401k Plan data: CITYSIDE SUBARU 401(K)PLAN plan

CITYSIDE SUBARU 401(K)PLAN 401k Plan overview

Plan Name	CITYSIDE SUBARU 401(K)PLAN
Plan identification number	001

CITYSIDE SUBARU 401(K)PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

CITYSIDE SUBARU has sponsored the creation of one or more 401k plans.

Company Name: CITYSIDE SUBARU

Employer identification number (EIN): 043251052

NAIC Classification: 441110
NAIC Description: New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CITYSIDE SUBARU 401(K)PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 RICHARD WHITE 2023-03-21
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01 RICHARD WHITE
001 2017-01-01 RICHARD WHITE
001 2016-01-01 RICHARD WHITE
001 2015-01-01 RICHARD WHITE
001 2014-01-01 RICHARD WHITE
001 2013-01-01 RICHARD WHITE
001 2012-01-01 RICHARD WHITE
001 2011-01-01 RICHARD WHITE
001 2010-01-01 RICHARD WHITE
001 2009-01-01 RICHARD WHITE RICHARD WHITE 2010-03-24

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	RICHARD WHITE	2023-03-21
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01	RICHARD WHITE
001	2017-01-01	RICHARD WHITE
001	2016-01-01	RICHARD WHITE
001	2015-01-01	RICHARD WHITE
001	2014-01-01	RICHARD WHITE
001	2013-01-01	RICHARD WHITE
001	2012-01-01	RICHARD WHITE
001	2011-01-01	RICHARD WHITE
001	2010-01-01	RICHARD WHITE
001	2009-01-01	RICHARD WHITE		RICHARD WHITE	2010-03-24

Plan Statistics for CITYSIDE SUBARU 401(K)PLAN

401k plan membership statisitcs for CITYSIDE SUBARU 401(K)PLAN

Measure Date Value
2021: CITYSIDE SUBARU 401(K)PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 65
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 56
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 11
Total of all active and inactive participants 2021-01-01 67
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 67
Number of participants with account balances 2021-01-01 67
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 3
2020: CITYSIDE SUBARU 401(K)PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 57
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 50
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 14
Total of all active and inactive participants 2020-01-01 64
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 64
Number of participants with account balances 2020-01-01 64
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 4
2019: CITYSIDE SUBARU 401(K)PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 58
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 49
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 8
Total of all active and inactive participants 2019-01-01 57
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 57
Number of participants with account balances 2019-01-01 57
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 3
2018: CITYSIDE SUBARU 401(K)PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 54
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 43
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 13
Total of all active and inactive participants 2018-01-01 56
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 56
Number of participants with account balances 2018-01-01 56
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 3
2017: CITYSIDE SUBARU 401(K)PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 53
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 43
Number of retired or separated participants receiving benefits 2017-01-01 1
Number of other retired or separated participants entitled to future benefits 2017-01-01 6
Total of all active and inactive participants 2017-01-01 50
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 50
Number of participants with account balances 2017-01-01 50
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 3
2016: CITYSIDE SUBARU 401(K)PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 47
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 36
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 13
Total of all active and inactive participants 2016-01-01 49
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 49
Number of participants with account balances 2016-01-01 49
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 4
2015: CITYSIDE SUBARU 401(K)PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 45
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 39
Number of retired or separated participants receiving benefits 2015-01-01 2
Number of other retired or separated participants entitled to future benefits 2015-01-01 5
Total of all active and inactive participants 2015-01-01 46
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 46
Number of participants with account balances 2015-01-01 46
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 1
2014: CITYSIDE SUBARU 401(K)PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 40
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 38
Number of retired or separated participants receiving benefits 2014-01-01 1
Number of other retired or separated participants entitled to future benefits 2014-01-01 4
Total of all active and inactive participants 2014-01-01 43
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 43
Number of participants with account balances 2014-01-01 43
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 1
2013: CITYSIDE SUBARU 401(K)PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 42
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 36
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 3
Total of all active and inactive participants 2013-01-01 39
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 39
Number of participants with account balances 2013-01-01 39
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 2
2012: CITYSIDE SUBARU 401(K)PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 40
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 33
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 5
Total of all active and inactive participants 2012-01-01 38
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 38
Number of participants with account balances 2012-01-01 38
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 2
2011: CITYSIDE SUBARU 401(K)PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 37
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 30
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 7
Total of all active and inactive participants 2011-01-01 37
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 37
Number of participants with account balances 2011-01-01 37
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 4
2010: CITYSIDE SUBARU 401(K)PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 32
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 30
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 5
Total of all active and inactive participants 2010-01-01 35
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 35
Number of participants with account balances 2010-01-01 35
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 4
2009: CITYSIDE SUBARU 401(K)PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 29
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 29
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 2
Total of all active and inactive participants 2009-01-01 31
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 31
Number of participants with account balances 2009-01-01 31
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 3

