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EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 401k Plan overview

Plan NameEJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN
Plan identification number 501

EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover

401k Sponsoring company profile

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

Company Name:EJB MOTORS, INC.
Employer identification number (EIN):251790069
NAIC Classification:441110
NAIC Description:New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-11-01
5012020-11-01
5012019-11-01
5012018-11-01
5012017-11-01
5012016-11-01VALERIE MORTON
5012015-11-01VALERIE MORTON
5012014-11-01TRACY A. GROSS-FRITZ
5012014-04-01
5012013-11-01TRACY A. GROSS-FRITZ
5012013-04-01
5012012-11-01KATHLEEN WALTERS
5012012-04-01KATHLEEN A. WALTERS
5012011-11-01MICHAEL A. BRENNER
5012010-11-01MICHAEL A. BRENNER

Plan Statistics for EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN

401k plan membership statisitcs for EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN

Measure Date Value
2021: EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-11-0169
Total number of active participants reported on line 7a of the Form 55002021-11-0168
Number of retired or separated participants receiving benefits2021-11-010
Number of other retired or separated participants entitled to future benefits2021-11-010
Total of all active and inactive participants2021-11-0168
2020: EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-11-0186
Total number of active participants reported on line 7a of the Form 55002020-11-0168
Number of retired or separated participants receiving benefits2020-11-011
Number of other retired or separated participants entitled to future benefits2020-11-010
Total of all active and inactive participants2020-11-0169
2019: EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-11-0170
Total number of active participants reported on line 7a of the Form 55002019-11-0168
Number of retired or separated participants receiving benefits2019-11-0118
Number of other retired or separated participants entitled to future benefits2019-11-010
Total of all active and inactive participants2019-11-0186
2018: EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-11-0175
Total number of active participants reported on line 7a of the Form 55002018-11-0169
Number of retired or separated participants receiving benefits2018-11-011
Number of other retired or separated participants entitled to future benefits2018-11-010
Total of all active and inactive participants2018-11-0170
2017: EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-11-01128
Total number of active participants reported on line 7a of the Form 55002017-11-0175
Number of retired or separated participants receiving benefits2017-11-010
Number of other retired or separated participants entitled to future benefits2017-11-010
Total of all active and inactive participants2017-11-0175
2016: EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-11-01130
Total number of active participants reported on line 7a of the Form 55002016-11-01128
Number of retired or separated participants receiving benefits2016-11-010
Number of other retired or separated participants entitled to future benefits2016-11-010
Total of all active and inactive participants2016-11-01128
2015: EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-11-01132
Total number of active participants reported on line 7a of the Form 55002015-11-01130
Number of retired or separated participants receiving benefits2015-11-010
Number of other retired or separated participants entitled to future benefits2015-11-010
Total of all active and inactive participants2015-11-01130
2014: EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-11-01130
Total number of active participants reported on line 7a of the Form 55002014-11-01129
Number of retired or separated participants receiving benefits2014-11-013
Number of other retired or separated participants entitled to future benefits2014-11-010
Total of all active and inactive participants2014-11-01132
Total participants, beginning-of-year2014-04-01109
Total number of active participants reported on line 7a of the Form 55002014-04-01108
Total of all active and inactive participants2014-04-01108
2013: EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year2013-11-01109
Total number of active participants reported on line 7a of the Form 55002013-11-01127
Number of retired or separated participants receiving benefits2013-11-013
Number of other retired or separated participants entitled to future benefits2013-11-010
Total of all active and inactive participants2013-11-01130
Total participants, beginning-of-year2013-04-01104
Total number of active participants reported on line 7a of the Form 55002013-04-01109
Total of all active and inactive participants2013-04-01109
