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AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 401k Plan overview

Plan NameAMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN
Plan identification number 501

AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental
  • Vision

401k Sponsoring company profile

AMERICAN TIRE DISTRIBUTORS, INC. has sponsored the creation of one or more 401k plans.

Company Name:AMERICAN TIRE DISTRIBUTORS, INC.
Employer identification number (EIN):560754594
NAIC Classification:423100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-12-01
5012019-12-01
5012019-12-01
5012018-12-01
5012018-12-01
5012017-12-01
5012017-12-01
5012016-12-01REBECCA SINCLAIR
5012015-12-01LAURIE HEAVNER
5012014-12-01LAURIE HEAVNER
5012013-12-01LAURIE HEAVNER
5012012-12-01LAURIE HEAVNER
5012011-12-01LAURIE HEAVNER2013-09-12
5012009-12-01LAURIE HEAVNER JASON YAUDES2011-09-15
5012008-12-01

Plan Statistics for AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN

401k plan membership statisitcs for AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN

Measure Date Value
2022: AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-013,568
Total number of active participants reported on line 7a of the Form 55002022-01-013,646
Number of retired or separated participants receiving benefits2022-01-0164
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-013,710
2021: AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-013,754
Total number of active participants reported on line 7a of the Form 55002021-01-013,537
Number of retired or separated participants receiving benefits2021-01-0131
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-013,568
2020: AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-12-014,470
Total number of active participants reported on line 7a of the Form 55002020-12-013,708
Number of retired or separated participants receiving benefits2020-12-0146
Number of other retired or separated participants entitled to future benefits2020-12-010
Total of all active and inactive participants2020-12-013,754
2019: AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-12-013,943
Total number of active participants reported on line 7a of the Form 55002019-12-013,600
Number of retired or separated participants receiving benefits2019-12-0127
Number of other retired or separated participants entitled to future benefits2019-12-010
Total of all active and inactive participants2019-12-013,627
2018: AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-12-014,690
Total number of active participants reported on line 7a of the Form 55002018-12-013,912
Number of retired or separated participants receiving benefits2018-12-0131
Number of other retired or separated participants entitled to future benefits2018-12-010
Total of all active and inactive participants2018-12-013,943
2017: AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-12-014,814
Total number of active participants reported on line 7a of the Form 55002017-12-014,654
Number of retired or separated participants receiving benefits2017-12-0136
Number of other retired or separated participants entitled to future benefits2017-12-010
Total of all active and inactive participants2017-12-014,690
2016: AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-12-014,343
Total number of active participants reported on line 7a of the Form 55002016-12-014,666
Number of retired or separated participants receiving benefits2016-12-0117
Number of other retired or separated participants entitled to future benefits2016-12-01131
Total of all active and inactive participants2016-12-014,814
2015: AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-12-014,650
Total number of active participants reported on line 7a of the Form 55002015-12-014,165
Number of retired or separated participants receiving benefits2015-12-0119
Number of other retired or separated participants entitled to future benefits2015-12-01113
Total of all active and inactive participants2015-12-014,297
2014: AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-12-013,889
Total number of active participants reported on line 7a of the Form 55002014-12-014,108
Number of retired or separated participants receiving benefits2014-12-010
Number of other retired or separated participants entitled to future benefits2014-12-014
Total of all active and inactive participants2014-12-014,112
Total participants2014-12-014,112
2013: AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-12-013,172
Total number of active participants reported on line 7a of the Form 55002013-12-013,889
Number of retired or separated participants receiving benefits2013-12-0132
Number of other retired or separated participants entitled to future benefits2013-12-01301
Total of all active and inactive participants2013-12-014,222
Total participants2013-12-014,222
2012: AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-12-013,254
Total number of active participants reported on line 7a of the Form 55002012-12-013,172
Number of retired or separated participants receiving benefits2012-12-0126
Number of other retired or separated participants entitled to future benefits2012-12-01174
Total of all active and inactive participants2012-12-013,372
Total participants2012-12-013,372
2011: AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-12-012,834
Total number of active participants reported on line 7a of the Form 55002011-12-013,254
Number of retired or separated participants receiving benefits2011-12-0172
Number of other retired or separated participants entitled to future benefits2011-12-01657
Total of all active and inactive participants2011-12-013,983
Total participants2011-12-013,983
2009: AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-12-012,234
Total number of active participants reported on line 7a of the Form 55002009-12-012,354
Number of retired or separated participants receiving benefits2009-12-0129
Number of other retired or separated participants entitled to future benefits2009-12-0158
Total of all active and inactive participants2009-12-012,441
Total participants2009-12-012,441

Financial Data on AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN

Measure Date Value
2021 : AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total transfer of assets to this plan2021-12-31$0
Total transfer of assets from this plan2021-12-31$1,435,628
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$1,135,935
