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| Plan Name | MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | MOCK BEROTH INC. |
| Employer identification number (EIN): | 582417249 |
| NAIC Classification: | 441300 |
| NAIC Description: | Automotive Parts, Accessories, and Tire Stores |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-12-01 | DENISE HART | 2024-05-22 | DENISE HART | 2024-05-22 |
| 501 | 2021-12-01 | DENISE HART | 2023-05-30 | DENISE HART | 2023-05-30 |
| 501 | 2020-12-01 | ||||
| 501 | 2019-12-01 | ||||
| 501 | 2018-12-01 | ||||
| 501 | 2017-12-01 | DENISE HART | DENISE HART | ||
| 501 | 2017-12-01 | ||||
| 501 | 2016-12-01 | DENISE HART | DENISE HART | 2018-07-10 | |
| 501 | 2015-12-01 | DENISE HART | |||
| 501 | 2014-12-01 | DENISE HART | |||
| 501 | 2013-12-01 | DENISE HART | |||
| 501 | 2012-12-01 | DENISE HART | |||
| 501 | 2011-12-01 | DENISE HART | |||
| 501 | 2009-12-01 | DENISE HART | |||
| 501 | 2008-12-01 |
| 2022: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-12-01 | Type of plan entity | Mulitple employer plan |
| 2022-12-01 | Plan funding arrangement – Insurance | Yes |
| 2022-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2021 form 5500 responses | ||
| 2021-12-01 | Type of plan entity | Mulitple employer plan |
| 2021-12-01 | Plan funding arrangement – Insurance | Yes |
| 2021-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2020 form 5500 responses | ||
| 2020-12-01 | Type of plan entity | Mulitple employer plan |
| 2020-12-01 | Plan funding arrangement – Insurance | Yes |
| 2020-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2019 form 5500 responses | ||
| 2019-12-01 | Type of plan entity | Mulitple employer plan |
| 2019-12-01 | Plan funding arrangement – Insurance | Yes |
| 2019-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2018 form 5500 responses | ||
| 2018-12-01 | Type of plan entity | Mulitple employer plan |
| 2018-12-01 | Plan funding arrangement – Insurance | Yes |
| 2018-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2017 form 5500 responses | ||
| 2017-12-01 | Type of plan entity | Mulitple employer plan |
| 2017-12-01 | Submission has been amended | Yes |
| 2017-12-01 | Plan funding arrangement – Insurance | Yes |
| 2017-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2016 form 5500 responses | ||
| 2016-12-01 | Type of plan entity | Mulitple employer plan |
| 2016-12-01 | Plan funding arrangement – Insurance | Yes |
| 2016-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2015 form 5500 responses | ||
| 2015-12-01 | Type of plan entity | Mulitple employer plan |
| 2015-12-01 | Plan funding arrangement – Insurance | Yes |
| 2015-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2014 form 5500 responses | ||
| 2014-12-01 | Type of plan entity | Mulitple employer plan |
| 2014-12-01 | Plan funding arrangement – Insurance | Yes |
| 2014-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2013 form 5500 responses | ||
| 2013-12-01 | Type of plan entity | Mulitple employer plan |
| 2013-12-01 | Plan funding arrangement – Insurance | Yes |
| 2013-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2012 form 5500 responses | ||
| 2012-12-01 | Type of plan entity | Mulitple employer plan |
| 2012-12-01 | Plan funding arrangement – Insurance | Yes |
| 2012-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2011 form 5500 responses | ||
| 2011-12-01 | Type of plan entity | Mulitple employer plan |
| 2011-12-01 | Plan funding arrangement – Insurance | Yes |
| 2011-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2009 form 5500 responses | ||
| 2009-12-01 | Type of plan entity | Mulitple employer plan |
| 2009-12-01 | Plan funding arrangement – Insurance | Yes |
| 2009-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: MOCK-BEROTH, INC. FLEXIBLE PREMIUM PLAN 2008 form 5500 responses | ||
| 2008-12-01 | Type of plan entity | Mulitple employer plan |
| 2008-12-01 | Submission has been amended | No |
| 2008-12-01 | This submission is the final filing | No |
| 2008-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-12-01 | Plan is a collectively bargained plan | No |
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) | |
| Policy contract number | 14171771-1001 |
| Policy instance | 3 |
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) | |
| Policy contract number | 907-25-S5921 |
| Policy instance | 1 |
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) | |
| Policy contract number | 38047 |
| Policy instance | 2 |
| WELLFLEET INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 33280 ) | |
| Policy contract number | MOCK-BEROTH |
| Policy instance | 10 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) | |
| Policy contract number | 95125 |
| Policy instance | 4 |
| RESERVE NATIONAL INSURANCE COMPANY DBA KEMPER BENEFITS (National Association of Insurance Commissioners NAIC id number: 68462 ) | |
| Policy contract number | KB20A20 |
| Policy instance | 5 |
| COMMUNITY EYE CARE (National Association of Insurance Commissioners NAIC id number: 52429 ) | |
| Policy contract number | TPO35012 |
| Policy instance | 6 |
| PROSPERITY LIFE GROUP (National Association of Insurance Commissioners NAIC id number: 60183 ) | |
| Policy contract number | MOCK-BEROTH |
| Policy instance | 7 |
| WELLFLEET INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 33280 ) | |