2012: EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year2012-11-01118
Total number of active participants reported on line 7a of the Form 55002012-11-01108
Number of retired or separated participants receiving benefits2012-11-011
Number of other retired or separated participants entitled to future benefits2012-11-010
Total of all active and inactive participants2012-11-01109
Total participants, beginning-of-year2012-04-01107
Total number of active participants reported on line 7a of the Form 55002012-04-01104
Total of all active and inactive participants2012-04-01104
2011: EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year2011-11-01103
Total number of active participants reported on line 7a of the Form 55002011-11-01118
Number of retired or separated participants receiving benefits2011-11-010
Number of other retired or separated participants entitled to future benefits2011-11-010
Total of all active and inactive participants2011-11-01118
2010: EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2010 401k membership
Total participants, beginning-of-year2010-11-01105
Total number of active participants reported on line 7a of the Form 55002010-11-01102
Number of retired or separated participants receiving benefits2010-11-011
Number of other retired or separated participants entitled to future benefits2010-11-010
Total of all active and inactive participants2010-11-01103

Financial Data on EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN

Measure Date Value
2022 : EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2022 401k financial data
Total plan liabilities at end of year2022-10-31$121,391
Total plan liabilities at beginning of year2022-10-31$131,220
Total income from all sources2022-10-31$664,049
Expenses. Total of all expenses incurred2022-10-31$742,131
Benefits paid (including direct rollovers)2022-10-31$463,720
Total plan assets at end of year2022-10-31$169,077
Total plan assets at beginning of year2022-10-31$256,988
Value of fidelity bond covering the plan2022-10-31$500,000
Total contributions received or receivable from participants2022-10-31$12,571
Expenses. Other expenses not covered elsewhere2022-10-31$246,681
Contributions received from other sources (not participants or employers)2022-10-31$1,878
Other income received2022-10-31$132
Net income (gross income less expenses)2022-10-31$-78,082
Net plan assets at end of year (total assets less liabilities)2022-10-31$47,686
Net plan assets at beginning of year (total assets less liabilities)2022-10-31$125,768
Total contributions received or receivable from employer(s)2022-10-31$649,468
Value of corrective distributions2022-10-31$9,273
Expenses. Administrative service providers (salaries,fees and commissions)2022-10-31$22,457
2021 : EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2021 401k financial data
Total plan liabilities at end of year2021-10-31$131,220
Total plan liabilities at beginning of year2021-10-31$0
Total income from all sources2021-10-31$355,180
Expenses. Total of all expenses incurred2021-10-31$513,268
Benefits paid (including direct rollovers)2021-10-31$252,217
Total plan assets at end of year2021-10-31$256,988
Total plan assets at beginning of year2021-10-31$283,856
Value of fidelity bond covering the plan2021-10-31$500,000
Total contributions received or receivable from participants2021-10-31$22,855
Expenses. Other expenses not covered elsewhere2021-10-31$200,374
Other income received2021-10-31$162
Net income (gross income less expenses)2021-10-31$-158,088
Net plan assets at end of year (total assets less liabilities)2021-10-31$125,768
Net plan assets at beginning of year (total assets less liabilities)2021-10-31$283,856
Total contributions received or receivable from employer(s)2021-10-31$332,163
Expenses. Administrative service providers (salaries,fees and commissions)2021-10-31$60,677
2020 : EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2020 401k financial data
Total plan liabilities at beginning of year2020-10-31$4,505
Total income from all sources2020-10-31$480,423
Expenses. Total of all expenses incurred2020-10-31$668,348
Benefits paid (including direct rollovers)2020-10-31$341,317
Total plan assets at end of year2020-10-31$283,856
Total plan assets at beginning of year2020-10-31$476,286
Value of fidelity bond covering the plan2020-10-31$500,000
Total contributions received or receivable from participants2020-10-31$30,969
Expenses. Other expenses not covered elsewhere2020-10-31$249,575
Other income received2020-10-31$969
Net income (gross income less expenses)2020-10-31$-187,925
Net plan assets at end of year (total assets less liabilities)2020-10-31$283,856
Net plan assets at beginning of year (total assets less liabilities)2020-10-31$471,781
Total contributions received or receivable from employer(s)2020-10-31$448,485
