401k Plan data: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN plan

RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 401k Plan overview

Plan Name	RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN
Plan identification number	501

RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

BOARD OF TRUSTEES,VEBA FOR RETIREES OF DAYCO WAYNESVILLE has sponsored the creation of one or more 401k plans.

Company Name: BOARD OF TRUSTEES,VEBA FOR RETIREES OF DAYCO WAYNESVILLE

Employer identification number (EIN): 208525177

NAIC Classification: 326200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01
501 2021-01-01
501 2020-01-01
501 2019-01-01 JEANETTE STUMP 2020-10-01
501 2018-01-01
501 2017-01-01 JEANETTE STUMP
501 2016-01-01 JEANETTE STUMP
501 2015-01-01 JEANETTE STUMP
501 2014-01-01 JEANETTE STUMP
501 2013-01-01 JEANETTE STUMP
501 2012-01-01 JEANETTE STUMP
501 2011-01-01 JEANETTE STUMP
501 2010-01-01 JEANETTE STUMP
501 2009-01-01 JEANETTE STUMP

Plan Statistics for RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN

401k plan membership statisitcs for RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN

Measure Date Value
2018: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 84
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 0
Number of retired or separated participants receiving benefits 2018-01-01 82
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 82
2017: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 84
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 0
Number of retired or separated participants receiving benefits 2017-01-01 84
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 84
2016: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 84
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Number of retired or separated participants receiving benefits 2016-01-01 84
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 84
2015: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 99
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 0
Number of retired or separated participants receiving benefits 2015-01-01 84
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 84
2014: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 99
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 0
Number of retired or separated participants receiving benefits 2014-01-01 99
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 99
2013: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 98
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 0
Number of retired or separated participants receiving benefits 2013-01-01 99
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 99
2012: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 101
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 0
Number of retired or separated participants receiving benefits 2012-01-01 98
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 98
2011: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 109
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 0
Number of retired or separated participants receiving benefits 2011-01-01 101
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 101
2010: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 122
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 0
Number of retired or separated participants receiving benefits 2010-01-01 109
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 109
2009: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 135
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 0
Number of retired or separated participants receiving benefits 2009-01-01 122
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 122

Measure	Date	Value
2018: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	84
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	0
Number of retired or separated participants receiving benefits	2018-01-01	82
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	82
2017: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	84
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	0
Number of retired or separated participants receiving benefits	2017-01-01	84
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	84
2016: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	84
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Number of retired or separated participants receiving benefits	2016-01-01	84
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	84
2015: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	99
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	0
Number of retired or separated participants receiving benefits	2015-01-01	84
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	84
2014: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	99
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	0
Number of retired or separated participants receiving benefits	2014-01-01	99
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	99
2013: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	98
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	0
Number of retired or separated participants receiving benefits	2013-01-01	99
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	99
2012: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	101
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	0
Number of retired or separated participants receiving benefits	2012-01-01	98
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	98
2011: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	109
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	0
Number of retired or separated participants receiving benefits	2011-01-01	101
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	101
2010: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	122
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	0
Number of retired or separated participants receiving benefits	2010-01-01	109
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	109
2009: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	135
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	0
Number of retired or separated participants receiving benefits	2009-01-01	122
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	122

