401k Plan data: CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN plan

CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN 401k Plan overview

Plan Name	CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN
Plan identification number	001

CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

BLOOMINGTON CARPET ONE has sponsored the creation of one or more 401k plans.

Company Name: BLOOMINGTON CARPET ONE

Employer identification number (EIN): 411631922

NAIC Classification: 442210
NAIC Description: Floor Covering Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01
001 2016-01-01
001 2015-01-01 KEITH CARLSON 2016-06-27
001 2014-01-01 TAMARA LANGE 2015-09-10
001 2013-01-01 KEITH CARLSON 2014-07-16
001 2012-01-01 TAMARA LANGE 2013-07-31
001 2011-01-01 TAMARA LANGE
001 2009-01-01 TAMARA LANGE

Plan Statistics for CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN

401k plan membership statisitcs for CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN

Measure Date Value
2022: CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 18
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 17
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 1
Total of all active and inactive participants 2022-01-01 18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 18
Number of participants with account balances 2022-01-01 17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 18
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 18
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 18
Number of participants with account balances 2021-01-01 17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 19
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 18
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 18
Number of participants with account balances 2020-01-01 16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 15
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 16
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 3
Total of all active and inactive participants 2019-01-01 19
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 19
Number of participants with account balances 2019-01-01 18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2011: CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 15
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 13
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 4
Total of all active and inactive participants 2011-01-01 17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 17
Number of participants with account balances 2011-01-01 17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 15
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 10
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 4
Total of all active and inactive participants 2009-01-01 14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 14
Number of participants with account balances 2009-01-01 14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2022: CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	18
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	17
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	1
Total of all active and inactive participants	2022-01-01	18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	18
Number of participants with account balances	2022-01-01	17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	18
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	18
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	18
Number of participants with account balances	2021-01-01	17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	19
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	18
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	18
Number of participants with account balances	2020-01-01	16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	15
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	16
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	3
Total of all active and inactive participants	2019-01-01	19
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	19
Number of participants with account balances	2019-01-01	18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2011: CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	15
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	13
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	4
Total of all active and inactive participants	2011-01-01	17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	17
Number of participants with account balances	2011-01-01	17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	15
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	10
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	4
Total of all active and inactive participants	2009-01-01	14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	14
Number of participants with account balances	2009-01-01	14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN

Measure	Date	Value
2022 : CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN 2022 401k financial data
Transfers to/from the plan	2022-12-31	$0
Total plan liabilities at end of year	2022-12-31	$0
Total plan liabilities at beginning of year	2022-12-31	$0
Total income from all sources	2022-12-31	$-193,221
Expenses. Total of all expenses incurred	2022-12-31	$31,935
Benefits paid (including direct rollovers)	2022-12-31	$13,497
Total plan assets at end of year	2022-12-31	$1,677,590
Total plan assets at beginning of year	2022-12-31	$1,902,746
Value of fidelity bond covering the plan	2022-12-31	$380,000
Assets. Value of tangible personal property	2022-12-31	$0
Total contributions received or receivable from participants	2022-12-31	$100,439
Assets. Value of loans (other than to participants)	2022-12-31	$0
Expenses. Other expenses not covered elsewhere	2022-12-31	$0
Contributions received from other sources (not participants or employers)	2022-12-31	$1,158
Other income received	2022-12-31	$-338,349
Noncash contributions received	2022-12-31	$0
Net income (gross income less expenses)	2022-12-31	$-225,156
Net plan assets at end of year (total assets less liabilities)	2022-12-31	$1,677,590
Net plan assets at beginning of year (total assets less liabilities)	2022-12-31	$1,902,746
Assets. Value of participant loans	2022-12-31	$0
Assets. Value of assets in partnership/joint-venture interests	2022-12-31	$0
Assets. Value of real-estate (other than employer real property)	2022-12-31	$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102	2022-12-31	$0
Assets. Value of employer securities	2022-12-31	$0
Assets. Value of employer real property	2022-12-31	$0
Total contributions received or receivable from employer(s)	2022-12-31	$43,531
Value of certain deemed distributions of participant loans	2022-12-31	$0
Value of corrective distributions	2022-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2022-12-31	$18,438
2021 : CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN 2021 401k financial data
Transfers to/from the plan	2021-12-31	$0
Total plan liabilities at end of year	2021-12-31	$0
Total plan liabilities at beginning of year	2021-12-31	$0
Total income from all sources	2021-12-31	$373,879
Expenses. Total of all expenses incurred	2021-12-31	$16,455
Benefits paid (including direct rollovers)	2021-12-31	$-920
Total plan assets at end of year	2021-12-31	$1,902,746
Total plan assets at beginning of year	2021-12-31	$1,545,322
Value of fidelity bond covering the plan	2021-12-31	$130,000
Assets. Value of tangible personal property	2021-12-31	$0
Total contributions received or receivable from participants	2021-12-31	$80,119
Assets. Value of loans (other than to participants)	2021-12-31	$0
Expenses. Other expenses not covered elsewhere	2021-12-31	$0
Contributions received from other sources (not participants or employers)	2021-12-31	$26,957
Other income received	2021-12-31	$222,534
Noncash contributions received	2021-12-31	$0
Net income (gross income less expenses)	2021-12-31	$357,424
Net plan assets at end of year (total assets less liabilities)	2021-12-31	$1,902,746
Net plan assets at beginning of year (total assets less liabilities)	2021-12-31	$1,545,322
Assets. Value of participant loans	2021-12-31	$0
Assets. Value of assets in partnership/joint-venture interests	2021-12-31	$0
Assets. Value of real-estate (other than employer real property)	2021-12-31	$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102	2021-12-31	$0
Assets. Value of employer securities	2021-12-31	$0
Assets. Value of employer real property	2021-12-31	$0
Total contributions received or receivable from employer(s)	2021-12-31	$44,269
Value of certain deemed distributions of participant loans	2021-12-31	$0
Value of corrective distributions	2021-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2021-12-31	$17,375
2020 : CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN 2020 401k financial data
Transfers to/from the plan	2020-12-31	$0
Total plan liabilities at end of year	2020-12-31	$0
Total plan liabilities at beginning of year	2020-12-31	$0
Total income from all sources	2020-12-31	$349,094
Expenses. Total of all expenses incurred	2020-12-31	$24,395
Benefits paid (including direct rollovers)	2020-12-31	$13,022
Total plan assets at end of year	2020-12-31	$1,545,322
Total plan assets at beginning of year	2020-12-31	$1,220,623
Value of fidelity bond covering the plan	2020-12-31	$130,000
Total contributions received or receivable from participants	2020-12-31	$75,486
Expenses. Other expenses not covered elsewhere	2020-12-31	$0
Contributions received from other sources (not participants or employers)	2020-12-31	$19,465
Other income received	2020-12-31	$207,073
Noncash contributions received	2020-12-31	$0
Net income (gross income less expenses)	2020-12-31	$324,699
Net plan assets at end of year (total assets less liabilities)	2020-12-31	$1,545,322
Net plan assets at beginning of year (total assets less liabilities)	2020-12-31	$1,220,623
Assets. Value of participant loans	2020-12-31	$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102	2020-12-31	$0
Total contributions received or receivable from employer(s)	2020-12-31	$47,070
Value of certain deemed distributions of participant loans	2020-12-31	$0
Value of corrective distributions	2020-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2020-12-31	$11,373
2019 : CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN 2019 401k financial data
Transfers to/from the plan	2019-12-31	$0
Total plan liabilities at end of year	2019-12-31	$0
Total plan liabilities at beginning of year	2019-12-31	$0
Total income from all sources	2019-12-31	$331,287
Expenses. Total of all expenses incurred	2019-12-31	$211,039
Benefits paid (including direct rollovers)	2019-12-31	$210,580
Total plan assets at end of year	2019-12-31	$1,220,623
Total plan assets at beginning of year	2019-12-31	$1,100,375
Value of fidelity bond covering the plan	2019-12-31	$100,000
Total contributions received or receivable from participants	2019-12-31	$60,220
Expenses. Other expenses not covered elsewhere	2019-12-31	$0
Contributions received from other sources (not participants or employers)	2019-12-31	$0
Other income received	2019-12-31	$228,369
Noncash contributions received	2019-12-31	$0
Net income (gross income less expenses)	2019-12-31	$120,248
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$1,220,623
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$1,100,375
Assets. Value of participant loans	2019-12-31	$3,542
Total contributions received or receivable from employer(s)	2019-12-31	$42,698
Value of certain deemed distributions of participant loans	2019-12-31	$0
Value of corrective distributions	2019-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2019-12-31	$459
2011 : CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$32,736
Expenses. Total of all expenses incurred	2011-12-31	$11,853
Benefits paid (including direct rollovers)	2011-12-31	$11,000
Total plan assets at end of year	2011-12-31	$447,442
Total plan assets at beginning of year	2011-12-31	$426,559
Value of fidelity bond covering the plan	2011-12-31	$200,000
Total contributions received or receivable from participants	2011-12-31	$35,636
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-24,797
Net income (gross income less expenses)	2011-12-31	$20,883
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$447,442
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$426,559
Assets. Value of participant loans	2011-12-31	$12,459
Total contributions received or receivable from employer(s)	2011-12-31	$21,897
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$853
2010 : CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$108,062
Expenses. Total of all expenses incurred	2010-12-31	$16,766
Benefits paid (including direct rollovers)	2010-12-31	$15,918
Total plan assets at end of year	2010-12-31	$426,559
Total plan assets at beginning of year	2010-12-31	$335,263
Value of fidelity bond covering the plan	2010-12-31	$200,000
Total contributions received or receivable from participants	2010-12-31	$36,579
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$48,162
Net income (gross income less expenses)	2010-12-31	$91,296
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$426,559
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$335,263
Assets. Value of participant loans	2010-12-31	$21,548
Total contributions received or receivable from employer(s)	2010-12-31	$23,321
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$848

Form 5500 Responses for CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN

2022: CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	This submission is the final filing	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	This submission is the final filing	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	This submission is the final filing	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2011: CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) 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	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: CARPETIME INC. DBA BLOOMINGTON CARPET ONE FLOOR & HOME 401(K) 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	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )

Policy contract number

940382

Policy instance

Insurance contract or identification number	940382
Number of Individuals Covered	17
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $876
Total amount of fees paid to insurance company	USD $0
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?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )

Policy contract number

940382

Policy instance

Insurance contract or identification number	940382
Number of Individuals Covered	15
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $735
Total amount of fees paid to insurance company	USD $0
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	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $735
Insurance broker organization code?	4
Insurance broker name	MORGAN STANLEY SMITH BARNEY LLC

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Company Name:	BLOOMINGTON CARPET ONE
Employer identification number (EIN):	411631922
NAIC Classification:	442210
NAIC Description:	Floor Covering Stores