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RABEN TIRE EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan NameRABEN TIRE EMPLOYEE BENEFIT PLAN
Plan identification number 502

RABEN TIRE EMPLOYEE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

RABEN TIRE CO., LLC has sponsored the creation of one or more 401k plans.

Company Name:RABEN TIRE CO., LLC
Employer identification number (EIN):351162941
NAIC Classification:441300
NAIC Description: Automotive Parts, Accessories, and Tire Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RABEN TIRE EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022020-01-01EVAN SCOCOS2021-07-13
5022019-01-01
5022018-01-01ERIC GLOVER2019-10-15
5022017-01-01PAIGE BUBLIK PAIGE BUBLIK2018-07-31
5022017-01-01PAIGE BUBLIK PAIGE BUBLIK2018-10-14
5022016-01-01DANIEL GARRETT
5022015-01-01DANIEL GARRETT
5022014-01-01DANIEL GARRETT
5022013-01-01MARK RABEN MARK RABEN2014-10-14
5022012-01-01MARK RABEN
5022011-01-01DANIEL GARRETT
5022010-01-01DANIEL GARRETT
5022009-01-01DANIEL GARRETT

Plan Statistics for RABEN TIRE EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for RABEN TIRE EMPLOYEE BENEFIT PLAN

Measure Date Value
2019: RABEN TIRE EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01311
Total number of active participants reported on line 7a of the Form 55002019-01-010
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-010
2018: RABEN TIRE EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01332
Total number of active participants reported on line 7a of the Form 55002018-01-01303
Number of retired or separated participants receiving benefits2018-01-013
Number of other retired or separated participants entitled to future benefits2018-01-015
Total of all active and inactive participants2018-01-01311
Number of employers contributing to the scheme2018-01-010
2017: RABEN TIRE EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01447
Total number of active participants reported on line 7a of the Form 55002017-01-01423
Total of all active and inactive participants2017-01-01423
2016: RABEN TIRE EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01460
Total number of active participants reported on line 7a of the Form 55002016-01-01447
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01447
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
2015: RABEN TIRE EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01405
Total number of active participants reported on line 7a of the Form 55002015-01-01410
Number of retired or separated participants receiving benefits2015-01-011
Total of all active and inactive participants2015-01-01411
Total participants2015-01-01411
2014: RABEN TIRE EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01405
Total number of active participants reported on line 7a of the Form 55002014-01-01404
Number of retired or separated participants receiving benefits2014-01-011
Total of all active and inactive participants2014-01-01405
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-01405
2013: RABEN TIRE EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01409
Total number of active participants reported on line 7a of the Form 55002013-01-01404
Number of retired or separated participants receiving benefits2013-01-011
Total of all active and inactive participants2013-01-01405
Total participants2013-01-01405
2012: RABEN TIRE EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01413
Total number of active participants reported on line 7a of the Form 55002012-01-01407
Number of retired or separated participants receiving benefits2012-01-012
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01409
Total participants2012-01-01409
2011: RABEN TIRE EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01411
Total number of active participants reported on line 7a of the Form 55002011-01-01411
Number of retired or separated participants receiving benefits2011-01-012
Total of all active and inactive participants2011-01-01413
Total participants2011-01-01413
2010: RABEN TIRE EMPLOYEE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01476
Total number of active participants reported on line 7a of the Form 55002010-01-01410
Number of retired or separated participants receiving benefits2010-01-011
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-01411
2009: RABEN TIRE EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01380
Total number of active participants reported on line 7a of the Form 55002009-01-01471
Number of retired or separated participants receiving benefits2009-01-015
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01476
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010

