2012-10-01T15:12:48-05:00 2011-12-31 263871397 Russell L Isenhour CPA PC 104 Third Street NE 100 Hickory NC 286015123 990 2011-01-01 561231050 Century Health Care Plan CENT 8283268365 PO Box 608 Hickory NC 28603 Richard Reese 8283268365 2012-10-01 1 Russell L Isenhour CPA P00043699 8283229300 2012-09-28 2011 2016-02-24 21:20:13Z Richard Reese 401 11th Street NW Hickory NC 28601 8563621 0 X N/A X 1978 NC EMPLOYEE WELFARE BENEFIT PLAN 3 0 0 0 0 0 0 0 11149498 8563621 0 0 0 0 11149498 8563621 0 0 10605878 8035356 0 0 0 0 0 543620 528265 11149498 8563621 0 0 0 0 0 0 0 0 To provide sickness and accident benefits for eligible employees of C.V. Industries. 0 0 8563621 8563621 PROVIDING HEALTH CARE BENEFITS TO APPROXIMATELY 1,200 PARTICIPANTS AND THEIR COVERED DEPENDENTS 8563621 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 3 0 1 0 0 0 0 0 0 1 1 0 0 1 0 1 1 0 0 0 X ROBERT JOHNSON 8283251851 401 11th Street NW Hickory NC 28601 X L SNYDER GARRISON JR 0.00 X 0 0 0 RICHARD REESE 0.00 X 0 0 0 ROBERT JOHNSON 0.00 X 0 0 0 0 0 0 0 0 0 0 Sun Life Assurance Company of Canada 1001 Haxall Point Suite 708 Richmond VA 23219 Stop Loss Agreement 267373 DirectNet LLC 1333 2nd St NW Suite 200 Hickory NC 28601 Networking Services 122696 Wells Fargo Third Party Administrators PO Box 3043 Charleston WV 253313043 Third Party Administrator 120621 3 EMPLOYER CONTRIBUTIONS 525100 5870147 5870147 EMPLOYEE CONTRIBUTIONS 525100 2260044 2260044 EMPLOYER RE NURSE 525100 422192 422192 COBRA SUBSIDY 525100 11238 11238 8563621 8563621 8563621 0 0 8035356 8035356 13319 13319 ADMINISTRATIVE FEES 514946 514946 8563621 8563621 0 0 0 0 0 0 X 0 0 0 0 0 0 0 0 0 0 0 0 X X 0 1 1 X 0 0 8563621 8563621 0 8563621 0 8563621 0 8563621 8563621 0 8563621 0 8563621 Form 990, Part VI, Section A, line 2 Richard Reese, Trustee, is an officer of CV Industries, Inc., which owns the employer of Snyder Garrison, Trustee. Form 990, Part VI, Section B, line 11 A 990 draft was provided by Russell L. Isenhour, CPA, PC to the Trustees for review. After approval from the Trustees, a final 990 was assembled and delivered to the Trustees for filing. Form 990, Part VI, Section C, line 19 There is not a written policy for conflict of interest. Governing documents and financial statements are available to the public upon request. Form 990 Part XII 2c The Trustees engaged Russell L. Isenhour, CPA, PC to audit the year ended December 31, 2011. Richard Reese, Trustee, assumes responsibility for oversight of the audit. Century Furniture LLC Pension Plan and Trust 401 11th St NW Hickory NC 28601 Defined Benefit Pension Plan (frozen 12/31/1994) NC 401(a) Century FurnitureLLC 0 CV Industries 401(K) Plan 401 11th St NW Hickory NC 28601 Defined Contribution Pension Plan NC 401(a) CV Industries Inc 0 CV Industries Inc Employee Stock Ownership Plan 401 11th St NW Hickory NC 28601 Defined Contribution Pension Plan NC 401(a) CV Industries Inc 0 CV Industries Inc 401 11th St NW Hickory NC 28601 561043374 Plan Sponsor NC C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0