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$30,972,971
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$30,819,889
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$29,255,151
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$30,972,971
Value of total assets at end of year2021-12-31$1,135,935
Value of total assets at beginning of year2021-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$1,564,738
Total interest from all sources2021-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Administrative expenses professional fees incurred2021-12-31$1,564,738
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$10,000,000
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$9,469,359
Assets. Other investments not covered elsewhere at end of year2021-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2021-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$1,869,162
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$613,019
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$0
Liabilities. Value of operating payables at end of year2021-12-31$3,900
Liabilities. Value of operating payables at beginning of year2021-12-31$0
Total non interest bearing cash at end of year2021-12-31$0
Total non interest bearing cash at beginning of year2021-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$0
Value of net assets at end of year (total assets less liabilities)2021-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$1,299,056
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$19,634,450
Employer contributions (assets) at end of year2021-12-31$522,916
Employer contributions (assets) at beginning of year2021-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$27,956,095
Liabilities. Value of benefit claims payable at end of year2021-12-31$1,132,035
Liabilities. Value of benefit claims payable at beginning of year2021-12-31$0
Did the plan have assets held for investment2021-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31BDO USA, LLP
Accountancy firm EIN2021-12-31135381590
2020 : AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$0
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$0
Value of total assets at end of year2020-12-31$449,279
Value of total assets at beginning of year2020-12-31$-1,593,563
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$0
Total interest from all sources2020-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$10,000,000
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Assets. Other investments not covered elsewhere at end of year2020-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2020-12-31$-2,153,910
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$0
Liabilities. Value of operating payables at end of year2020-12-31$0
Liabilities. Value of operating payables at beginning of year2020-12-31$0
Total non interest bearing cash at end of year2020-12-31$449,279
Total non interest bearing cash at beginning of year2020-12-31$449,279
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$0
Value of net assets at end of year (total assets less liabilities)2020-12-31$449,279
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$-1,593,563
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Employer contributions (assets) at end of year2020-12-31$0
Employer contributions (assets) at beginning of year2020-12-31$111,068
Liabilities. Value of benefit claims payable at end of year2020-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2020-12-31$0
Did the plan have assets held for investment2020-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31BDO USA, LLP
Accountancy firm EIN2020-12-31135381590
Total unrealized appreciation/depreciation of assets2020-11-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-11-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-11-30$4,775,619
Total income from all sources (including contributions)2020-11-30$0
Total loss/gain on sale of assets2020-11-30$0
Total of all expenses incurred2020-11-30$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-11-30$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-11-30$0
Value of total assets at end of year2020-11-30$-2,153,910
Value of total assets at beginning of year2020-11-30$2,621,709
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-11-30$0
Total interest from all sources2020-11-30$0
Total dividends received (eg from common stock, registered investment company shares)2020-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-11-30No
Administrative expenses professional fees incurred2020-11-30$3,787,195
Was this plan covered by a fidelity bond2020-11-30Yes
Value of fidelity bond cover2020-11-30$10,000,000
Were there any nonexempt tranactions with any party-in-interest2020-11-30No
Contributions received from participants2020-11-30$0
Assets. Other investments not covered elsewhere at end of year2020-11-30$-2,153,910
Assets. Other investments not covered elsewhere at beginning of year2020-11-30$1,061,749
Income. Received or receivable in cash from other sources (including rollovers)2020-11-30$2,390,565
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-11-30$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-11-30$0
Liabilities. Value of operating payables at end of year2020-11-30$0
Liabilities. Value of operating payables at beginning of year2020-11-30$15,626
Total non interest bearing cash at end of year2020-11-30$0
Total non interest bearing cash at beginning of year2020-11-30$449,279
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-11-30No
Value of net income/loss2020-11-30$0
Value of net assets at end of year (total assets less liabilities)2020-11-30$-2,153,910
Value of net assets at beginning of year (total assets less liabilities)2020-11-30$-2,153,910
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2020-11-30No
Were any leases to which the plan was party in default or uncollectible2020-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2020-11-30$1,608,500
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-11-30No
Was there a failure to transmit to the plan any participant contributions2020-11-30No
Has the plan failed to provide any benefit when due under the plan2020-11-30No
Contributions received in cash from employer2020-11-30$0
Employer contributions (assets) at end of year2020-11-30$0
Employer contributions (assets) at beginning of year2020-11-30$1,110,681
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-11-30$34,916,009
