2022-11-07T11:33:03-06:00 2021-12-31 440160260 FORVIS LLP 1003 RED BANKS ROAD GREENVILLE NC 27858 990 2021-01-01 202026448 CAROLINA DEALERSHIPS INC WELFARE BENEF CARO 3367245921 PO BOX 5657 WINSTONSALEM NC 27113 CHESTER A MICHAEL III TRUSTEE 3367245921 2022-11-02 1 CHESTER MICHAEL III 999009999 BRANDON HALES P01319929 2523210505 2022-11-02 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z TOM PAULSON PO BOX 5657 WINSTON SALEM NC 27113 19497853 0 X N/A X 2005 NC TO PROVIDE HEALTH AND DISABILITY BENEFITS COVERING SUBSTANTIALLY ALL OF THE EMPLOYEES OF THE PARTICIPATING EMPLOYERS. 13 0 0 0 0 0 0 0 17173061 19495030 2862 2823 0 0 17175923 19497853 0 0 12873914 15497197 0 0 0 0 0 4072733 4738310 16946647 20235507 229276 -737654 4484598 3746944 1718917 2447780 2765681 1299164 TO PROVIDE HEALTH AND DISABILITY BENEFITS COVERING SUBSTANTIALLY ALL OF THE EMPLOYEES OF THE PARTICIPATING EMPLOYERS. 0 0 20235507 19497853 TO PROVIDE HEALTH AND DISABILITY BENEFITS COVERING SUBSTANTIALLY ALL OF THE EMPLOYEES OF THE PARTICIPATING EMPLOYERS. 20235507 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 13 0 1 0 0 0 0 0 1 1 1 0 0 1 0 0 0 0 0 0 X RENEE C PAKKALA 9197904758 4900 CAPITAL BLVD RALEIGH NC 27616 X CHESTER A MICHAEL III TRUSTEE 0.00 X 0 0 0 CHED NEAL TRUSTEE 0.00 X 0 0 0 T DAVID NEILL TRUSTEE 0.00 X 0 0 0 0 0 0 0 0 0 0 BLUE CROSS & BLUE SHIELD 1965 IVY CREEK BLVD DURHAM NC 27707 ADMINISTRATIVE 1984340 1 EMPLOYER CONTRIBUTIONS 900099 10026906 10026906 EMPLOYEE CONTRIBUTIONS 900099 9468124 9468124 19495030 2823 2823 19497853 19497853 0 0 15497197 15497197 2753970 2753970 ADMINISTRATIVE 1984340 1984340 20235507 20235507 0 0 2158393 1315621 1765064 1764277 561141 667046 4484598 3746944 1718917 2447780 1718917 2447780 X 0 0 0 0 2765681 1299164 2765681 1299164 4484598 3746944 X -737654 -728863 X 0 1 X 0 0 0 DEPOSITS/ADVANCES FROM THIRD PARTY ADMINISTRATORS 667046 667046 CLAIMS INCURRED BUT NOT REPORTED 2447780 2447780 X 19497853 0 19497853 0 19497853 20235507 0 20235507 0 20235507 PART X, LINE 2: THE FOLLOWING IS AN EXCERPT FROM THE FINANCIAL STATEMENTS OF CAROLINA DEALERSHIPS, INC. WELFARE BENEFIT TRUST CAFETERIA PLAN REGARDING THE ADOPTION OF FIN 48: THE VEBA TRUST FUNDING CERTAIN BENEFITS OF THE PLAN RECEIVED AN EXEMPTION LETTER FROM THE INTERNAL REVENUE SERVICE(IRS), DATED FEBRUARY 2, 2007, STATING THAT THE TRUST IS TAX-EXEMPT UNDER TO PROVISIONS OF SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE ("IRC"). HOWEVER, AS A RESULT OF THE PLAN'S FUNDING POLICY, FROM TIME TO TIME THE TRUST MAY BE SUBJECT TO INCOME TAXES. NO FEDERAL OR STATE INCOME TAXES HAVE BEEN RECORDED IN 2021 OR 2020 FOR UNRELATED BUSINESS TAXABLE INCOME. IN ADDITION, THE PLAN AND THE TRUST ARE REQUIRED TO OPERATE IN CONFORMITY WITH THE IRC TO MAINTAIN THE TAX-EXEMPT STATUS OF THE TRUST. THE EMPLOYER BELIEVES THAT THE TRUST, AS AMENDED, CONTINUES TO QUALIFY AND OPERATE IN ACCORDANCE WITH APPLICABLE PROVISIONS OF THE IRC, AND THEREFORE, BELIEVES THAT THE RELATED TRUST IS TAX-EXEMPT. GAAP REQUIRES PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2021 AND 2020, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAKING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. SEE SCHEDULE R PART V FOR 0 PARTICIPATING EMPLOYERS(INTERESTED 0 PERSONS) RELATED THROUGH COMMON 0 OWNERSHIP 0 FORM 990, PART VI, SECTION A, LINE 2 T. DAVID NEILL TRUSTEE COMMON OWNERSHIP IN RELATED ORGANIZATIONS BETWEEN MEMBERS CHESTER A. MICHAEL III TRUSTEE COMMON OWNERSHIP IN RELATED ORGANIZATIONS BETWEEN MEMBERS CHED NEAL TRUSTEE COMMON OWNERSHIP IN RELATED ORGANIZATIONS BETWEEN MEMBERS FORM 990, PART VI, SECTION A, LINE 7B DECISIONS SUBJECT TO APPROVAL OF MEMBER TRUSTEES HAVE THE RIGHT TO APPROVE OR RATIFY ALL DECISIONS OF THE GOVERNING COMMITTEE. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS MADE AVAILABLE FOR REVIEW BY ALL MEMBERS OF COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 NO DOCUMENTS ARE AVAILABLE TO THE PUBLIC FORM 990, PART XI, LINE 9: NET CHANGE IN BENEFIT OBLIGATIONS -728,863. 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