Expenses. Administrative service providers (salaries,fees and commissions)2020-10-31$77,456
2019 : EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2019 401k financial data
Total plan liabilities at end of year2019-10-31$4,505
Total plan liabilities at beginning of year2019-10-31$40,613
Total income from all sources2019-10-31$766,885
Expenses. Total of all expenses incurred2019-10-31$620,645
Benefits paid (including direct rollovers)2019-10-31$327,744
Total plan assets at end of year2019-10-31$476,286
Total plan assets at beginning of year2019-10-31$366,154
Value of fidelity bond covering the plan2019-10-31$500,000
Total contributions received or receivable from participants2019-10-31$31,740
Expenses. Other expenses not covered elsewhere2019-10-31$222,514
Other income received2019-10-31$1,045
Net income (gross income less expenses)2019-10-31$146,240
Net plan assets at end of year (total assets less liabilities)2019-10-31$471,781
Net plan assets at beginning of year (total assets less liabilities)2019-10-31$325,541
Total contributions received or receivable from employer(s)2019-10-31$734,100
Expenses. Administrative service providers (salaries,fees and commissions)2019-10-31$70,387
2018 : EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-10-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-10-31$40,613
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-10-31$31,172
Total income from all sources (including contributions)2018-10-31$870,739
Total loss/gain on sale of assets2018-10-31$0
Total of all expenses incurred2018-10-31$874,030
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-10-31$477,381
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-10-31$870,242
Value of total assets at end of year2018-10-31$366,154
Value of total assets at beginning of year2018-10-31$360,004
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-10-31$396,649
Total interest from all sources2018-10-31$497
Total dividends received (eg from common stock, registered investment company shares)2018-10-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-10-31No
Was this plan covered by a fidelity bond2018-10-31Yes
Value of fidelity bond cover2018-10-31$1,000,000
If this is an individual account plan, was there a blackout period2018-10-31No
Were there any nonexempt tranactions with any party-in-interest2018-10-31No
Contributions received from participants2018-10-31$68,586
Participant contributions at end of year2018-10-31$0
Participant contributions at beginning of year2018-10-31$371
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-10-31$40,613
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-10-31$0
Administrative expenses (other) incurred2018-10-31$287,682
Liabilities. Value of operating payables at end of year2018-10-31$0
Liabilities. Value of operating payables at beginning of year2018-10-31$5,158
Total non interest bearing cash at end of year2018-10-31$0
Total non interest bearing cash at beginning of year2018-10-31$4,787
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-10-31No
Value of net income/loss2018-10-31$-3,291
Value of net assets at end of year (total assets less liabilities)2018-10-31$325,541
Value of net assets at beginning of year (total assets less liabilities)2018-10-31$328,832
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-10-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-10-31No
Were any leases to which the plan was party in default or uncollectible2018-10-31No
Investment advisory and management fees2018-10-31$26,471
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-10-31$366,154
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-10-31$354,846
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-10-31$354,846
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-10-31$497
Expenses. Payments to insurance carriers foe the provision of benefits2018-10-31$477,381
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-10-31No
Was there a failure to transmit to the plan any participant contributions2018-10-31No
Has the plan failed to provide any benefit when due under the plan2018-10-31No
Assets. Invements in employer securities at end of year2018-10-31$0
Assets. Invements in employer securities at beginning of year2018-10-31$0
Contributions received in cash from employer2018-10-31$801,656
Contract administrator fees2018-10-31$82,496
Liabilities. Value of benefit claims payable at end of year2018-10-31$0
Liabilities. Value of benefit claims payable at beginning of year2018-10-31$26,014
Did the plan have assets held for investment2018-10-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-10-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-10-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-10-31No
Opinion of an independent qualified public accountant for this plan2018-10-31Unqualified
Accountancy firm name2018-10-31YOUNG, OAKES, BROWN & CO., P.C.