Liabilities. Value of benefit claims payable at end of year2020-11-30$0
Liabilities. Value of benefit claims payable at beginning of year2020-11-30$4,759,993
Did the plan have assets held for investment2020-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-11-30No
Opinion of an independent qualified public accountant for this plan2020-11-30Unqualified
Accountancy firm name2020-11-30BDO USA, LLP
Accountancy firm EIN2020-11-30135381590
2019 : AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-11-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-11-30$4,775,619
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-11-30$2,798,765
Total income from all sources (including contributions)2019-11-30$45,821,103
Total loss/gain on sale of assets2019-11-30$0
Total of all expenses incurred2019-11-30$46,180,578
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-11-30$43,186,838
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-11-30$43,363,627
Value of total assets at end of year2019-11-30$2,621,709
Value of total assets at beginning of year2019-11-30$1,004,330
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-11-30$2,993,740
Total interest from all sources2019-11-30$0
Total dividends received (eg from common stock, registered investment company shares)2019-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-11-30No
Administrative expenses professional fees incurred2019-11-30$211,119
Was this plan covered by a fidelity bond2019-11-30Yes
Value of fidelity bond cover2019-11-30$10,000,000
Were there any nonexempt tranactions with any party-in-interest2019-11-30No
Contributions received from participants2019-11-30$11,506,541
Assets. Other investments not covered elsewhere at end of year2019-11-30$1,061,749
Assets. Other investments not covered elsewhere at beginning of year2019-11-30$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-11-30$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-11-30$15,368
Other income not declared elsewhere2019-11-30$2,457,476
Liabilities. Value of operating payables at end of year2019-11-30$15,626
Liabilities. Value of operating payables at beginning of year2019-11-30$17,477
Total non interest bearing cash at end of year2019-11-30$449,279
Total non interest bearing cash at beginning of year2019-11-30$427,435
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-11-30No
Value of net income/loss2019-11-30$-359,475
Value of net assets at end of year (total assets less liabilities)2019-11-30$-2,153,910
Value of net assets at beginning of year (total assets less liabilities)2019-11-30$-1,794,435
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2019-11-30No
Were any leases to which the plan was party in default or uncollectible2019-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2019-11-30$2,080,535
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-11-30No
Was there a failure to transmit to the plan any participant contributions2019-11-30No
Has the plan failed to provide any benefit when due under the plan2019-11-30No
Contributions received in cash from employer2019-11-30$31,857,086
Employer contributions (assets) at end of year2019-11-30$1,110,681
Employer contributions (assets) at beginning of year2019-11-30$561,527
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-11-30$41,106,303
Contract administrator fees2019-11-30$2,782,621
Liabilities. Value of benefit claims payable at end of year2019-11-30$4,759,993
Liabilities. Value of benefit claims payable at beginning of year2019-11-30$2,781,288
Did the plan have assets held for investment2019-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-11-30No
Opinion of an independent qualified public accountant for this plan2019-11-30Unqualified
Accountancy firm name2019-11-30BDO USA, LLP
Accountancy firm EIN2019-11-30135381590
2018 : AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-11-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-11-30$561,527
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-11-30$3,580,488
Total income from all sources (including contributions)2018-11-30$38,177,512
Total loss/gain on sale of assets2018-11-30$0
Total of all expenses incurred2018-11-30$35,745,641
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-11-30$31,869,680
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-11-30$38,177,512
Value of total assets at end of year2018-11-30$1,022,654
Value of total assets at beginning of year2018-11-30$1,609,744
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-11-30$3,875,961
Total interest from all sources2018-11-30$0
Total dividends received (eg from common stock, registered investment company shares)2018-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-11-30No
Was this plan covered by a fidelity bond2018-11-30Yes
Value of fidelity bond cover2018-11-30$10,000,000
Were there any nonexempt tranactions with any party-in-interest2018-11-30No
Contributions received from participants2018-11-30$11,851,736
Income. Received or receivable in cash from other sources (including rollovers)2018-11-30$1,921,101
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-11-30$33,692
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-11-30$178,443
Other income not declared elsewhere2018-11-30$1,921,101
Liabilities. Value of operating payables at end of year2018-11-30$17,477
Liabilities. Value of operating payables at beginning of year2018-11-30$0
Total non interest bearing cash at end of year2018-11-30$427,435
Total non interest bearing cash at beginning of year2018-11-30$54,795
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-11-30No
Value of net income/loss2018-11-30$2,431,871
Value of net assets at end of year (total assets less liabilities)2018-11-30$461,127
Value of net assets at beginning of year (total assets less liabilities)2018-11-30$-1,970,744
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2018-11-30No
Were any leases to which the plan was party in default or uncollectible2018-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2018-11-30$1,661,932
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-11-30No
Was there a failure to transmit to the plan any participant contributions2018-11-30No
Has the plan failed to provide any benefit when due under the plan2018-11-30No
Contributions received in cash from employer2018-11-30$24,404,675
Employer contributions (assets) at end of year2018-11-30$561,527
Employer contributions (assets) at beginning of year2018-11-30$1,376,506