Financial Data on RABEN TIRE EMPLOYEE BENEFIT PLAN

Measure Date Value
2019 : RABEN TIRE EMPLOYEE BENEFIT PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$174,353
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$187,398
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$135,537
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$174,353
Value of total assets at end of year2019-12-31$15,701
Value of total assets at beginning of year2019-12-31$28,746
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$51,861
Total interest from all sources2019-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$1,000,000
If this is an individual account plan, was there a blackout period2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$0
Total non interest bearing cash at end of year2019-12-31$15,701
Total non interest bearing cash at beginning of year2019-12-31$28,746
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$-13,045
Value of net assets at end of year (total assets less liabilities)2019-12-31$15,701
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$28,746
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$174,353
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$135,537
Contract administrator fees2019-12-31$51,861
Did the plan have assets held for investment2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Accountancy firm name2019-12-31HARDING SHYMANSKI & COMPANY, P.S.C.
Accountancy firm EIN2019-12-31351346211
2018 : RABEN TIRE EMPLOYEE BENEFIT PLAN 2018 401k financial data
Total income from all sources (including contributions)2018-12-31$3,101,569
Total of all expenses incurred2018-12-31$3,499,665
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$3,219,149
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$3,101,569
Value of total assets at end of year2018-12-31$28,746
Value of total assets at beginning of year2018-12-31$426,842
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$280,516
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$1,000,000
If this is an individual account plan, was there a blackout period2018-12-31No
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$1,274,539
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-12-31$375,376
Total non interest bearing cash at end of year2018-12-31$28,746
Total non interest bearing cash at beginning of year2018-12-31$51,466
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-398,096
Value of net assets at end of year (total assets less liabilities)2018-12-31$28,746
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$426,842
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$183,841
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$1,827,030
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$3,035,308
Contract administrator fees2018-12-31$280,516
Did the plan have assets held for investment2018-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31No
Opinion of an independent qualified public accountant for this plan2018-12-31Unqualified
Accountancy firm name2018-12-31HARDING SHYMANSKI & COMPANY, P.S.C.
Accountancy firm EIN2018-12-31351346211
2017 : RABEN TIRE EMPLOYEE BENEFIT PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total income from all sources (including contributions)2017-12-31$4,184,635
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$4,053,939
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$3,699,367
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$4,184,635
Value of total assets at end of year2017-12-31$426,842
Value of total assets at beginning of year2017-12-31$296,146
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$354,572
Total interest from all sources2017-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$1,069,372
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$375,376
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-12-31$375,376
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-12-31$201,275
Administrative expenses (other) incurred2017-12-31$18,476
Total non interest bearing cash at end of year2017-12-31$51,466
Total non interest bearing cash at beginning of year2017-12-31$94,871
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$130,696
Value of net assets at end of year (total assets less liabilities)2017-12-31$426,842
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$296,146
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$215,705
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$2,739,887
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$3,483,662
Contract administrator fees2017-12-31$336,096
Did the plan have assets held for investment2017-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31No
Opinion of an independent qualified public accountant for this plan2017-12-31Unqualified
Accountancy firm name2017-12-31HARDING SHYMANSKI & COMPANY, P.S.C.
Accountancy firm EIN2017-12-31351346211
2016 : RABEN TIRE EMPLOYEE BENEFIT PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total income from all sources (including contributions)2016-12-31$5,010,239
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$4,719,877
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$4,374,259
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$5,010,239
Value of total assets at end of year2016-12-31$296,146
Value of total assets at beginning of year2016-12-31$5,784
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$345,618
Total interest from all sources2016-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$871,788
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$201,275
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$201,275
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$0
Administrative expenses (other) incurred2016-12-31$29,544
Total non interest bearing cash at end of year2016-12-31$94,871
Total non interest bearing cash at beginning of year2016-12-31$5,784
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$290,362
Value of net assets at end of year (total assets less liabilities)2016-12-31$296,146
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$5,784
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$208,857
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$3,937,176
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$4,165,402
Contract administrator fees2016-12-31$316,074
Did the plan have assets held for investment2016-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31No
Opinion of an independent qualified public accountant for this plan2016-12-31Unqualified
Accountancy firm name2016-12-31HARDING SHYMANSKI & COMPANY, P.S.C.
Accountancy firm EIN2016-12-31351346211
2015 : RABEN TIRE EMPLOYEE BENEFIT PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total income from all sources (including contributions)2015-12-31$4,096,669
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$4,104,910
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$3,865,096
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$4,096,669
Value of total assets at end of year2015-12-31$5,784
Value of total assets at beginning of year2015-12-31$14,025
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$239,814
Total interest from all sources2015-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Administrative expenses professional fees incurred2015-12-31$29,124
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$960,431
Administrative expenses (other) incurred2015-12-31$41,033
Total non interest bearing cash at end of year2015-12-31$5,784
Total non interest bearing cash at beginning of year2015-12-31$14,025
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$-8,241
Value of net assets at end of year (total assets less liabilities)2015-12-31$5,784
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$14,025
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$329,757
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$3,136,238
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$3,535,339
Contract administrator fees2015-12-31$169,657
Did the plan have assets held for investment2015-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31No
Opinion of an independent qualified public accountant for this plan2015-12-31Unqualified
Accountancy firm name2015-12-31FALL CREEK ASSOCIATES LLC
Accountancy firm EIN2015-12-31364785555
2014 : RABEN TIRE EMPLOYEE BENEFIT PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total income from all sources (including contributions)2014-12-31$3,429,968
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$3,426,054
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$3,248,733
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$3,429,968
