401k Plan data: MARK MILLER HOLDINGS LLC MUTUAL OF OMAHA BENEFITS plan

MARK MILLER HOLDINGS LLC MUTUAL OF OMAHA BENEFITS 401k Plan overview

Plan Name	MARK MILLER HOLDINGS LLC MUTUAL OF OMAHA BENEFITS
Plan identification number	502

MARK MILLER HOLDINGS LLC MUTUAL OF OMAHA BENEFITS Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

MARK MILLER HOLDINGS LLC DBA MARK MILLER TOYOTA has sponsored the creation of one or more 401k plans.

Company Name: MARK MILLER HOLDINGS LLC DBA MARK MILLER TOYOTA

Employer identification number (EIN): 202210221

NAIC Classification: 423100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MARK MILLER HOLDINGS LLC MUTUAL OF OMAHA BENEFITS

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2021-04-01

Plan Statistics for MARK MILLER HOLDINGS LLC MUTUAL OF OMAHA BENEFITS

401k plan membership statisitcs for MARK MILLER HOLDINGS LLC MUTUAL OF OMAHA BENEFITS

Measure Date Value
2021: MARK MILLER HOLDINGS LLC MUTUAL OF OMAHA BENEFITS 2021 401k membership
Total participants, beginning-of-year 2021-04-01 134
Total number of active participants reported on line 7a of the Form 5500 2021-04-01 155
Number of retired or separated participants receiving benefits 2021-04-01 0
Number of other retired or separated participants entitled to future benefits 2021-04-01 0
Total of all active and inactive participants 2021-04-01 155

Measure	Date	Value
2021: MARK MILLER HOLDINGS LLC MUTUAL OF OMAHA BENEFITS 2021 401k membership
Total participants, beginning-of-year	2021-04-01	134
Total number of active participants reported on line 7a of the Form 5500	2021-04-01	155
Number of retired or separated participants receiving benefits	2021-04-01	0
Number of other retired or separated participants entitled to future benefits	2021-04-01	0
Total of all active and inactive participants	2021-04-01	155

Form 5500 Responses for MARK MILLER HOLDINGS LLC MUTUAL OF OMAHA BENEFITS

2021: MARK MILLER HOLDINGS LLC MUTUAL OF OMAHA BENEFITS 2021 form 5500 responses
2021-04-01	Type of plan entity	Single employer plan
2021-04-01	First time form 5500 has been submitted	Yes
2021-04-01	Submission has been amended	No
2021-04-01	This submission is the final filing	Yes
2021-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-04-01	Plan is a collectively bargained plan	No
2021-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-04-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0707E

Policy instance

Insurance contract or identification number	GLUG0707E
Number of Individuals Covered	192
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $1,251
Total amount of fees paid to insurance company	USD $676
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
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 $12,515
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,251
Amount paid for insurance broker fees	676
Additional information about fees paid to insurance broker	BROKER COMMISSIONS AND OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUD 0707E

Policy instance

Insurance contract or identification number	GUD 0707E
Number of Individuals Covered	191
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,753
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	Yes
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 $31,893
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	1753
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0707E

Policy instance

Insurance contract or identification number	GVTL0707E
Number of Individuals Covered	86
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $5,007
Total amount of fees paid to insurance company	USD $1,393
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
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 $33,381
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,007
Amount paid for insurance broker fees	1393
Additional information about fees paid to insurance broker	BROKER COMMISSIONS AND OTHER COMPENSATION
Insurance broker organization code?	3

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Company Name:	MARK MILLER HOLDINGS LLC DBA MARK MILLER TOYOTA
Employer identification number (EIN):	202210221
NAIC Classification:	423100