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-11-30$30,207,748
Contract administrator fees2018-11-30$3,875,961
Liabilities. Value of benefit claims payable at end of year2018-11-30$544,050
Liabilities. Value of benefit claims payable at beginning of year2018-11-30$3,580,488
Did the plan have assets held for investment2018-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-11-30No
Opinion of an independent qualified public accountant for this plan2018-11-30Unqualified
Accountancy firm name2018-11-30BDO USA, LLP
Accountancy firm EIN2018-11-30135381590
2017 : AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-11-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-11-30$3,580,488
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-11-30$2,710,662
Total income from all sources (including contributions)2017-11-30$41,839,391
Total loss/gain on sale of assets2017-11-30$0
Total of all expenses incurred2017-11-30$41,971,330
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-11-30$38,873,602
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-11-30$41,839,391
Value of total assets at end of year2017-11-30$1,609,744
Value of total assets at beginning of year2017-11-30$871,857
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-11-30$3,097,728
Total interest from all sources2017-11-30$0
Total dividends received (eg from common stock, registered investment company shares)2017-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-11-30No
Was this plan covered by a fidelity bond2017-11-30Yes
Value of fidelity bond cover2017-11-30$10,000,000
Were there any nonexempt tranactions with any party-in-interest2017-11-30No
Contributions received from participants2017-11-30$10,660,094
Income. Received or receivable in cash from other sources (including rollovers)2017-11-30$1,089,685
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-11-30$178,443
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-11-30$399,558
Total non interest bearing cash at end of year2017-11-30$54,795
Total non interest bearing cash at beginning of year2017-11-30$145,810
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-11-30No
Value of net income/loss2017-11-30$-131,939
Value of net assets at end of year (total assets less liabilities)2017-11-30$-1,970,744
Value of net assets at beginning of year (total assets less liabilities)2017-11-30$-1,838,805
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2017-11-30No
Were any leases to which the plan was party in default or uncollectible2017-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2017-11-30$1,419,887
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-11-30No
Was there a failure to transmit to the plan any participant contributions2017-11-30No
Has the plan failed to provide any benefit when due under the plan2017-11-30No
Contributions received in cash from employer2017-11-30$30,089,612
Employer contributions (assets) at end of year2017-11-30$1,376,506
Employer contributions (assets) at beginning of year2017-11-30$326,489
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-11-30$37,453,715
Contract administrator fees2017-11-30$3,097,728
Liabilities. Value of benefit claims payable at end of year2017-11-30$3,580,488
Liabilities. Value of benefit claims payable at beginning of year2017-11-30$2,710,662
Did the plan have assets held for investment2017-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-11-30No
Opinion of an independent qualified public accountant for this plan2017-11-30Unqualified
Accountancy firm name2017-11-30BDO USA, LLP
Accountancy firm EIN2017-11-30135381590
2016 : AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-11-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-11-30$2,710,662
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-11-30$3,492,968
Total income from all sources (including contributions)2016-11-30$37,541,635
Total loss/gain on sale of assets2016-11-30$0
Total of all expenses incurred2016-11-30$36,481,364
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-11-30$33,405,042
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-11-30$37,541,635
Value of total assets at end of year2016-11-30$871,857
Value of total assets at beginning of year2016-11-30$593,892
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-11-30$3,076,322
Total interest from all sources2016-11-30$0
Total dividends received (eg from common stock, registered investment company shares)2016-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-11-30No
Was this plan covered by a fidelity bond2016-11-30Yes
Value of fidelity bond cover2016-11-30$10,000,000
Were there any nonexempt tranactions with any party-in-interest2016-11-30No
Contributions received from participants2016-11-30$10,918,359
Participant contributions at end of year2016-11-30$0
Participant contributions at beginning of year2016-11-30$593,892
Income. Received or receivable in cash from other sources (including rollovers)2016-11-30$951,025
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-11-30$399,558
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-11-30$0
Liabilities. Value of operating payables at end of year2016-11-30$0
Liabilities. Value of operating payables at beginning of year2016-11-30$59,381
Total non interest bearing cash at end of year2016-11-30$145,810
Total non interest bearing cash at beginning of year2016-11-30$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-11-30No
Value of net income/loss2016-11-30$1,060,271
Value of net assets at end of year (total assets less liabilities)2016-11-30$-1,838,805
Value of net assets at beginning of year (total assets less liabilities)2016-11-30$-2,899,076
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2016-11-30No
Were any leases to which the plan was party in default or uncollectible2016-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2016-11-30$1,914,397
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-11-30No
Was there a failure to transmit to the plan any participant contributions2016-11-30No
Has the plan failed to provide any benefit when due under the plan2016-11-30No
Contributions received in cash from employer2016-11-30$25,672,251
Employer contributions (assets) at end of year2016-11-30$326,489
Employer contributions (assets) at beginning of year2016-11-30$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-11-30$31,490,645
Contract administrator fees2016-11-30$3,076,322
Liabilities. Value of benefit claims payable at end of year2016-11-30$2,710,662