Measure	Date	Value
2021: CITYSIDE SUBARU 401(K)PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	65
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	56
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	11
Total of all active and inactive participants	2021-01-01	67
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	67
Number of participants with account balances	2021-01-01	67
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	3
2020: CITYSIDE SUBARU 401(K)PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	57
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	50
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	14
Total of all active and inactive participants	2020-01-01	64
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	64
Number of participants with account balances	2020-01-01	64
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	4
2019: CITYSIDE SUBARU 401(K)PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	58
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	49
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	8
Total of all active and inactive participants	2019-01-01	57
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	57
Number of participants with account balances	2019-01-01	57
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	3
2018: CITYSIDE SUBARU 401(K)PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	54
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	43
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	13
Total of all active and inactive participants	2018-01-01	56
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	56
Number of participants with account balances	2018-01-01	56
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	3
2017: CITYSIDE SUBARU 401(K)PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	53
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	43
Number of retired or separated participants receiving benefits	2017-01-01	1
Number of other retired or separated participants entitled to future benefits	2017-01-01	6
Total of all active and inactive participants	2017-01-01	50
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	50
Number of participants with account balances	2017-01-01	50
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	3
2016: CITYSIDE SUBARU 401(K)PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	47
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	36
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	13
Total of all active and inactive participants	2016-01-01	49
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	49
Number of participants with account balances	2016-01-01	49
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	4
2015: CITYSIDE SUBARU 401(K)PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	45
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	39
Number of retired or separated participants receiving benefits	2015-01-01	2
Number of other retired or separated participants entitled to future benefits	2015-01-01	5
Total of all active and inactive participants	2015-01-01	46
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	46
Number of participants with account balances	2015-01-01	46
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	1
2014: CITYSIDE SUBARU 401(K)PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	40
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	38
Number of retired or separated participants receiving benefits	2014-01-01	1
Number of other retired or separated participants entitled to future benefits	2014-01-01	4
Total of all active and inactive participants	2014-01-01	43
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	43
Number of participants with account balances	2014-01-01	43
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	1
2013: CITYSIDE SUBARU 401(K)PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	42
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	36
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	3
Total of all active and inactive participants	2013-01-01	39
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	39
Number of participants with account balances	2013-01-01	39
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	2
2012: CITYSIDE SUBARU 401(K)PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	40
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	33
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	5
Total of all active and inactive participants	2012-01-01	38
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	38
Number of participants with account balances	2012-01-01	38
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	2
2011: CITYSIDE SUBARU 401(K)PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	37
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	30
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	7
Total of all active and inactive participants	2011-01-01	37
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	37
Number of participants with account balances	2011-01-01	37
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	4
2010: CITYSIDE SUBARU 401(K)PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	32
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	30
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	5
Total of all active and inactive participants	2010-01-01	35
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	35
Number of participants with account balances	2010-01-01	35
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	4
2009: CITYSIDE SUBARU 401(K)PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	29
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	29
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	2
Total of all active and inactive participants	2009-01-01	31
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	31
Number of participants with account balances	2009-01-01	31
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	3