Accountancy firm EIN2018-10-31251589048
2017 : EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-10-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-10-31$31,172
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-10-31$6,769
Total income from all sources (including contributions)2017-10-31$913,364
Total loss/gain on sale of assets2017-10-31$0
Total of all expenses incurred2017-10-31$1,024,451
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-10-31$616,986
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-10-31$912,650
Value of total assets at end of year2017-10-31$360,004
Value of total assets at beginning of year2017-10-31$446,688
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-10-31$407,465
Total interest from all sources2017-10-31$714
Total dividends received (eg from common stock, registered investment company shares)2017-10-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-10-31No
Was this plan covered by a fidelity bond2017-10-31Yes
Value of fidelity bond cover2017-10-31$1,000,000
If this is an individual account plan, was there a blackout period2017-10-31No
Were there any nonexempt tranactions with any party-in-interest2017-10-31No
Contributions received from participants2017-10-31$55,353
Participant contributions at end of year2017-10-31$371
Participant contributions at beginning of year2017-10-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-10-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-10-31$0
Administrative expenses (other) incurred2017-10-31$283,884
Liabilities. Value of operating payables at end of year2017-10-31$5,158
Liabilities. Value of operating payables at beginning of year2017-10-31$0
Total non interest bearing cash at end of year2017-10-31$4,787
Total non interest bearing cash at beginning of year2017-10-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-10-31No
Value of net income/loss2017-10-31$-111,087
Value of net assets at end of year (total assets less liabilities)2017-10-31$328,832
Value of net assets at beginning of year (total assets less liabilities)2017-10-31$439,919
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-10-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-10-31No
Were any leases to which the plan was party in default or uncollectible2017-10-31No
Investment advisory and management fees2017-10-31$41,085
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-10-31$354,846
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-10-31$446,688
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-10-31$446,688
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-10-31$714
Expenses. Payments to insurance carriers foe the provision of benefits2017-10-31$616,986
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-10-31No
Was there a failure to transmit to the plan any participant contributions2017-10-31No
Has the plan failed to provide any benefit when due under the plan2017-10-31No
Assets. Invements in employer securities at end of year2017-10-31$0
Assets. Invements in employer securities at beginning of year2017-10-31$0
Contributions received in cash from employer2017-10-31$857,297
Contract administrator fees2017-10-31$82,496
Liabilities. Value of benefit claims payable at end of year2017-10-31$26,014
Liabilities. Value of benefit claims payable at beginning of year2017-10-31$6,769
Did the plan have assets held for investment2017-10-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-10-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-10-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-10-31No
Opinion of an independent qualified public accountant for this plan2017-10-31Unqualified
Accountancy firm name2017-10-31YOUNG, OAKES, BROWN & CO., P.C.
Accountancy firm EIN2017-10-31251589048
2016 : EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-10-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-10-31$6,769
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-10-31$30,158
Total income from all sources (including contributions)2016-10-31$1,020,422
Total loss/gain on sale of assets2016-10-31$0
Total of all expenses incurred2016-10-31$1,082,210
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-10-31$678,765
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-10-31$1,019,610
Value of total assets at end of year2016-10-31$446,688
Value of total assets at beginning of year2016-10-31$531,865
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-10-31$403,445
Total interest from all sources2016-10-31$812
Total dividends received (eg from common stock, registered investment company shares)2016-10-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-10-31No
Was this plan covered by a fidelity bond2016-10-31Yes
Value of fidelity bond cover2016-10-31$500,000
If this is an individual account plan, was there a blackout period2016-10-31No
Were there any nonexempt tranactions with any party-in-interest2016-10-31No
Contributions received from participants2016-10-31$126,109
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-10-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-10-31$25,920
Administrative expenses (other) incurred2016-10-31$280,797
Total non interest bearing cash at end of year2016-10-31$0
Total non interest bearing cash at beginning of year2016-10-31$105,034
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-10-31No
Value of net income/loss2016-10-31$-61,788
Value of net assets at end of year (total assets less liabilities)2016-10-31$439,919
Value of net assets at beginning of year (total assets less liabilities)2016-10-31$501,707
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-10-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-10-31No
Were any leases to which the plan was party in default or uncollectible2016-10-31No
Investment advisory and management fees2016-10-31$36,644
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-10-31$446,688
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-10-31$426,831
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-10-31$426,831
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-10-31$812
Expenses. Payments to insurance carriers foe the provision of benefits2016-10-31$678,765
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-10-31No
Was there a failure to transmit to the plan any participant contributions2016-10-31No
Has the plan failed to provide any benefit when due under the plan2016-10-31No
Assets. Invements in employer securities at end of year2016-10-31$0
Assets. Invements in employer securities at beginning of year2016-10-31$0
Contributions received in cash from employer2016-10-31$893,501
Contract administrator fees2016-10-31$86,004
Liabilities. Value of benefit claims payable at end of year2016-10-31$6,769
Liabilities. Value of benefit claims payable at beginning of year2016-10-31$4,238
Did the plan have assets held for investment2016-10-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-10-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-10-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-10-31No
Opinion of an independent qualified public accountant for this plan2016-10-31Unqualified
Accountancy firm name2016-10-31YOUNG, OAKES, BROWN & CO., P.C.
