401k Plan data: AUTO SUPPLY COMPANY MEDICAL PLAN plan

AUTO SUPPLY COMPANY MEDICAL PLAN 401k Plan overview

Plan Name	AUTO SUPPLY COMPANY MEDICAL PLAN
Plan identification number	501

AUTO SUPPLY COMPANY MEDICAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

AUTO SUPPLY COMPANY, INC. has sponsored the creation of one or more 401k plans.

Company Name: AUTO SUPPLY COMPANY, INC.

Employer identification number (EIN): 561542433

NAIC Classification: 441300
NAIC Description: Automotive Parts, Accessories, and Tire Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AUTO SUPPLY COMPANY MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2016-07-01 CLIFF METCALF
501 2015-07-01 CLIFF METCALF
501 2014-07-01 CLIFF METCALF
501 2013-07-01 CLIFF METCALF
501 2012-07-01 CLIFF METCALF
501 2011-07-01 CLIFF METCALF

Plan id#	Filing Submission Date	Name of Administrator
501	2016-07-01	CLIFF METCALF
501	2015-07-01	CLIFF METCALF
501	2014-07-01	CLIFF METCALF
501	2013-07-01	CLIFF METCALF
501	2012-07-01	CLIFF METCALF
501	2011-07-01	CLIFF METCALF

Plan Statistics for AUTO SUPPLY COMPANY MEDICAL PLAN

401k plan membership statisitcs for AUTO SUPPLY COMPANY MEDICAL PLAN

Measure Date Value
2016: AUTO SUPPLY COMPANY MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year 2016-07-01 122
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 123
Number of retired or separated participants receiving benefits 2016-07-01 0
Number of other retired or separated participants entitled to future benefits 2016-07-01 0
Total of all active and inactive participants 2016-07-01 123
2015: AUTO SUPPLY COMPANY MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year 2015-07-01 126
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 120
Number of retired or separated participants receiving benefits 2015-07-01 0
Number of other retired or separated participants entitled to future benefits 2015-07-01 0
Total of all active and inactive participants 2015-07-01 120
2014: AUTO SUPPLY COMPANY MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year 2014-07-01 122
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 121
Number of retired or separated participants receiving benefits 2014-07-01 0
Number of other retired or separated participants entitled to future benefits 2014-07-01 0
Total of all active and inactive participants 2014-07-01 121
2013: AUTO SUPPLY COMPANY MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year 2013-07-01 123
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 121
Number of retired or separated participants receiving benefits 2013-07-01 0
Number of other retired or separated participants entitled to future benefits 2013-07-01 0
Total of all active and inactive participants 2013-07-01 121
2012: AUTO SUPPLY COMPANY MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 130
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 124
Number of retired or separated participants receiving benefits 2012-07-01 1
Number of other retired or separated participants entitled to future benefits 2012-07-01 0
Total of all active and inactive participants 2012-07-01 125
2011: AUTO SUPPLY COMPANY MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year 2011-07-01 143
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 133
Number of retired or separated participants receiving benefits 2011-07-01 0
Number of other retired or separated participants entitled to future benefits 2011-07-01 0
Total of all active and inactive participants 2011-07-01 133

Measure	Date	Value
2016: AUTO SUPPLY COMPANY MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year	2016-07-01	122
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	123
Number of retired or separated participants receiving benefits	2016-07-01	0
Number of other retired or separated participants entitled to future benefits	2016-07-01	0
Total of all active and inactive participants	2016-07-01	123
2015: AUTO SUPPLY COMPANY MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year	2015-07-01	126
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	120
Number of retired or separated participants receiving benefits	2015-07-01	0
Number of other retired or separated participants entitled to future benefits	2015-07-01	0
Total of all active and inactive participants	2015-07-01	120
2014: AUTO SUPPLY COMPANY MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year	2014-07-01	122
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	121
Number of retired or separated participants receiving benefits	2014-07-01	0
Number of other retired or separated participants entitled to future benefits	2014-07-01	0
Total of all active and inactive participants	2014-07-01	121
2013: AUTO SUPPLY COMPANY MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year	2013-07-01	123
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	121
Number of retired or separated participants receiving benefits	2013-07-01	0
Number of other retired or separated participants entitled to future benefits	2013-07-01	0
Total of all active and inactive participants	2013-07-01	121
2012: AUTO SUPPLY COMPANY MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	130
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	124
Number of retired or separated participants receiving benefits	2012-07-01	1
Number of other retired or separated participants entitled to future benefits	2012-07-01	0
Total of all active and inactive participants	2012-07-01	125
2011: AUTO SUPPLY COMPANY MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year	2011-07-01	143
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	133
Number of retired or separated participants receiving benefits	2011-07-01	0
Number of other retired or separated participants entitled to future benefits	2011-07-01	0
Total of all active and inactive participants	2011-07-01	133

Form 5500 Responses for AUTO SUPPLY COMPANY MEDICAL PLAN

2016: AUTO SUPPLY COMPANY MEDICAL PLAN 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Submission has been amended	No
2016-07-01	This submission is the final filing	No
2016-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-07-01	Plan is a collectively bargained plan	No
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: AUTO SUPPLY COMPANY MEDICAL PLAN 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Submission has been amended	No
2015-07-01	This submission is the final filing	No
2015-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-07-01	Plan is a collectively bargained plan	No
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: AUTO SUPPLY COMPANY MEDICAL PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Submission has been amended	No
2014-07-01	This submission is the final filing	No
2014-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-07-01	Plan is a collectively bargained plan	No
2014-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: AUTO SUPPLY COMPANY MEDICAL PLAN 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Submission has been amended	No
2013-07-01	This submission is the final filing	No
2013-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-07-01	Plan is a collectively bargained plan	No
2013-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: AUTO SUPPLY COMPANY MEDICAL PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Submission has been amended	No
2012-07-01	This submission is the final filing	No
2012-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-07-01	Plan is a collectively bargained plan	No
2012-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: AUTO SUPPLY COMPANY MEDICAL PLAN 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Submission has been amended	No
2011-07-01	This submission is the final filing	No
2011-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-07-01	Plan is a collectively bargained plan	No
2011-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-07-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )

Policy contract number

072109

Policy instance

Insurance contract or identification number	072109
Number of Individuals Covered	191
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $1,111
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $257,453
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,111
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	JOSEPH HUGHES

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Company Name:	AUTO SUPPLY COMPANY, INC.
Employer identification number (EIN):	561542433
NAIC Classification:	441300
NAIC Description:	Automotive Parts, Accessories, and Tire Stores