Value of total assets at end of year2014-12-31$14,025
Value of total assets at beginning of year2014-12-31$10,111
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$177,321
Total interest from all sources2014-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Administrative expenses professional fees incurred2014-12-31$33,715
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$600,000
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$904,421
Total non interest bearing cash at end of year2014-12-31$14,025
Total non interest bearing cash at beginning of year2014-12-31$10,111
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$3,914
Value of net assets at end of year (total assets less liabilities)2014-12-31$14,025
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$10,111
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2014-12-31$322,411
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$2,525,547
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$2,926,322
Contract administrator fees2014-12-31$143,606
Did the plan have assets held for investment2014-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31No
Opinion of an independent qualified public accountant for this plan2014-12-31Unqualified
Accountancy firm name2014-12-31FALL CREEK ASSOCIATES LLC
Accountancy firm EIN2014-12-31364785555
2013 : RABEN TIRE EMPLOYEE BENEFIT PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total income from all sources (including contributions)2013-12-31$3,125,631
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$3,219,521
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$3,076,266
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$3,125,631
Value of total assets at end of year2013-12-31$10,111
Value of total assets at beginning of year2013-12-31$104,001
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$143,255
Total interest from all sources2013-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Administrative expenses professional fees incurred2013-12-31$9,199
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$600,000
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$691,047
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-12-31$29,017
Administrative expenses (other) incurred2013-12-31$50,546
Total non interest bearing cash at end of year2013-12-31$10,111
Total non interest bearing cash at beginning of year2013-12-31$74,984
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$-93,890
Value of net assets at end of year (total assets less liabilities)2013-12-31$10,111
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$104,001
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2013-12-31$305,739
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$2,434,584
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$2,770,527
Contract administrator fees2013-12-31$83,510
Did the plan have assets held for investment2013-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31No
Opinion of an independent qualified public accountant for this plan2013-12-31Unqualified
Accountancy firm name2013-12-31FALL CREEK ASSOCIATES LLC
Accountancy firm EIN2013-12-31364785555
2012 : RABEN TIRE EMPLOYEE BENEFIT PLAN 2012 401k financial data
Total income from all sources (including contributions)2012-12-31$3,479,759
Total of all expenses incurred2012-12-31$3,460,082
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$3,322,182
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$3,479,759
Value of total assets at end of year2012-12-31$74,983
Value of total assets at beginning of year2012-12-31$26,288
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$137,900
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Administrative expenses professional fees incurred2012-12-31$7,621
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$600,000
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$814,676
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-12-31$29,017
Administrative expenses (other) incurred2012-12-31$36,649
Total non interest bearing cash at end of year2012-12-31$45,966
Total non interest bearing cash at beginning of year2012-12-31$26,288
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$19,677
Value of net assets at end of year (total assets less liabilities)2012-12-31$74,983
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$26,288
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2012-12-31$294,420
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$2,665,083
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$3,027,762
Contract administrator fees2012-12-31$93,630
Did the plan have assets held for investment2012-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31No
Opinion of an independent qualified public accountant for this plan2012-12-31Unqualified
Accountancy firm name2012-12-31FALL CREEK ASSOCIATES LLC
Accountancy firm EIN2012-12-31352134560
2011 : RABEN TIRE EMPLOYEE BENEFIT PLAN 2011 401k financial data
Total income from all sources (including contributions)2011-12-31$2,664,600
Total of all expenses incurred2011-12-31$2,757,982
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$2,591,554
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$2,664,600
Value of total assets at end of year2011-12-31$26,288
Value of total assets at beginning of year2011-12-31$119,670
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$166,428
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Administrative expenses professional fees incurred2011-12-31$7,800
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$600,000
If this is an individual account plan, was there a blackout period2011-12-31No
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$789,356
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-12-31$47,353
Administrative expenses (other) incurred2011-12-31$46,624
Total non interest bearing cash at end of year2011-12-31$26,288
Total non interest bearing cash at beginning of year2011-12-31$72,317
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$-93,382
Value of net assets at end of year (total assets less liabilities)2011-12-31$26,288
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$119,670
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2011-12-31$263,919
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$1,875,244
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$2,327,635
Contract administrator fees2011-12-31$112,004
Did the plan have assets held for investment2011-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31No
Opinion of an independent qualified public accountant for this plan2011-12-31Unqualified
Accountancy firm name2011-12-31FALL CREEK ASSOCIATES LLC
Accountancy firm EIN2011-12-31352134560
2010 : RABEN TIRE EMPLOYEE BENEFIT PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets2010-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total income from all sources (including contributions)2010-12-31$3,591,575
Total loss/gain on sale of assets2010-12-31$0
Total of all expenses incurred2010-12-31$3,627,423
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$3,471,655
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$3,591,575
Value of total assets at end of year2010-12-31$119,670
Value of total assets at beginning of year2010-12-31$155,518
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$155,768
Total interest from all sources2010-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Administrative expenses professional fees incurred2010-12-31$8,223
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$600,000
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$602,553
Value of other receiveables (less allowance for doubtful accounts) at end of year2010-12-31$47,353
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2010-12-31$24,125
Total non interest bearing cash at end of year2010-12-31$72,317
Total non interest bearing cash at beginning of year2010-12-31$131,393
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$-35,848
Value of net assets at end of year (total assets less liabilities)2010-12-31$119,670
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$155,518
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2010-12-31$250,161
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$2,989,022
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$3,221,494
Contract administrator fees2010-12-31$147,545
Did the plan have assets held for investment2010-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31No
Opinion of an independent qualified public accountant for this plan2010-12-31Unqualified
Accountancy firm name2010-12-31GIRARDOT, STRAUCH, & CO.
Accountancy firm EIN2010-12-31351519864

