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| Plan Name | NATIONAL CARPET OUTLET HEALTH AND WELFARE PLAN 2255 MEDINA RD MEDINA OH 44256 |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | NATIONAL CARPET MILL OUTLET DBA NATIONAL DESIGN MART |
| Employer identification number (EIN): | 341865728 |
| NAIC Classification: | 442210 |
| NAIC Description: | Floor Covering Stores |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-01-01 | ||||
| 501 | 2022-01-01 | AARON MILLS | 2023-09-21 |
| Measure | Date | Value |
|---|---|---|
| 2023: NATIONAL CARPET OUTLET HEALTH AND WELFARE PLAN 2255 MEDINA RD MEDINA OH 44256 2023 401k membership | ||
| Total participants, beginning-of-year | 2023-01-01 | 168 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-01-01 | 162 |
| Total of all active and inactive participants | 2023-01-01 | 162 |
| 2022: NATIONAL CARPET OUTLET HEALTH AND WELFARE PLAN 2255 MEDINA RD MEDINA OH 44256 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-01-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 168 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 168 |
| Measure | Date | Value |
|---|---|---|
| 2022 : NATIONAL CARPET OUTLET HEALTH AND WELFARE PLAN 2255 MEDINA RD MEDINA OH 44256 2022 401k financial data | ||
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-12-31 | No |
| Was this plan covered by a fidelity bond | 2022-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2022-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-12-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-12-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-12-31 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2022-12-31 | No |
| Did the plan have assets held for investment | 2022-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-12-31 | No |
| 2023: NATIONAL CARPET OUTLET HEALTH AND WELFARE PLAN 2255 MEDINA RD MEDINA OH 44256 2023 form 5500 responses | ||
|---|---|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Submission has been amended | No |
| 2023-01-01 | This submission is the final filing | No |
| 2023-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2023-01-01 | Plan is a collectively bargained plan | No |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022: NATIONAL CARPET OUTLET HEALTH AND WELFARE PLAN 2255 MEDINA RD MEDINA OH 44256 2022 form 5500 responses | ||
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | First time form 5500 has been submitted | Yes |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 0628812 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 00635563 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | G00619774 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | G00619774 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 0628812 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 00635563 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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