Financial Data on CITYSIDE SUBARU 401(K)PLAN

Measure	Date	Value
2021 : CITYSIDE SUBARU 401(K)PLAN 2021 401k financial data
Total income from all sources	2021-12-31	$1,088,306
Expenses. Total of all expenses incurred	2021-12-31	$157,799
Benefits paid (including direct rollovers)	2021-12-31	$135,513
Total plan assets at end of year	2021-12-31	$5,529,005
Total plan assets at beginning of year	2021-12-31	$4,598,498
Value of fidelity bond covering the plan	2021-12-31	$459,850
Total contributions received or receivable from participants	2021-12-31	$312,391
Other income received	2021-12-31	$625,915
Net income (gross income less expenses)	2021-12-31	$930,507
Net plan assets at end of year (total assets less liabilities)	2021-12-31	$5,529,005
Net plan assets at beginning of year (total assets less liabilities)	2021-12-31	$4,598,498
Assets. Value of participant loans	2021-12-31	$67,454
Total contributions received or receivable from employer(s)	2021-12-31	$150,000
Expenses. Administrative service providers (salaries,fees and commissions)	2021-12-31	$22,286
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
2020 : CITYSIDE SUBARU 401(K)PLAN 2020 401k financial data
Total income from all sources	2020-12-31	$887,934
Expenses. Total of all expenses incurred	2020-12-31	$101,060
Benefits paid (including direct rollovers)	2020-12-31	$84,577
Total plan assets at end of year	2020-12-31	$4,598,498
Total plan assets at beginning of year	2020-12-31	$3,811,624
Value of fidelity bond covering the plan	2020-12-31	$382,000
Total contributions received or receivable from participants	2020-12-31	$230,513
Expenses. Other expenses not covered elsewhere	2020-12-31	$929
Other income received	2020-12-31	$522,921
Net income (gross income less expenses)	2020-12-31	$786,874
Net plan assets at end of year (total assets less liabilities)	2020-12-31	$4,598,498
Net plan assets at beginning of year (total assets less liabilities)	2020-12-31	$3,811,624
Assets. Value of participant loans	2020-12-31	$60,376
Total contributions received or receivable from employer(s)	2020-12-31	$134,500
Expenses. Administrative service providers (salaries,fees and commissions)	2020-12-31	$15,554
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
2019 : CITYSIDE SUBARU 401(K)PLAN 2019 401k financial data
Total income from all sources	2019-12-31	$1,007,550
Expenses. Total of all expenses incurred	2019-12-31	$124,898
Benefits paid (including direct rollovers)	2019-12-31	$111,228
Total plan assets at end of year	2019-12-31	$3,811,624
Total plan assets at beginning of year	2019-12-31	$2,928,972
Value of fidelity bond covering the plan	2019-12-31	$300,000
Total contributions received or receivable from participants	2019-12-31	$264,261
Expenses. Other expenses not covered elsewhere	2019-12-31	$750
Other income received	2019-12-31	$643,289
Net income (gross income less expenses)	2019-12-31	$882,652
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$3,811,624
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$2,928,972
Assets. Value of participant loans	2019-12-31	$64,377
Total contributions received or receivable from employer(s)	2019-12-31	$100,000
Expenses. Administrative service providers (salaries,fees and commissions)	2019-12-31	$12,920
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
2018 : CITYSIDE SUBARU 401(K)PLAN 2018 401k financial data
Total income from all sources	2018-12-31	$153,544
Expenses. Total of all expenses incurred	2018-12-31	$86,797
Benefits paid (including direct rollovers)	2018-12-31	$73,109
Total plan assets at end of year	2018-12-31	$2,928,972
Total plan assets at beginning of year	2018-12-31	$2,862,225
Value of fidelity bond covering the plan	2018-12-31	$300,000
Total contributions received or receivable from participants	2018-12-31	$237,983
Expenses. Other expenses not covered elsewhere	2018-12-31	$2,590
Other income received	2018-12-31	$-184,439
Net income (gross income less expenses)	2018-12-31	$66,747
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$2,928,972
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$2,862,225
Assets. Value of participant loans	2018-12-31	$95,908
Total contributions received or receivable from employer(s)	2018-12-31	$100,000
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$11,098
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
2017 : CITYSIDE SUBARU 401(K)PLAN 2017 401k financial data
Total income from all sources	2017-12-31	$621,354
Expenses. Total of all expenses incurred	2017-12-31	$183,176
Benefits paid (including direct rollovers)	2017-12-31	$170,443
Total plan assets at end of year	2017-12-31	$2,862,225
Total plan assets at beginning of year	2017-12-31	$2,424,047
Value of fidelity bond covering the plan	2017-12-31	$245,000
Total contributions received or receivable from participants	2017-12-31	$176,539
Other income received	2017-12-31	$384,815
Net income (gross income less expenses)	2017-12-31	$438,178
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$2,862,225
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$2,424,047
Assets. Value of participant loans	2017-12-31	$109,849
Total contributions received or receivable from employer(s)	2017-12-31	$60,000
Value of corrective distributions	2017-12-31	$3,007
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$9,726
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
2016 : CITYSIDE SUBARU 401(K)PLAN 2016 401k financial data
Total income from all sources	2016-12-31	$372,401
Expenses. Total of all expenses incurred	2016-12-31	$8,322
Benefits paid (including direct rollovers)	2016-12-31	$8,322
Total plan assets at end of year	2016-12-31	$2,424,047
Total plan assets at beginning of year	2016-12-31	$2,059,968
Value of fidelity bond covering the plan	2016-12-31	$300,000
Total contributions received or receivable from participants	2016-12-31	$172,479
Other income received	2016-12-31	$139,922
Net income (gross income less expenses)	2016-12-31	$364,079
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$2,424,047
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$2,059,968
Assets. Value of participant loans	2016-12-31	$134,017