Liabilities. Value of benefit claims payable at beginning of year2016-11-30$3,433,587
Did the plan have assets held for investment2016-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-11-30No
Opinion of an independent qualified public accountant for this plan2016-11-30Unqualified
Accountancy firm name2016-11-30BDO LLP USA
Accountancy firm EIN2016-11-30135318159
2015 : AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-11-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-11-30$3,492,968
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-11-30$2,345,970
Total income from all sources (including contributions)2015-11-30$34,614,103
Total loss/gain on sale of assets2015-11-30$0
Total of all expenses incurred2015-11-30$35,639,746
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-11-30$33,217,136
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-11-30$34,614,103
Value of total assets at end of year2015-11-30$593,892
Value of total assets at beginning of year2015-11-30$472,537
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-11-30$2,422,610
Total interest from all sources2015-11-30$0
Total dividends received (eg from common stock, registered investment company shares)2015-11-30$0
Was this plan covered by a fidelity bond2015-11-30Yes
Value of fidelity bond cover2015-11-30$10,000,000
If this is an individual account plan, was there a blackout period2015-11-30No
Were there any nonexempt tranactions with any party-in-interest2015-11-30No
Contributions received from participants2015-11-30$8,841,104
Income. Received or receivable in cash from other sources (including rollovers)2015-11-30$335,351
Liabilities. Value of operating payables at end of year2015-11-30$59,381
Liabilities. Value of operating payables at beginning of year2015-11-30$38,283
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-11-30No
Value of net income/loss2015-11-30$-1,025,643
Value of net assets at end of year (total assets less liabilities)2015-11-30$-2,899,076
Value of net assets at beginning of year (total assets less liabilities)2015-11-30$-1,873,433
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2015-11-30No
Were any leases to which the plan was party in default or uncollectible2015-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2015-11-30$1,978,259
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-11-30No
Was there a failure to transmit to the plan any participant contributions2015-11-30No
Has the plan failed to provide any benefit when due under the plan2015-11-30No
Contributions received in cash from employer2015-11-30$25,437,648
Employer contributions (assets) at end of year2015-11-30$593,892
Employer contributions (assets) at beginning of year2015-11-30$472,537
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-11-30$31,238,877
Contract administrator fees2015-11-30$2,422,610
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32015-11-30No
Liabilities. Value of benefit claims payable at end of year2015-11-30$3,433,587
Liabilities. Value of benefit claims payable at beginning of year2015-11-30$2,307,687
Did the plan have assets held for investment2015-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-11-30No
Opinion of an independent qualified public accountant for this plan2015-11-30Unqualified
Accountancy firm name2015-11-30BDO LLP USA
Accountancy firm EIN2015-11-30135318159
2014 : AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-11-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-11-30$2,345,970
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-11-30$2,138,183
Total income from all sources (including contributions)2014-11-30$26,448,497
Total loss/gain on sale of assets2014-11-30$0
Total of all expenses incurred2014-11-30$26,572,618
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-11-30$24,701,545
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-11-30$26,448,497
Value of total assets at end of year2014-11-30$472,537
Value of total assets at beginning of year2014-11-30$388,871
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-11-30$1,871,073
Total interest from all sources2014-11-30$0
Total dividends received (eg from common stock, registered investment company shares)2014-11-30$0
Was this plan covered by a fidelity bond2014-11-30Yes
Value of fidelity bond cover2014-11-30$10,000,000
If this is an individual account plan, was there a blackout period2014-11-30No
Were there any nonexempt tranactions with any party-in-interest2014-11-30No
Contributions received from participants2014-11-30$8,515,122
Income. Received or receivable in cash from other sources (including rollovers)2014-11-30$273,012
Liabilities. Value of operating payables at end of year2014-11-30$38,283
Liabilities. Value of operating payables at beginning of year2014-11-30$37,256
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-11-30No
Value of net income/loss2014-11-30$-124,121
Value of net assets at end of year (total assets less liabilities)2014-11-30$-1,873,433
Value of net assets at beginning of year (total assets less liabilities)2014-11-30$-1,749,312
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2014-11-30No
Were any leases to which the plan was party in default or uncollectible2014-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2014-11-30$1,707,876
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-11-30No
Was there a failure to transmit to the plan any participant contributions2014-11-30No
Has the plan failed to provide any benefit when due under the plan2014-11-30No
Contributions received in cash from employer2014-11-30$17,660,363
Employer contributions (assets) at end of year2014-11-30$472,537
Employer contributions (assets) at beginning of year2014-11-30$388,871
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-11-30$22,993,669
Contract administrator fees2014-11-30$1,871,073
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32014-11-30No
Liabilities. Value of benefit claims payable at end of year2014-11-30$2,307,687
Liabilities. Value of benefit claims payable at beginning of year2014-11-30$2,100,927
Did the plan have assets held for investment2014-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-11-30No
Opinion of an independent qualified public accountant for this plan2014-11-30Unqualified
Accountancy firm name2014-11-30BDO LLP USA
Accountancy firm EIN2014-11-30135318159
2013 : AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-11-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-11-30$2,138,183
