extracted sections are limited.$1.16$0.00$1.16$2.55