Total contributions received or receivable from employer(s)	2016-12-31	$60,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : CITYSIDE SUBARU 401(K)PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$195,090
Expenses. Total of all expenses incurred	2015-12-31	$170,238
Benefits paid (including direct rollovers)	2015-12-31	$168,738
Total plan assets at end of year	2015-12-31	$2,059,968
Total plan assets at beginning of year	2015-12-31	$2,035,116
Value of fidelity bond covering the plan	2015-12-31	$210,000
Total contributions received or receivable from participants	2015-12-31	$185,771
Contributions received from other sources (not participants or employers)	2015-12-31	$20,850
Other income received	2015-12-31	$-61,531
Net income (gross income less expenses)	2015-12-31	$24,852
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$2,059,968
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$2,035,116
Assets. Value of participant loans	2015-12-31	$129,933
Total contributions received or receivable from employer(s)	2015-12-31	$50,000
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$1,500
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : CITYSIDE SUBARU 401(K)PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$305,455
Expenses. Total of all expenses incurred	2014-12-31	$98,228
Benefits paid (including direct rollovers)	2014-12-31	$95,952
Total plan assets at end of year	2014-12-31	$2,035,116
Total plan assets at beginning of year	2014-12-31	$1,827,889
Value of fidelity bond covering the plan	2014-12-31	$100,000
Total contributions received or receivable from participants	2014-12-31	$142,451
Other income received	2014-12-31	$113,004
Net income (gross income less expenses)	2014-12-31	$207,227
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$2,035,116
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$1,827,889
Assets. Value of participant loans	2014-12-31	$123,499
Total contributions received or receivable from employer(s)	2014-12-31	$50,000
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$2,276
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : CITYSIDE SUBARU 401(K)PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$360,547
Expenses. Total of all expenses incurred	2013-12-31	$32,623
Benefits paid (including direct rollovers)	2013-12-31	$30,742
Total plan assets at end of year	2013-12-31	$1,827,889
Total plan assets at beginning of year	2013-12-31	$1,499,965
Value of fidelity bond covering the plan	2013-12-31	$100,000
Total contributions received or receivable from participants	2013-12-31	$119,136
Other income received	2013-12-31	$201,411
Net income (gross income less expenses)	2013-12-31	$327,924
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$1,827,889
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$1,499,965
Assets. Value of participant loans	2013-12-31	$123,805
Total contributions received or receivable from employer(s)	2013-12-31	$40,000
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$1,881
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : CITYSIDE SUBARU 401(K)PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$302,552
Expenses. Total of all expenses incurred	2012-12-31	$127,648
Benefits paid (including direct rollovers)	2012-12-31	$122,330
Total plan assets at end of year	2012-12-31	$1,499,965
Total plan assets at beginning of year	2012-12-31	$1,325,061
Value of fidelity bond covering the plan	2012-12-31	$100,000
Total contributions received or receivable from participants	2012-12-31	$114,169
Other income received	2012-12-31	$148,383
Net income (gross income less expenses)	2012-12-31	$174,904
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$1,499,965
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$1,325,061
Assets. Value of participant loans	2012-12-31	$177,494
Total contributions received or receivable from employer(s)	2012-12-31	$40,000
Value of corrective distributions	2012-12-31	$5,075
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$243
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : CITYSIDE SUBARU 401(K)PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$91,957
Expenses. Total of all expenses incurred	2011-12-31	$44,238
Benefits paid (including direct rollovers)	2011-12-31	$43,261
Total plan assets at end of year	2011-12-31	$1,325,061
Total plan assets at beginning of year	2011-12-31	$1,277,342
Value of fidelity bond covering the plan	2011-12-31	$100,000
Total contributions received or receivable from participants	2011-12-31	$120,397
Contributions received from other sources (not participants or employers)	2011-12-31	$1,688
Other income received	2011-12-31	$-70,128
Net income (gross income less expenses)	2011-12-31	$47,719
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,325,061
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$1,277,342
Assets. Value of participant loans	2011-12-31	$149,440
Total contributions received or receivable from employer(s)	2011-12-31	$40,000
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$977
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : CITYSIDE SUBARU 401(K)PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$309,797
Expenses. Total of all expenses incurred	2010-12-31	$8,404
Benefits paid (including direct rollovers)	2010-12-31	$7,622
Total plan assets at end of year	2010-12-31	$1,277,342
Total plan assets at beginning of year	2010-12-31	$975,949
Value of fidelity bond covering the plan	2010-12-31	$100,000
Total contributions received or receivable from participants	2010-12-31	$126,648
Expenses. Other expenses not covered elsewhere	2010-12-31	$782
Contributions received from other sources (not participants or employers)	2010-12-31	$1,000
Other income received	2010-12-31	$152,149
Net income (gross income less expenses)	2010-12-31	$301,393
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$1,277,342
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$975,949
Assets. Value of participant loans	2010-12-31	$124,151
Total contributions received or receivable from employer(s)	2010-12-31	$30,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : CITYSIDE SUBARU 401(K)PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for CITYSIDE SUBARU 401(K)PLAN