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-11-30$2,406,901
Total income from all sources (including contributions)2013-11-30$24,343,911
Total loss/gain on sale of assets2013-11-30$0
Total of all expenses incurred2013-11-30$24,102,910
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-11-30$22,376,425
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-11-30$24,343,911
Value of total assets at end of year2013-11-30$388,871
Value of total assets at beginning of year2013-11-30$416,588
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-11-30$1,726,485
Total interest from all sources2013-11-30$0
Total dividends received (eg from common stock, registered investment company shares)2013-11-30$0
Was this plan covered by a fidelity bond2013-11-30Yes
Value of fidelity bond cover2013-11-30$10,000,000
If this is an individual account plan, was there a blackout period2013-11-30No
Were there any nonexempt tranactions with any party-in-interest2013-11-30No
Contributions received from participants2013-11-30$7,684,570
Income. Received or receivable in cash from other sources (including rollovers)2013-11-30$222,000
Liabilities. Value of operating payables at end of year2013-11-30$37,256
Liabilities. Value of operating payables at beginning of year2013-11-30$31,188
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-11-30No
Value of net income/loss2013-11-30$241,001
Value of net assets at end of year (total assets less liabilities)2013-11-30$-1,749,312
Value of net assets at beginning of year (total assets less liabilities)2013-11-30$-1,990,313
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2013-11-30No
Were any leases to which the plan was party in default or uncollectible2013-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2013-11-30$1,583,521
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-11-30No
Was there a failure to transmit to the plan any participant contributions2013-11-30No
Has the plan failed to provide any benefit when due under the plan2013-11-30No
Contributions received in cash from employer2013-11-30$16,437,341
Employer contributions (assets) at end of year2013-11-30$388,871
Employer contributions (assets) at beginning of year2013-11-30$416,588
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-11-30$20,792,904
Contract administrator fees2013-11-30$1,726,485
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32013-11-30No
Liabilities. Value of benefit claims payable at end of year2013-11-30$2,100,927
Liabilities. Value of benefit claims payable at beginning of year2013-11-30$2,375,713
Did the plan have assets held for investment2013-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-11-30No
Opinion of an independent qualified public accountant for this plan2013-11-30Unqualified
Accountancy firm name2013-11-30BDO LLP USA
Accountancy firm EIN2013-11-30135318159
2012 : AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-11-30$2,406,901
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-11-30$2,277,559
Total income from all sources (including contributions)2012-11-30$23,615,859
Total of all expenses incurred2012-11-30$23,681,091
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-11-30$21,763,196
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-11-30$23,615,859
Value of total assets at end of year2012-11-30$416,588
Value of total assets at beginning of year2012-11-30$352,478
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-11-30$1,917,895
Was this plan covered by a fidelity bond2012-11-30Yes
Value of fidelity bond cover2012-11-30$10,000,000
Were there any nonexempt tranactions with any party-in-interest2012-11-30No
Contributions received from participants2012-11-30$6,840,728
Income. Received or receivable in cash from other sources (including rollovers)2012-11-30$119,990
Liabilities. Value of operating payables at end of year2012-11-30$31,188
Liabilities. Value of operating payables at beginning of year2012-11-30$40,308
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-11-30No
Value of net income/loss2012-11-30$-65,232
Value of net assets at end of year (total assets less liabilities)2012-11-30$-1,990,313
Value of net assets at beginning of year (total assets less liabilities)2012-11-30$-1,925,081
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2012-11-30No
Were any leases to which the plan was party in default or uncollectible2012-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2012-11-30$1,843,352
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-11-30No
Was there a failure to transmit to the plan any participant contributions2012-11-30No
Has the plan failed to provide any benefit when due under the plan2012-11-30No
Contributions received in cash from employer2012-11-30$16,655,141
Employer contributions (assets) at end of year2012-11-30$416,588
Employer contributions (assets) at beginning of year2012-11-30$352,478
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-11-30$19,919,844
Contract administrator fees2012-11-30$1,917,895
Liabilities. Value of benefit claims payable at end of year2012-11-30$2,375,713
Liabilities. Value of benefit claims payable at beginning of year2012-11-30$2,237,251
Did the plan have assets held for investment2012-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-11-30No
Opinion of an independent qualified public accountant for this plan2012-11-30Unqualified
Accountancy firm name2012-11-30BDO LLP USA
Accountancy firm EIN2012-11-30135318159
2011 : AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-11-30$2,277,559
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-11-30$148,467
Total income from all sources (including contributions)2011-11-30$20,566,474
Total of all expenses incurred2011-11-30$22,491,555
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-11-30$20,649,111
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-11-30$20,566,474
Value of total assets at end of year2011-11-30$352,478
Value of total assets at beginning of year2011-11-30$148,467
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-11-30$1,842,444
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-11-30No
Was this plan covered by a fidelity bond2011-11-30Yes
Value of fidelity bond cover2011-11-30$10,000,000
Were there any nonexempt tranactions with any party-in-interest2011-11-30No
Contributions received from participants2011-11-30$4,950,787
Income. Received or receivable in cash from other sources (including rollovers)2011-11-30$626,966