Financial Data on RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN

Measure	Date	Value
2018 : RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$46,528
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$2,355
Total income from all sources (including contributions)	2018-12-31	$239,797
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$285,664
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$266,325
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$239,797
Value of total assets at end of year	2018-12-31	$188,900
Value of total assets at beginning of year	2018-12-31	$190,594
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$19,339
Total interest from all sources	2018-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Administrative expenses professional fees incurred	2018-12-31	$11,811
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$80,672
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2018-12-31	$46,480
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2018-12-31	$2,040
Administrative expenses (other) incurred	2018-12-31	$3,759
Liabilities. Value of operating payables at end of year	2018-12-31	$48
Liabilities. Value of operating payables at beginning of year	2018-12-31	$315
Total non interest bearing cash at end of year	2018-12-31	$187,922
Total non interest bearing cash at beginning of year	2018-12-31	$188,917
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$-45,867
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$142,372
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$188,239
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2018-12-31	$266,325
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Assets. Invements in employer securities at end of year	2018-12-31	$0
Assets. Invements in employer securities at beginning of year	2018-12-31	$0
Contributions received in cash from employer	2018-12-31	$159,125
Contract administrator fees	2018-12-31	$3,769
Assets. Value of buildings and other operty used in plan operation at end of year	2018-12-31	$978
Assets. Value of buildings and other operty used in plan operation at beginning of year	2018-12-31	$1,677
Did the plan have assets held for investment	2018-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	No
Opinion of an independent qualified public accountant for this plan	2018-12-31	Unqualified
Accountancy firm name	2018-12-31	MCELHANEY & ASSOCIATES, LLC
Accountancy firm EIN	2018-12-31	383806684
2017 : RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$2,355
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$42,326
Total income from all sources (including contributions)	2017-12-31	$245,280
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$285,072
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$265,590
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$245,280
Value of total assets at end of year	2017-12-31	$190,594
Value of total assets at beginning of year	2017-12-31	$270,357
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$19,482
Total interest from all sources	2017-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Administrative expenses professional fees incurred	2017-12-31	$12,105
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$85,680
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2017-12-31	$2,040
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2017-12-31	$41,940
Administrative expenses (other) incurred	2017-12-31	$3,597
Liabilities. Value of operating payables at end of year	2017-12-31	$315
Liabilities. Value of operating payables at beginning of year	2017-12-31	$386
Total non interest bearing cash at end of year	2017-12-31	$188,917
Total non interest bearing cash at beginning of year	2017-12-31	$270,200
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$-39,792
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$188,239
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$228,031
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2017-12-31	$265,590
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Assets. Invements in employer securities at end of year	2017-12-31	$0
Assets. Invements in employer securities at beginning of year	2017-12-31	$0
Contributions received in cash from employer	2017-12-31	$159,600
Contract administrator fees	2017-12-31	$3,780
Assets. Value of buildings and other operty used in plan operation at end of year	2017-12-31	$1,677
Assets. Value of buildings and other operty used in plan operation at beginning of year	2017-12-31	$157
Did the plan have assets held for investment	2017-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	No
Opinion of an independent qualified public accountant for this plan	2017-12-31	Unqualified
Accountancy firm name	2017-12-31	MCELHANEY & ASSOCIATES, LLC
Accountancy firm EIN	2017-12-31	383806684
2016 : RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$42,326
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$44,978
Total income from all sources (including contributions)	2016-12-31	$245,140
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$264,155
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$244,215
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$245,140
Value of total assets at end of year	2016-12-31	$270,357
Value of total assets at beginning of year	2016-12-31	$292,024
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$19,940
Total interest from all sources	2016-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Administrative expenses professional fees incurred	2016-12-31	$13,606
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$85,540
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2016-12-31	$41,940
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2016-12-31	$42,365
Administrative expenses (other) incurred	2016-12-31	$2,569
Liabilities. Value of operating payables at end of year	2016-12-31	$386
Liabilities. Value of operating payables at beginning of year	2016-12-31	$2,613
Total non interest bearing cash at end of year	2016-12-31	$270,200
Total non interest bearing cash at beginning of year	2016-12-31	$292,024
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$-19,015
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$228,031
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$247,046
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2016-12-31	$244,215
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Assets. Invements in employer securities at end of year	2016-12-31	$0
Assets. Invements in employer securities at beginning of year	2016-12-31	$0
Contributions received in cash from employer	2016-12-31	$159,600
Contract administrator fees	2016-12-31	$3,765
Assets. Value of buildings and other operty used in plan operation at end of year	2016-12-31	$157
Assets. Value of buildings and other operty used in plan operation at beginning of year	2016-12-31	$0
Did the plan have assets held for investment	2016-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	No
Opinion of an independent qualified public accountant for this plan	2016-12-31	Unqualified
Accountancy firm name	2016-12-31	MCELHANEY & ASSOCIATES, LLC
Accountancy firm EIN	2016-12-31	383806684
2015 : RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$44,978
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$4,050
Total income from all sources (including contributions)	2015-12-31	$262,260
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$291,506
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$273,582
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$262,260
Value of total assets at end of year	2015-12-31	$292,024
Value of total assets at beginning of year	2015-12-31	$280,342
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$17,924
Total interest from all sources	2015-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Administrative expenses professional fees incurred	2015-12-31	$10,745
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$93,535
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2015-12-31	$11,414
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-12-31	$42,365
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$4,050
Administrative expenses (other) incurred	2015-12-31	$3,264
Liabilities. Value of operating payables at end of year	2015-12-31	$2,613
Liabilities. Value of operating payables at beginning of year	2015-12-31	$0
Total non interest bearing cash at end of year	2015-12-31	$292,024
Total non interest bearing cash at beginning of year	2015-12-31	$280,342
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-29,246
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$247,046
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$276,292
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2015-12-31	$262,168
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Assets. Invements in employer securities at end of year	2015-12-31	$0
Assets. Invements in employer securities at beginning of year	2015-12-31	$0
Contributions received in cash from employer	2015-12-31	$168,725
Contract administrator fees	2015-12-31	$3,915
Did the plan have assets held for investment	2015-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	No
Opinion of an independent qualified public accountant for this plan	2015-12-31	Unqualified
Accountancy firm name	2015-12-31	MCELHANEY & ASSOCIATES, LLC
Accountancy firm EIN	2015-12-31	383806684
2014 : RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$4,050
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$4,445
Total income from all sources (including contributions)	2014-12-31	$288,890
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$291,200
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$273,689
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$286,490
Value of total assets at end of year	2014-12-31	$280,342
Value of total assets at beginning of year	2014-12-31	$283,047
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$17,511
Total interest from all sources	2014-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Administrative expenses professional fees incurred	2014-12-31	$12,374