Accountancy firm EIN2016-10-31251589048
2015 : EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-10-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-10-31$30,158
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-10-31$212,938
Total income from all sources (including contributions)2015-10-31$990,391
Total loss/gain on sale of assets2015-10-31$0
Total of all expenses incurred2015-10-31$773,134
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-10-31$399,789
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-10-31$989,260
Value of total assets at end of year2015-10-31$531,865
Value of total assets at beginning of year2015-10-31$497,388
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-10-31$373,345
Total interest from all sources2015-10-31$1,131
Total dividends received (eg from common stock, registered investment company shares)2015-10-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-10-31No
Was this plan covered by a fidelity bond2015-10-31Yes
Value of fidelity bond cover2015-10-31$500,000
If this is an individual account plan, was there a blackout period2015-10-31No
Were there any nonexempt tranactions with any party-in-interest2015-10-31No
Contributions received from participants2015-10-31$144,566
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-10-31$25,920
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-10-31$0
Administrative expenses (other) incurred2015-10-31$252,842
Liabilities. Value of operating payables at end of year2015-10-31$0
Liabilities. Value of operating payables at beginning of year2015-10-31$103,649
Total non interest bearing cash at end of year2015-10-31$105,034
Total non interest bearing cash at beginning of year2015-10-31$103,649
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-10-31No
Value of net income/loss2015-10-31$217,257
Value of net assets at end of year (total assets less liabilities)2015-10-31$501,707
Value of net assets at beginning of year (total assets less liabilities)2015-10-31$284,450
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-10-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-10-31No
Were any leases to which the plan was party in default or uncollectible2015-10-31No
Investment advisory and management fees2015-10-31$36,785
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-10-31$426,831
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-10-31$393,739
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-10-31$393,739
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-10-31$1,131
Expenses. Payments to insurance carriers foe the provision of benefits2015-10-31$399,789
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-10-31No
Was there a failure to transmit to the plan any participant contributions2015-10-31No
Has the plan failed to provide any benefit when due under the plan2015-10-31No
Assets. Invements in employer securities at end of year2015-10-31$0
Assets. Invements in employer securities at beginning of year2015-10-31$0
Contributions received in cash from employer2015-10-31$844,694
Contract administrator fees2015-10-31$83,718
Liabilities. Value of benefit claims payable at end of year2015-10-31$4,238
Liabilities. Value of benefit claims payable at beginning of year2015-10-31$109,289
Did the plan have assets held for investment2015-10-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-10-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-10-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-10-31No
Opinion of an independent qualified public accountant for this plan2015-10-31Unqualified
Accountancy firm name2015-10-31YOUNG, OAKES, BROWN & CO., P.C.
