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| Plan Name | OCCUPATIONAL INJURY BENEFIT PLAN |
| Plan identification number | 518 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | ABC AUTO PARTS, LTD. |
| Employer identification number (EIN): | 751306065 |
| NAIC Classification: | 441300 |
| NAIC Description: | Automotive Parts, Accessories, and Tire Stores |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 518 | 2017-03-01 | KAREN CLOUD | KAREN CLOUD | 2018-07-23 | |
| 518 | 2016-03-01 | KAREN CLOUD | KAREN CLOUD | 2017-07-30 |
| Measure | Date | Value |
|---|---|---|
| 2017: OCCUPATIONAL INJURY BENEFIT PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-03-01 | 377 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-03-01 | 357 |
| Number of retired or separated participants receiving benefits | 2017-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-03-01 | 0 |
| Total of all active and inactive participants | 2017-03-01 | 357 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2017-03-01 | 0 |
| Total participants | 2017-03-01 | 357 |
| 2016: OCCUPATIONAL INJURY BENEFIT PLAN 2016 401k membership | ||
| Total participants, beginning-of-year | 2016-03-01 | 338 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-03-01 | 377 |
| Number of retired or separated participants receiving benefits | 2016-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-03-01 | 0 |
| Total of all active and inactive participants | 2016-03-01 | 377 |
| Total participants | 2016-03-01 | 377 |
| 2017: OCCUPATIONAL INJURY BENEFIT PLAN 2017 form 5500 responses | ||
|---|---|---|
| 2017-03-01 | Type of plan entity | Single employer plan |
| 2017-03-01 | Submission has been amended | No |
| 2017-03-01 | This submission is the final filing | No |
| 2017-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-03-01 | Plan is a collectively bargained plan | No |
| 2017-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: OCCUPATIONAL INJURY BENEFIT PLAN 2016 form 5500 responses | ||
| 2016-03-01 | Type of plan entity | Single employer plan |
| 2016-03-01 | Submission has been amended | No |
| 2016-03-01 | This submission is the final filing | No |
| 2016-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-03-01 | Plan is a collectively bargained plan | No |
| 2016-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| WESTERN HERITAGE (National Association of Insurance Commissioners NAIC id number: 37150 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | TNS0000261 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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