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$106,340
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2014-12-31	$24,753
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-12-31	$4,050
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$4,445
Other income not declared elsewhere	2014-12-31	$2,400
Administrative expenses (other) incurred	2014-12-31	$982
Total non interest bearing cash at end of year	2014-12-31	$280,342
Total non interest bearing cash at beginning of year	2014-12-31	$281,450
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-2,310
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$276,292
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$278,602
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$248,936
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Assets. Invements in employer securities at end of year	2014-12-31	$0
Assets. Invements in employer securities at beginning of year	2014-12-31	$0
Contributions received in cash from employer	2014-12-31	$180,150
Contract administrator fees	2014-12-31	$4,155
Assets. Value of buildings and other operty used in plan operation at end of year	2014-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2014-12-31	$1,597
Did the plan have assets held for investment	2014-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	No
Opinion of an independent qualified public accountant for this plan	2014-12-31	Unqualified
Accountancy firm name	2014-12-31	MCELHANEY & ASSOCIATES, LLC
Accountancy firm EIN	2014-12-31	383806684
2013 : RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$4,445
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$5,205
Total income from all sources (including contributions)	2013-12-31	$319,515
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$294,808
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$284,286
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$319,515
Value of total assets at end of year	2013-12-31	$283,047
Value of total assets at beginning of year	2013-12-31	$259,100
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$10,522
Total interest from all sources	2013-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Administrative expenses professional fees incurred	2013-12-31	$5,000
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$125,140
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2013-12-31	$54,296
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-12-31	$4,445
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-12-31	$5,205
Administrative expenses (other) incurred	2013-12-31	$1,146
Total non interest bearing cash at end of year	2013-12-31	$281,450
Total non interest bearing cash at beginning of year	2013-12-31	$257,387
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$24,707
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$278,602
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$253,895
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$229,990
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Assets. Invements in employer securities at end of year	2013-12-31	$0
Assets. Invements in employer securities at beginning of year	2013-12-31	$0
Contributions received in cash from employer	2013-12-31	$194,375
Contract administrator fees	2013-12-31	$4,376
Assets. Value of buildings and other operty used in plan operation at end of year	2013-12-31	$1,597
Assets. Value of buildings and other operty used in plan operation at beginning of year	2013-12-31	$1,713
Did the plan have assets held for investment	2013-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	No
Opinion of an independent qualified public accountant for this plan	2013-12-31	Unqualified
Accountancy firm name	2013-12-31	MCELHANEY & ASSOCIATES, LLC
Accountancy firm EIN	2013-12-31	383806684
2012 : RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$5,205
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$4,585
Total income from all sources (including contributions)	2012-12-31	$360,355
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$324,539
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$306,774
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$360,355
Value of total assets at end of year	2012-12-31	$259,100
Value of total assets at beginning of year	2012-12-31	$222,664
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$17,765
Total interest from all sources	2012-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Administrative expenses professional fees incurred	2012-12-31	$12,000
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$150,155
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2012-12-31	$89,370
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-12-31	$5,205
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$4,585
Administrative expenses (other) incurred	2012-12-31	$1,194
Total non interest bearing cash at end of year	2012-12-31	$257,387
Total non interest bearing cash at beginning of year	2012-12-31	$222,664
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$35,816
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$253,895
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$218,079
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$217,404
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Assets. Invements in employer securities at end of year	2012-12-31	$0
Assets. Invements in employer securities at beginning of year	2012-12-31	$0
Contributions received in cash from employer	2012-12-31	$210,200
Contract administrator fees	2012-12-31	$4,571
Assets. Value of buildings and other operty used in plan operation at end of year	2012-12-31	$1,713
Assets. Value of buildings and other operty used in plan operation at beginning of year	2012-12-31	$0
Did the plan have assets held for investment	2012-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	No
Opinion of an independent qualified public accountant for this plan	2012-12-31	Unqualified
Accountancy firm name	2012-12-31	MCELHANEY & ASSOCIATES, LLC
Accountancy firm EIN	2012-12-31	383806684
2011 : RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$4,585
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$5,840
Total income from all sources (including contributions)	2011-12-31	$386,065
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$344,975
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$327,222
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$386,065
Value of total assets at end of year	2011-12-31	$222,664
Value of total assets at beginning of year	2011-12-31	$182,829
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$17,753
Total interest from all sources	2011-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Administrative expenses professional fees incurred	2011-12-31	$11,500
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$164,490
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2011-12-31	$120,422
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$4,585
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$5,840
Administrative expenses (other) incurred	2011-12-31	$1,483
Total non interest bearing cash at end of year	2011-12-31	$222,664
Total non interest bearing cash at beginning of year	2011-12-31	$182,829
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$41,090
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$218,079
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$176,989
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2011-12-31	$206,800
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Assets. Invements in employer securities at end of year	2011-12-31	$0
Assets. Invements in employer securities at beginning of year	2011-12-31	$0
Contributions received in cash from employer	2011-12-31	$221,575
Contract administrator fees	2011-12-31	$4,770
Did the plan have assets held for investment	2011-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	No
Opinion of an independent qualified public accountant for this plan	2011-12-31	Unqualified
Accountancy firm name	2011-12-31	MCELHANEY & ASSOCIATES, LLC
Accountancy firm EIN	2011-12-31	383806684
2010 : RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$5,840
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$9,300
Total income from all sources (including contributions)	2010-12-31	$449,168
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$390,131
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$378,935
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$449,168
Value of total assets at end of year	2010-12-31	$182,829
Value of total assets at beginning of year	2010-12-31	$127,252
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$11,196
Total interest from all sources	2010-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Administrative expenses professional fees incurred	2010-12-31	$4,701
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$202,543
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2010-12-31	$378,935
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-12-31	$5,840
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$9,300
Administrative expenses (other) incurred	2010-12-31	$1,395
Total non interest bearing cash at end of year	2010-12-31	$182,829
Total non interest bearing cash at beginning of year	2010-12-31	$127,252
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$59,037
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$176,989
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$117,952
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Assets. Invements in employer securities at end of year	2010-12-31	$0
Assets. Invements in employer securities at beginning of year	2010-12-31	$0
Contributions received in cash from employer	2010-12-31	$246,625
Contract administrator fees	2010-12-31	$5,100
Did the plan have assets held for investment	2010-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	No
Opinion of an independent qualified public accountant for this plan	2010-12-31	Unqualified
Accountancy firm name	2010-12-31	MCELHANEY & ASSOCIATES, LLC
Accountancy firm EIN	2010-12-31	383806684