Accountancy firm EIN2015-10-31251589048
2014 : EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-10-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-10-31$212,938
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-10-31$0
Total income from all sources (including contributions)2014-10-31$1,010,430
Total loss/gain on sale of assets2014-10-31$0
Total of all expenses incurred2014-10-31$984,289
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-10-31$666,205
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-10-31$1,009,801
Value of total assets at end of year2014-10-31$497,388
Value of total assets at beginning of year2014-10-31$258,309
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-10-31$318,084
Total interest from all sources2014-10-31$629
Total dividends received (eg from common stock, registered investment company shares)2014-10-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-10-31No
Was this plan covered by a fidelity bond2014-10-31Yes
Value of fidelity bond cover2014-10-31$1,000,000
If this is an individual account plan, was there a blackout period2014-10-31No
Were there any nonexempt tranactions with any party-in-interest2014-10-31No
Contributions received from participants2014-10-31$166,701
Administrative expenses (other) incurred2014-10-31$211,039
Liabilities. Value of operating payables at end of year2014-10-31$103,649
Liabilities. Value of operating payables at beginning of year2014-10-31$0
Total non interest bearing cash at end of year2014-10-31$103,649
Total non interest bearing cash at beginning of year2014-10-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-10-31No
Value of net income/loss2014-10-31$26,141
Value of net assets at end of year (total assets less liabilities)2014-10-31$284,450
Value of net assets at beginning of year (total assets less liabilities)2014-10-31$258,309
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-10-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-10-31No
Were any leases to which the plan was party in default or uncollectible2014-10-31No
Investment advisory and management fees2014-10-31$32,810
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-10-31$393,739
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-10-31$258,309
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-10-31$258,309
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-10-31$629
Expenses. Payments to insurance carriers foe the provision of benefits2014-10-31$666,205
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-10-31No
Was there a failure to transmit to the plan any participant contributions2014-10-31No
Has the plan failed to provide any benefit when due under the plan2014-10-31No
Assets. Invements in employer securities at end of year2014-10-31$0
Assets. Invements in employer securities at beginning of year2014-10-31$0
Contributions received in cash from employer2014-10-31$843,100
Contract administrator fees2014-10-31$74,235
Liabilities. Value of benefit claims payable at end of year2014-10-31$109,289
Liabilities. Value of benefit claims payable at beginning of year2014-10-31$0
Did the plan have assets held for investment2014-10-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-10-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-10-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-10-31No
Opinion of an independent qualified public accountant for this plan2014-10-31Unqualified
Accountancy firm name2014-10-31YOUNG, OAKES, BROWN & CO., P.C.
Accountancy firm EIN2014-10-31251589048
2013 : EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-10-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-10-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-10-31$2,582
Total income from all sources (including contributions)2013-10-31$1,404,048
Total loss/gain on sale of assets2013-10-31$0
Total of all expenses incurred2013-10-31$1,431,011
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-10-31$1,147,761
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-10-31$832,728
Value of total assets at end of year2013-10-31$258,309
Value of total assets at beginning of year2013-10-31$287,854
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-10-31$283,250
Total interest from all sources2013-10-31$642
Total dividends received (eg from common stock, registered investment company shares)2013-10-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-10-31No
Was this plan covered by a fidelity bond2013-10-31Yes
Value of fidelity bond cover2013-10-31$1,000,000
If this is an individual account plan, was there a blackout period2013-10-31No
Were there any nonexempt tranactions with any party-in-interest2013-10-31No
Contributions received from participants2013-10-31$179,083
Other income not declared elsewhere2013-10-31$570,678
Administrative expenses (other) incurred2013-10-31$184,960
Liabilities. Value of operating payables at end of year2013-10-31$0
Liabilities. Value of operating payables at beginning of year2013-10-31$2,582
Total non interest bearing cash at end of year2013-10-31$0
Total non interest bearing cash at beginning of year2013-10-31$-1,761
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-10-31No
Value of net income/loss2013-10-31$-26,963
Value of net assets at end of year (total assets less liabilities)2013-10-31$258,309
Value of net assets at beginning of year (total assets less liabilities)2013-10-31$285,272
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-10-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-10-31No
Were any leases to which the plan was party in default or uncollectible2013-10-31No
Investment advisory and management fees2013-10-31$29,725
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-10-31$258,309
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-10-31$289,615
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-10-31$289,615
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-10-31$642
Expenses. Payments to insurance carriers foe the provision of benefits2013-10-31$1,147,761
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-10-31No
Was there a failure to transmit to the plan any participant contributions2013-10-31No
Has the plan failed to provide any benefit when due under the plan2013-10-31No
Contributions received in cash from employer2013-10-31$653,645
Contract administrator fees2013-10-31$68,565
Did the plan have assets held for investment2013-10-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-10-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-10-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-10-31No
Opinion of an independent qualified public accountant for this plan2013-10-31Unqualified
Accountancy firm name2013-10-31YOUNG, OAKES, BROWN & CO., P.C.