Liabilities. Value of operating payables at end of year2011-11-30$40,308
Liabilities. Value of operating payables at beginning of year2011-11-30$24,443
Total non interest bearing cash at end of year2011-11-30$0
Total non interest bearing cash at beginning of year2011-11-30$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-11-30No
Value of net income/loss2011-11-30$-1,925,081
Value of net assets at end of year (total assets less liabilities)2011-11-30$-1,925,081
Value of net assets at beginning of year (total assets less liabilities)2011-11-30$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2011-11-30No
Were any leases to which the plan was party in default or uncollectible2011-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2011-11-30$1,095,866
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-11-30No
Was there a failure to transmit to the plan any participant contributions2011-11-30No
Has the plan failed to provide any benefit when due under the plan2011-11-30No
Contributions received in cash from employer2011-11-30$14,988,721
Employer contributions (assets) at end of year2011-11-30$352,478
Employer contributions (assets) at beginning of year2011-11-30$148,467
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-11-30$19,553,245
Contract administrator fees2011-11-30$1,842,444
Liabilities. Value of benefit claims payable at end of year2011-11-30$2,237,251
Liabilities. Value of benefit claims payable at beginning of year2011-11-30$124,024
Did the plan have assets held for investment2011-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-11-30No
Opinion of an independent qualified public accountant for this plan2011-11-30Unqualified
Accountancy firm name2011-11-30BDO LLP USA
Accountancy firm EIN2011-11-30135318159

Form 5500 Responses for AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN

2022: AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedYes
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2020 form 5500 responses
2020-12-01Type of plan entitySingle employer plan
2020-12-01Submission has been amendedNo
2020-12-01This submission is the final filingNo
2020-12-01This return/report is a short plan year return/report (less than 12 months)Yes
2020-12-01Plan is a collectively bargained planNo
2020-12-01Plan funding arrangement – InsuranceYes
2020-12-01Plan funding arrangement – TrustYes
2020-12-01Plan funding arrangement – General assets of the sponsorYes
2020-12-01Plan benefit arrangement – InsuranceYes
2020-12-01Plan benefit arrangement - TrustYes
2020-12-01Plan benefit arrangement – General assets of the sponsorYes
2019: AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2019 form 5500 responses
2019-12-01Type of plan entitySingle employer plan
2019-12-01Submission has been amendedNo
2019-12-01This submission is the final filingNo
2019-12-01This return/report is a short plan year return/report (less than 12 months)No
2019-12-01Plan is a collectively bargained planNo
2019-12-01Plan funding arrangement – InsuranceYes
2019-12-01Plan funding arrangement – TrustYes
2019-12-01Plan funding arrangement – General assets of the sponsorYes
2019-12-01Plan benefit arrangement – InsuranceYes
2019-12-01Plan benefit arrangement - TrustYes
2019-12-01Plan benefit arrangement – General assets of the sponsorYes
2018: AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2018 form 5500 responses
2018-12-01Type of plan entitySingle employer plan
2018-12-01Submission has been amendedNo
2018-12-01This submission is the final filingNo
2018-12-01This return/report is a short plan year return/report (less than 12 months)No
2018-12-01Plan is a collectively bargained planNo
2018-12-01Plan funding arrangement – InsuranceYes
2018-12-01Plan funding arrangement – TrustYes
2018-12-01Plan funding arrangement – General assets of the sponsorYes
2018-12-01Plan benefit arrangement – InsuranceYes
2018-12-01Plan benefit arrangement - TrustYes
2018-12-01Plan benefit arrangement – General assets of the sponsorYes
2017: AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2017 form 5500 responses
2017-12-01Type of plan entitySingle employer plan
2017-12-01Submission has been amendedYes
2017-12-01This submission is the final filingNo
2017-12-01This return/report is a short plan year return/report (less than 12 months)No
2017-12-01Plan is a collectively bargained planNo
2017-12-01Plan funding arrangement – InsuranceYes
2017-12-01Plan funding arrangement – TrustYes
2017-12-01Plan funding arrangement – General assets of the sponsorYes
2017-12-01Plan benefit arrangement – InsuranceYes
2017-12-01Plan benefit arrangement - TrustYes
2017-12-01Plan benefit arrangement – General assets of the sponsorYes
2016: AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2016 form 5500 responses
2016-12-01Type of plan entitySingle employer plan
2016-12-01Submission has been amendedNo
2016-12-01This submission is the final filingNo
2016-12-01This return/report is a short plan year return/report (less than 12 months)No
2016-12-01Plan is a collectively bargained planNo
2016-12-01Plan funding arrangement – InsuranceYes
2016-12-01Plan funding arrangement – TrustYes
2016-12-01Plan funding arrangement – General assets of the sponsorYes
2016-12-01Plan benefit arrangement – InsuranceYes
2016-12-01Plan benefit arrangement - TrustYes
2016-12-01Plan benefit arrangement – General assets of the sponsorYes
2015: AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2015 form 5500 responses
2015-12-01Type of plan entitySingle employer plan
2015-12-01Submission has been amendedNo
2015-12-01This submission is the final filingNo
2015-12-01This return/report is a short plan year return/report (less than 12 months)No
2015-12-01Plan is a collectively bargained planNo
2015-12-01Plan funding arrangement – InsuranceYes
2015-12-01Plan funding arrangement – TrustYes
2015-12-01Plan benefit arrangement – InsuranceYes
2015-12-01Plan benefit arrangement - TrustYes
2014: AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2014 form 5500 responses
2014-12-01Type of plan entitySingle employer plan
2014-12-01Submission has been amendedNo
2014-12-01This submission is the final filingNo
2014-12-01This return/report is a short plan year return/report (less than 12 months)No
2014-12-01Plan is a collectively bargained planNo
2014-12-01Plan funding arrangement – InsuranceYes
2014-12-01Plan funding arrangement – TrustYes
2014-12-01Plan funding arrangement – General assets of the sponsorYes
