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| Plan Name | SEMINOLE TIRE CO INC SELF FUNDED MEDICAL REIMBURSEMENT PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | SEMINOLE TIRE CO INC |
| Employer identification number (EIN): | 591722382 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2009-10-01 | JENNIFER A. SAPP |
| Measure | Date | Value |
|---|---|---|
| 2009: SEMINOLE TIRE CO INC SELF FUNDED MEDICAL REIMBURSEMENT PLAN 2009 401k membership | ||
| Total participants, beginning-of-year | 2009-10-01 | 7 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-10-01 | 7 |
| Number of retired or separated participants receiving benefits | 2009-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-10-01 | 0 |
| Total of all active and inactive participants | 2009-10-01 | 7 |
| Measure | Date | Value |
|---|---|---|
| 2011 : SEMINOLE TIRE CO INC SELF FUNDED MEDICAL REIMBURSEMENT PLAN 2011 401k financial data | ||
| Transfers to/from the plan | 2011-09-30 | $-33,796 |
| Total income from all sources | 2011-09-30 | $149 |
| Expenses. Total of all expenses incurred | 2011-09-30 | $972 |
| Benefits paid (including direct rollovers) | 2011-09-30 | $901 |
| Total plan assets at end of year | 2011-09-30 | $0 |
| Total plan assets at beginning of year | 2011-09-30 | $34,619 |
| Other income received | 2011-09-30 | $119 |
| Net income (gross income less expenses) | 2011-09-30 | $-823 |
| Net plan assets at end of year (total assets less liabilities) | 2011-09-30 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-09-30 | $34,619 |
| Total contributions received or receivable from employer(s) | 2011-09-30 | $30 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2011-09-30 | $71 |
| 2009: SEMINOLE TIRE CO INC SELF FUNDED MEDICAL REIMBURSEMENT PLAN 2009 form 5500 responses | ||
|---|---|---|
| 2009-10-01 | Type of plan entity | Single employer plan |
| 2009-10-01 | Plan funding arrangement – Trust | Yes |
| 2009-10-01 | Plan benefit arrangement - Trust | Yes |
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