Accountancy firm EIN2013-10-31251589048
2012 : EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-10-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-10-31$2,582
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-10-31$0
Total income from all sources (including contributions)2012-10-31$929,310
Total loss/gain on sale of assets2012-10-31$0
Total of all expenses incurred2012-10-31$785,074
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-10-31$529,608
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-10-31$782,034
Value of total assets at end of year2012-10-31$287,854
Value of total assets at beginning of year2012-10-31$141,036
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-10-31$255,466
Total interest from all sources2012-10-31$1,397
Total dividends received (eg from common stock, registered investment company shares)2012-10-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-10-31No
Was this plan covered by a fidelity bond2012-10-31No
If this is an individual account plan, was there a blackout period2012-10-31No
Were there any nonexempt tranactions with any party-in-interest2012-10-31No
Contributions received from participants2012-10-31$181,816
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-10-31$2,582
Other income not declared elsewhere2012-10-31$145,879
Administrative expenses (other) incurred2012-10-31$162,334
Total non interest bearing cash at end of year2012-10-31$-1,761
Total non interest bearing cash at beginning of year2012-10-31$-22,004
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-10-31No
Value of net income/loss2012-10-31$144,236
Value of net assets at end of year (total assets less liabilities)2012-10-31$285,272
Value of net assets at beginning of year (total assets less liabilities)2012-10-31$141,036
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-10-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-10-31No
Were any leases to which the plan was party in default or uncollectible2012-10-31No
Investment advisory and management fees2012-10-31$29,463
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-10-31$289,615
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-10-31$163,030
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-10-31$163,030
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-10-31$1,397
Expenses. Payments to insurance carriers foe the provision of benefits2012-10-31$529,608
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-10-31No
Was there a failure to transmit to the plan any participant contributions2012-10-31No
Has the plan failed to provide any benefit when due under the plan2012-10-31No
Contributions received in cash from employer2012-10-31$600,218
Employer contributions (assets) at end of year2012-10-31$0
Employer contributions (assets) at beginning of year2012-10-31$10
Contract administrator fees2012-10-31$63,669
Did the plan have assets held for investment2012-10-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-10-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-10-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-10-31No
Opinion of an independent qualified public accountant for this plan2012-10-31Unqualified
Accountancy firm name2012-10-31YOUNG, OAKES, BROWN & CO., P.C.
Accountancy firm EIN2012-10-31251589048
2011 : EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-10-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-10-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-10-31$0
Total income from all sources (including contributions)2011-10-31$755,939
Total loss/gain on sale of assets2011-10-31$0
Total of all expenses incurred2011-10-31$614,903
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-10-31$386,894
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-10-31$692,702
Value of total assets at end of year2011-10-31$141,036
Value of total assets at beginning of year2011-10-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-10-31$228,009
Total interest from all sources2011-10-31$900
Total dividends received (eg from common stock, registered investment company shares)2011-10-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-10-31No
Was this plan covered by a fidelity bond2011-10-31No
Were there any nonexempt tranactions with any party-in-interest2011-10-31No
Contributions received from participants2011-10-31$170,579
Other income not declared elsewhere2011-10-31$62,337
Administrative expenses (other) incurred2011-10-31$141,658
Total non interest bearing cash at end of year2011-10-31$-22,004
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-10-31No
Value of net income/loss2011-10-31$141,036
Value of net assets at end of year (total assets less liabilities)2011-10-31$141,036
Value of net assets at beginning of year (total assets less liabilities)2011-10-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-10-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-10-31No
Were any leases to which the plan was party in default or uncollectible2011-10-31No
Investment advisory and management fees2011-10-31$28,490
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-10-31$163,030
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-10-31$900
Expenses. Payments to insurance carriers foe the provision of benefits2011-10-31$386,894
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-10-31No
Was there a failure to transmit to the plan any participant contributions2011-10-31No
Has the plan failed to provide any benefit when due under the plan2011-10-31No
Contributions received in cash from employer2011-10-31$522,123
Employer contributions (assets) at end of year2011-10-31$10
Contract administrator fees2011-10-31$57,861
Did the plan have assets held for investment2011-10-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-10-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-10-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-10-31No
Opinion of an independent qualified public accountant for this plan2011-10-31Unqualified
Accountancy firm name2011-10-31YOUNG, OAKES, BROWN & CO., P.C.