2014-12-01Plan benefit arrangement – InsuranceYes
2014-12-01Plan benefit arrangement - TrustYes
2014-12-01Plan benefit arrangement – General assets of the sponsorYes
2013: AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2013 form 5500 responses
2013-12-01Type of plan entitySingle employer plan
2013-12-01Submission has been amendedNo
2013-12-01This submission is the final filingNo
2013-12-01This return/report is a short plan year return/report (less than 12 months)No
2013-12-01Plan is a collectively bargained planNo
2013-12-01Plan funding arrangement – InsuranceYes
2013-12-01Plan funding arrangement – TrustYes
2013-12-01Plan funding arrangement – General assets of the sponsorYes
2013-12-01Plan benefit arrangement – InsuranceYes
2013-12-01Plan benefit arrangement - TrustYes
2013-12-01Plan benefit arrangement – General assets of the sponsorYes
2012: AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2012 form 5500 responses
2012-12-01Type of plan entitySingle employer plan
2012-12-01Submission has been amendedNo
2012-12-01This submission is the final filingNo
2012-12-01This return/report is a short plan year return/report (less than 12 months)No
2012-12-01Plan is a collectively bargained planNo
2012-12-01Plan funding arrangement – InsuranceYes
2012-12-01Plan funding arrangement – TrustYes
2012-12-01Plan funding arrangement – General assets of the sponsorYes
2012-12-01Plan benefit arrangement – InsuranceYes
2012-12-01Plan benefit arrangement - TrustYes
2012-12-01Plan benefit arrangement – General assets of the sponsorYes
2011: AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2011 form 5500 responses
2011-12-01Type of plan entitySingle employer plan
2011-12-01Submission has been amendedNo
2011-12-01This submission is the final filingNo
2011-12-01This return/report is a short plan year return/report (less than 12 months)No
2011-12-01Plan is a collectively bargained planNo
2011-12-01Plan funding arrangement – InsuranceYes
2011-12-01Plan funding arrangement – TrustYes
2011-12-01Plan funding arrangement – General assets of the sponsorYes
2011-12-01Plan benefit arrangement – InsuranceYes
2011-12-01Plan benefit arrangement - TrustYes
2011-12-01Plan benefit arrangement – General assets of the sponsorYes
2009: AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2009 form 5500 responses
2009-12-01Type of plan entitySingle employer plan
2009-12-01Submission has been amendedNo
2009-12-01This submission is the final filingNo
2009-12-01This return/report is a short plan year return/report (less than 12 months)No
2009-12-01Plan is a collectively bargained planNo
2009-12-01Plan funding arrangement – InsuranceYes
2009-12-01Plan funding arrangement – TrustYes
2009-12-01Plan funding arrangement – General assets of the sponsorYes
2009-12-01Plan benefit arrangement – InsuranceYes
2009-12-01Plan benefit arrangement - TrustYes
2009-12-01Plan benefit arrangement – General assets of the sponsorYes
2008: AMERICAN TIRE DISTRIBUTORS EMPLOYEE WELFARE PLAN 2008 form 5500 responses
2008-12-01Type of plan entitySingle employer plan
2008-12-01Submission has been amendedNo
2008-12-01This submission is the final filingNo
2008-12-01This return/report is a short plan year return/report (less than 12 months)No
2008-12-01Plan is a collectively bargained planNo

Insurance Providers Used on plan

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL36321
Policy instance 1
Insurance contract or identification numberHCL36321
Number of Individuals Covered3538
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $25,981
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,299,056
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees21425
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number937260
Policy instance 1
Insurance contract or identification number937260
Number of Individuals Covered3645
Insurance policy start date2020-12-01
Insurance policy end date2020-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $127,439
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number937260
Policy instance 2
Insurance contract or identification number937260
Number of Individuals Covered3645
Insurance policy start date2020-01-01
Insurance policy end date2020-11-30
Total amount of commissions paid to insurance brokerUSD $16,535
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,438,956
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,535
Insurance broker organization code?3
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-013386-000
Policy instance 1
Insurance contract or identification number16-013386-000
Number of Individuals Covered3967
Insurance policy start date2019-12-01
Insurance policy end date2019-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $169,544
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-013386-000
Policy instance 2
Insurance contract or identification number16-013386-000
Number of Individuals Covered3967
Insurance policy start date2019-12-01
Insurance policy end date2019-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $138,652
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number937260
Policy instance 1
Insurance contract or identification number937260
Number of Individuals Covered3645
Insurance policy start date2020-01-01
Insurance policy end date2020-11-30
Total amount of commissions paid to insurance brokerUSD $16,535
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,438,956
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30016818
Policy instance 2
Insurance contract or identification number30016818
Number of Individuals Covered3639
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-013386-000
Policy instance 1
Insurance contract or identification number16-013386-000
Number of Individuals Covered3967
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,663,829
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30016818
Policy instance 2
Insurance contract or identification number30016818
Number of Individuals Covered3573
Insurance policy start date2017-12-01
Insurance policy end date2018-11-30
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-013386-000
Policy instance 1
Insurance contract or identification number16-013386-000
Number of Individuals Covered3996
Insurance policy start date2018-01-01
Insurance policy end date2018-11-30
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,794,719
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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