Form 5500 Responses for RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN

2018: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: RETIREES OF DAYCO WAYNESVILLE HEALTH CARE PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

128802

Policy instance

Insurance contract or identification number	128802
Number of Individuals Covered	82
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
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 $266,060
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

128802/1784575

Policy instance

Insurance contract or identification number	128802/1784575
Number of Individuals Covered	84
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
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 $265,590
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

128802/1784575

Policy instance

Insurance contract or identification number	128802/1784575
Number of Individuals Covered	84
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Are there contracts with allocated funds for individual policies?	No
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 $262,400
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

128802/1784575

Policy instance

Insurance contract or identification number	128802/1784575
Number of Individuals Covered	88
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Are there contracts with allocated funds for individual policies?	No
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 $248,704
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

128802/1931596

Policy instance

Insurance contract or identification number	128802/1931596
Number of Individuals Covered	90
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Are there contracts with allocated funds for individual policies?	No
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 $229,990
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

128802/1931595

Policy instance

Insurance contract or identification number	128802/1931595
Number of Individuals Covered	91
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Are there contracts with allocated funds for individual policies?	No
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 $217,404
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

003150001

Policy instance

Insurance contract or identification number	003150001
Number of Individuals Covered	92
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Are there contracts with allocated funds for individual policies?	No
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 $206,800
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	BOARD OF TRUSTEES,VEBA FOR RETIREES OF DAYCO WAYNESVILLE
Employer identification number (EIN):	208525177
NAIC Classification:	326200

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-01-01
501	2021-01-01
501	2020-01-01
501	2019-01-01	JEANETTE STUMP	2020-10-01
501	2018-01-01
501	2017-01-01	JEANETTE STUMP
501	2016-01-01	JEANETTE STUMP
501	2015-01-01	JEANETTE STUMP
501	2014-01-01	JEANETTE STUMP
501	2013-01-01	JEANETTE STUMP
501	2012-01-01	JEANETTE STUMP
501	2011-01-01	JEANETTE STUMP
501	2010-01-01	JEANETTE STUMP
501	2009-01-01	JEANETTE STUMP