Form 5500 Responses for RABEN TIRE EMPLOYEE BENEFIT PLAN

2019: RABEN TIRE EMPLOYEE BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement - TrustYes
2018: RABEN TIRE EMPLOYEE BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: RABEN TIRE EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: RABEN TIRE EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: RABEN TIRE EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: RABEN TIRE EMPLOYEE BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: RABEN TIRE EMPLOYEE BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: RABEN TIRE EMPLOYEE BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: RABEN TIRE EMPLOYEE BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: RABEN TIRE EMPLOYEE BENEFIT PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: RABEN TIRE EMPLOYEE BENEFIT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberKM05933701
Policy instance 1
Insurance contract or identification numberKM05933701
Number of Individuals Covered693
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $10,064
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $143,953
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,064
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 )
Policy contract number417006412430
Policy instance 2
Insurance contract or identification number417006412430
Number of Individuals Covered291
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $183,915
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0B99K
Policy instance 3
Insurance contract or identification numberGLUG0B99K
Number of Individuals Covered477
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $19,544
Total amount of fees paid to insurance companyUSD $20,037
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT,CRITICAL ILLNESS,ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $121,785
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,095
Amount paid for insurance broker fees5757
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberKM05933701
Policy instance 1
Insurance contract or identification numberKM05933701
Number of Individuals Covered977
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $23,950
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 BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 $248,304
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,969
Insurance broker organization code?3
Insurance broker nameBENEFIT EXCHANGES ALLIANCE
UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 )
Policy contract number417005412430
Policy instance 2
Insurance contract or identification number417005412430
Number of Individuals Covered338
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
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 $215,520
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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