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MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 401k Plan overview

Plan NameMEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE
Plan identification number 501

MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

COMMUNITY WHOLESALE TIRE DISTRIBUTING, INC. has sponsored the creation of one or more 401k plans.

Company Name:COMMUNITY WHOLESALE TIRE DISTRIBUTING, INC.
Employer identification number (EIN):430799202
NAIC Classification:423100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-01-01ADRIENNE BERRA2024-07-10 ADRIENNE BERRA2024-07-10
5012022-01-01ADRIENNE BERRA2023-06-13 ADRIENNE BERRA2023-06-13
5012021-01-01ADRIENNE BERRA2022-05-19 ADRIENNE BERRA2022-05-19
5012020-01-01ADRIENNE BERRA2021-06-15 ADRIENNE BERRA2021-06-15
5012019-01-01ADRIENNE BERRA2020-05-14 ADRIENNE BERRA2020-05-14
5012018-01-01ADRIENNE BERRA2019-07-23 ADRIENNE BERRA2019-07-23
5012017-01-01
5012016-01-01
5012015-01-01
5012014-01-01
5012013-01-01
5012012-01-01BETH BERRA
5012011-01-01BETH BERRA
5012009-01-01BETH BERRA

Plan Statistics for MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE

401k plan membership statisitcs for MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE

Measure Date Value
2023: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2023 401k membership
Total participants, beginning-of-year2023-01-01219
Total number of active participants reported on line 7a of the Form 55002023-01-01218
Total of all active and inactive participants2023-01-01218
2022: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2022 401k membership
Total participants, beginning-of-year2022-01-01196
Total number of active participants reported on line 7a of the Form 55002022-01-01219
Total of all active and inactive participants2022-01-01219
2021: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2021 401k membership
Total participants, beginning-of-year2021-01-01194
Total number of active participants reported on line 7a of the Form 55002021-01-01196
Total of all active and inactive participants2021-01-01196
2020: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2020 401k membership
Total participants, beginning-of-year2020-01-01178
Total number of active participants reported on line 7a of the Form 55002020-01-01194
Total of all active and inactive participants2020-01-01194
2019: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2019 401k membership
Total participants, beginning-of-year2019-01-01163
Total number of active participants reported on line 7a of the Form 55002019-01-01178
Total of all active and inactive participants2019-01-01178
2018: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2018 401k membership
Total participants, beginning-of-year2018-01-01155
Total number of active participants reported on line 7a of the Form 55002018-01-01163
Total of all active and inactive participants2018-01-01163
2017: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2017 401k membership
Total participants, beginning-of-year2017-01-01156
Total number of active participants reported on line 7a of the Form 55002017-01-01155
Total of all active and inactive participants2017-01-01155
2016: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2016 401k membership
Total participants, beginning-of-year2016-01-01141
Total number of active participants reported on line 7a of the Form 55002016-01-01156
Total of all active and inactive participants2016-01-01156
2015: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2015 401k membership
Total participants, beginning-of-year2015-01-01132
Total number of active participants reported on line 7a of the Form 55002015-01-01141
Total of all active and inactive participants2015-01-01141
2014: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2014 401k membership
Total participants, beginning-of-year2014-01-01127
Total number of active participants reported on line 7a of the Form 55002014-01-01132
Total of all active and inactive participants2014-01-01132
2013: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2013 401k membership
Total participants, beginning-of-year2013-01-01132
Total number of active participants reported on line 7a of the Form 55002013-01-01127
Total of all active and inactive participants2013-01-01127
2012: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2012 401k membership
Total participants, beginning-of-year2012-01-01131
Total number of active participants reported on line 7a of the Form 55002012-01-01132
Total of all active and inactive participants2012-01-01132
2011: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2011 401k membership
Total participants, beginning-of-year2011-01-01124
Total number of active participants reported on line 7a of the Form 55002011-01-01131
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01131
2009: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2009 401k membership
Total participants, beginning-of-year2009-01-01107
Total number of active participants reported on line 7a of the Form 55002009-01-01116
Total of all active and inactive participants2009-01-01116

Form 5500 Responses for MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE

2023: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan funding arrangement – General assets of the sponsorYes
2023-01-01Plan benefit arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – General assets of the sponsorYes
2022: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: MEDICAL BENEFIT PLAN FOR EMPLOYEES OF COMMUNITY WHOLESALE TIRE 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10277084
Policy instance 4
Insurance contract or identification number10277084
Number of Individuals Covered274
Insurance policy start date2023-10-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $368
Total amount of fees paid to insurance companyUSD $129
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $2,570
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10277088
Policy instance 3
Insurance contract or identification number10277088
Number of Individuals Covered274
Insurance policy start date2023-10-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $1,210
Total amount of fees paid to insurance companyUSD $403
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,068
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )
Policy contract number417003413886
Policy instance 2
Insurance contract or identification number417003413886
Number of Individuals Covered218
Insurance policy start date2023-01-01
Insurance policy end date2024-01-01
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $312,182
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number226962
Policy instance 1
Insurance contract or identification number226962
Number of Individuals Covered252
Insurance policy start date2023-01-01
Insurance policy end date2023-10-01
Total amount of commissions paid to insurance brokerUSD $7,284
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $66,492
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number226962
Policy instance 1
Insurance contract or identification number226962
Number of Individuals Covered273
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Total amount of commissions paid to insurance brokerUSD $7,747
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $95,092
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )
Policy contract number417003413886
Policy instance 2
Insurance contract or identification number417003413886
Number of Individuals Covered219
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $416,329
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number226962
Policy instance 1
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number417002413886
Policy instance 2
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number417002413886
Policy instance 2
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number226962
Policy instance 1
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number91180000
Policy instance 1
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number226962
Policy instance 2
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number417002413886
Policy instance 3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0450669
Policy instance 1
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number226962
Policy instance 3
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number91180000
Policy instance 2
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 95060 )
Policy contract number6368500000
Policy instance 2
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number91180000
Policy instance 1
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number226962
Policy instance 3
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number91180000
Policy instance 1
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 95060 )
Policy contract number6368500000
Policy instance 2
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number226962
Policy instance 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number226962
Policy instance 3
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 95060 )
Policy contract number6368500000
Policy instance 2
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number91181000
Policy instance 1
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number91181000
Policy instance 1
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number860248G
Policy instance 2
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 95060 )
Policy contract number6368500000
Policy instance 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number226962
Policy instance 4
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 95060 )
Policy contract number6368500000
Policy instance 3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number860248G
Policy instance 2
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number91181000
Policy instance 1
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number860248G
Policy instance 2
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0715962
Policy instance 3
DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 )
Policy contract number91181000
Policy instance 1

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