401k Plan data: MERVIS MOTORS EMPLOYEE BENEFIT PLAN plan

MERVIS MOTORS EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	MERVIS MOTORS EMPLOYEE BENEFIT PLAN
Plan identification number	501

MERVIS MOTORS EMPLOYEE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

MERVIS MOTORS, INC. has sponsored the creation of one or more 401k plans.

Company Name: MERVIS MOTORS, INC.

Employer identification number (EIN): 251145741

NAIC Classification: 441110
NAIC Description: New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MERVIS MOTORS EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-11-01 DON POTTERS 2019-06-05
501 2016-11-01
501 2015-11-01

Plan Statistics for MERVIS MOTORS EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for MERVIS MOTORS EMPLOYEE BENEFIT PLAN

Measure Date Value
2017: MERVIS MOTORS EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-11-01 141
Total number of active participants reported on line 7a of the Form 5500 2017-11-01 136
Number of retired or separated participants receiving benefits 2017-11-01 0
Number of other retired or separated participants entitled to future benefits 2017-11-01 0
Total of all active and inactive participants 2017-11-01 136
2016: MERVIS MOTORS EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-11-01 135
Total number of active participants reported on line 7a of the Form 5500 2016-11-01 141
Number of retired or separated participants receiving benefits 2016-11-01 0
Number of other retired or separated participants entitled to future benefits 2016-11-01 2
Total of all active and inactive participants 2016-11-01 143
2015: MERVIS MOTORS EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-11-01 112
Total number of active participants reported on line 7a of the Form 5500 2015-11-01 135
Number of retired or separated participants receiving benefits 2015-11-01 0
Total of all active and inactive participants 2015-11-01 135

Measure	Date	Value
2017: MERVIS MOTORS EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-11-01	141
Total number of active participants reported on line 7a of the Form 5500	2017-11-01	136
Number of retired or separated participants receiving benefits	2017-11-01	0
Number of other retired or separated participants entitled to future benefits	2017-11-01	0
Total of all active and inactive participants	2017-11-01	136
2016: MERVIS MOTORS EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-11-01	135
Total number of active participants reported on line 7a of the Form 5500	2016-11-01	141
Number of retired or separated participants receiving benefits	2016-11-01	0
Number of other retired or separated participants entitled to future benefits	2016-11-01	2
Total of all active and inactive participants	2016-11-01	143
2015: MERVIS MOTORS EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-11-01	112
Total number of active participants reported on line 7a of the Form 5500	2015-11-01	135
Number of retired or separated participants receiving benefits	2015-11-01	0
Total of all active and inactive participants	2015-11-01	135

Form 5500 Responses for MERVIS MOTORS EMPLOYEE BENEFIT PLAN

2017: MERVIS MOTORS EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-11-01	Type of plan entity	Single employer plan
2017-11-01	Plan funding arrangement – Insurance	Yes
2017-11-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-11-01	Plan benefit arrangement – Insurance	Yes
2017-11-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: MERVIS MOTORS EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-11-01	Type of plan entity	Single employer plan
2016-11-01	Plan funding arrangement – Insurance	Yes
2016-11-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-11-01	Plan benefit arrangement – Insurance	Yes
2016-11-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: MERVIS MOTORS EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-11-01	Type of plan entity	Single employer plan
2015-11-01	Plan funding arrangement – Insurance	Yes
2015-11-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-11-01	Plan benefit arrangement – Insurance	Yes
2015-11-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00401050

Policy instance

Insurance contract or identification number	00401050
Number of Individuals Covered	136
Insurance policy start date	2017-11-01
Insurance policy end date	2018-10-31
Total amount of commissions paid to insurance broker	USD $8,005
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $92,171
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000021896

Policy instance

Insurance contract or identification number	0000021896
Number of Individuals Covered	98
Insurance policy start date	2017-11-01
Insurance policy end date	2018-10-31
Total amount of commissions paid to insurance broker	USD $3,265
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $28,725
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	MERVIS MOTORS, INC.
Employer identification number (EIN):	251145741
NAIC Classification:	441110
NAIC Description:	New Car Dealers

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2017-11-01	DON POTTERS	2019-06-05
501	2016-11-01
501	2015-11-01