| Policy contract number | MOCK-BEROTH |
| Policy instance | 8 |
| WELLFLEET INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 33280 ) | |
| Policy contract number | MOCK-BEROTH |
| Policy instance | 9 |
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) | |
| Policy contract number | 38047 |
| Policy instance | 2 |
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) | |
| Policy contract number | 1049435 |
| Policy instance | 1 |
| RESERVE NATIONAL INSURANCE COMPANY DBA KEMPER BENEFITS (National Association of Insurance Commissioners NAIC id number: 68462 ) | |
| Policy contract number | KB20A20 |
| Policy instance | 5 |
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) | |
| Policy contract number | 082692 |
| Policy instance | 3 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) | |
| Policy contract number | 35487 |
| Policy instance | 4 |
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) | |
| Policy contract number | 038047 |
| Policy instance | 6 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 0922523 |
| Policy instance | 7 |
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) | |
| Policy contract number | 1049435 |
| Policy instance | 1 |
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) | |
| Policy contract number | 38047 |
| Policy instance | 2 |
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) | |
| Policy contract number | 082692 |
| Policy instance | 3 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) | |
| Policy contract number | 35487 |
| Policy instance | 4 |
| RESERVE NATIONAL INSURANCE COMPANY DBA KEMPER BENEFITS (National Association of Insurance Commissioners NAIC id number: 68462 ) | |
| Policy contract number | KB20A20 |
| Policy instance | 5 |
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) | |
| Policy contract number | 038047 |
| Policy instance | 6 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 0922523 |
| Policy instance | 7 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) | |
| Policy contract number | 35487 |
| Policy instance | 4 |
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) | |
| Policy contract number | 082692 |
| Policy instance | 3 |
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) | |
| Policy contract number | 38047 |
| Policy instance | 2 |
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) | |
| Policy contract number | 1049435 |
| Policy instance | 1 |
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) | |
| Policy contract number | 1049435 |
| Policy instance | 1 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) | |
| Policy contract number | 35487 |
| Policy instance | 2 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) | |
| Policy contract number | 35487 |
| Policy instance | 3 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) | |
| Policy contract number | 35487 |
| Policy instance | 4 |
| BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 ) | |
| Policy contract number | 082692 |
| Policy instance | 5 |
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) | |
| Policy contract number | 38047 |
| Policy instance | 6 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) | |
| Policy contract number | 95125 |
| Policy instance | 7 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 695041 |
| Policy instance | 3 |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 ) | |
| Policy contract number | E4367918 |
| Policy instance | 2 |
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) | |
| Policy contract number | 1049435 |
| Policy instance | 1 |
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) | |
| Policy contract number | 580663085 |
| Policy instance | 1 |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 ) | |
| Policy contract number | E4367918 |
| Policy instance | 3 |
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) | |
| Policy contract number | 1049435 |
| Policy instance | 2 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |
| Policy contract number | MBINC98 |
| Policy instance | 2 |
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) | |
| Policy contract number | 5448476 |
| Policy instance | 1 |
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) | |
| Policy contract number | 580663085 |
| Policy instance | 3 |
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) | |
| Policy contract number | 5448476 |
| Policy instance | 1 |
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) | |
| Policy contract number | 580663085 |
| Policy instance | 3 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |
| Policy contract number | 023060 |
| Policy instance | 2 |
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) | |
| Policy contract number | 5448476 |
| Policy instance | 1 |
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) | |
| Policy contract number | 580663085 |
| Policy instance | 3 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |
| Policy contract number | 023060 |
| Policy instance | 2 |
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) | |
| Policy contract number | 5448476 |
| Policy instance | 1 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |
| Policy contract number | 023060 |
| Policy instance | 2 |
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) | |
| Policy contract number | 580663085 |
| Policy instance | 3 |
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