2021: CITYSIDE SUBARU 401(K)PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: CITYSIDE SUBARU 401(K)PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: CITYSIDE SUBARU 401(K)PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: CITYSIDE SUBARU 401(K)PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: CITYSIDE SUBARU 401(K)PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: CITYSIDE SUBARU 401(K)PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: CITYSIDE SUBARU 401(K)PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: CITYSIDE SUBARU 401(K)PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: CITYSIDE SUBARU 401(K)PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: CITYSIDE SUBARU 401(K)PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: CITYSIDE SUBARU 401(K)PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: CITYSIDE SUBARU 401(K)PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: CITYSIDE SUBARU 401(K)PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

375091-01

Policy instance

Insurance contract or identification number	375091-01
Number of Individuals Covered	16
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

375091-01

Policy instance

Insurance contract or identification number	375091-01
Number of Individuals Covered	13
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

375091-01

Policy instance

Insurance contract or identification number	375091-01
Number of Individuals Covered	12
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

375091-01

Policy instance

Insurance contract or identification number	375091-01
Number of Individuals Covered	13
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

375091-01

Policy instance

Insurance contract or identification number	375091-01
Number of Individuals Covered	10
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

375091-01

Policy instance

Insurance contract or identification number	375091-01
Number of Individuals Covered	12
Insurance policy start date	2016-01-01
Insurance policy end date	2016-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-830435

Policy instance

Insurance contract or identification number	GA-830435
Number of Individuals Covered	0
Insurance policy start date	2016-01-01
Insurance policy end date	2016-04-30
Total amount of commissions paid to insurance broker	USD $2,642
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,642
Insurance broker organization code?	3
Insurance broker name	NYLIFE SECURITIES LLC

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

25790

Policy instance

Insurance contract or identification number	25790
Number of Individuals Covered	0
Insurance policy start date	2012-01-01
Insurance policy end date	2012-04-30
Total amount of commissions paid to insurance broker	USD $1,258
Total amount of fees paid to insurance company	USD $100
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $1,258
Insurance broker organization code?	3
Amount paid for insurance broker fees	100
Additional information about fees paid to insurance broker	TPA LOAN FEES
Insurance broker name	PENRET SERVICES, INC.

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

25790

Policy instance

Insurance contract or identification number	25790
Number of Individuals Covered	33
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,945
Total amount of fees paid to insurance company	USD $2,169
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

25790

Policy instance

Insurance contract or identification number	25790
Number of Individuals Covered	39
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,170
Total amount of fees paid to insurance company	USD $1,027
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,170
Insurance broker organization code?	3
Amount paid for insurance broker fees	600
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker name	PENRET SERVICES, INC.

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Company Name:	CITYSIDE SUBARU
Employer identification number (EIN):	043251052
NAIC Classification:	441110
NAIC Description:	New Car Dealers