Accountancy firm EIN2011-10-31251589048

Form 5500 Responses for EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN

2021: EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2021 form 5500 responses
2021-11-01Type of plan entitySingle employer plan
2021-11-01Submission has been amendedNo
2021-11-01This submission is the final filingNo
2021-11-01This return/report is a short plan year return/report (less than 12 months)No
2021-11-01Plan is a collectively bargained planNo
2021-11-01Plan funding arrangement – InsuranceYes
2021-11-01Plan funding arrangement – TrustYes
2021-11-01Plan benefit arrangement – InsuranceYes
2021-11-01Plan benefit arrangement - TrustYes
2020: EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2020 form 5500 responses
2020-11-01Type of plan entitySingle employer plan
2020-11-01Submission has been amendedNo
2020-11-01This submission is the final filingNo
2020-11-01This return/report is a short plan year return/report (less than 12 months)No
2020-11-01Plan is a collectively bargained planNo
2020-11-01Plan funding arrangement – InsuranceYes
2020-11-01Plan funding arrangement – TrustYes
2020-11-01Plan benefit arrangement – InsuranceYes
2020-11-01Plan benefit arrangement - TrustYes
2019: EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2019 form 5500 responses
2019-11-01Type of plan entitySingle employer plan
2019-11-01Submission has been amendedNo
2019-11-01This submission is the final filingNo
2019-11-01This return/report is a short plan year return/report (less than 12 months)No
2019-11-01Plan is a collectively bargained planNo
2019-11-01Plan funding arrangement – InsuranceYes
2019-11-01Plan funding arrangement – TrustYes
2019-11-01Plan benefit arrangement – InsuranceYes
2019-11-01Plan benefit arrangement - TrustYes
2018: EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2018 form 5500 responses
2018-11-01Type of plan entitySingle employer plan
2018-11-01Submission has been amendedNo
2018-11-01This submission is the final filingNo
2018-11-01This return/report is a short plan year return/report (less than 12 months)No
2018-11-01Plan is a collectively bargained planNo
2018-11-01Plan funding arrangement – InsuranceYes
2018-11-01Plan funding arrangement – TrustYes
2018-11-01Plan benefit arrangement – InsuranceYes
2018-11-01Plan benefit arrangement - TrustYes
2017: EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2017 form 5500 responses
2017-11-01Type of plan entitySingle employer plan
2017-11-01Submission has been amendedNo
2017-11-01This submission is the final filingNo
2017-11-01This return/report is a short plan year return/report (less than 12 months)No
2017-11-01Plan is a collectively bargained planNo
2017-11-01Plan funding arrangement – InsuranceYes
2017-11-01Plan funding arrangement – TrustYes
2017-11-01Plan benefit arrangement – InsuranceYes
2017-11-01Plan benefit arrangement - TrustYes
2016: EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2016 form 5500 responses
2016-11-01Type of plan entitySingle employer plan
2016-11-01Submission has been amendedNo
2016-11-01This submission is the final filingNo
2016-11-01This return/report is a short plan year return/report (less than 12 months)No
2016-11-01Plan is a collectively bargained planNo
2016-11-01Plan funding arrangement – InsuranceYes
2016-11-01Plan funding arrangement – TrustYes
2016-11-01Plan benefit arrangement – InsuranceYes
2016-11-01Plan benefit arrangement - TrustYes
2015: EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2015 form 5500 responses
2015-11-01Type of plan entitySingle employer plan
2015-11-01Submission has been amendedNo
2015-11-01This submission is the final filingNo
2015-11-01This return/report is a short plan year return/report (less than 12 months)No
2015-11-01Plan is a collectively bargained planNo
2015-11-01Plan funding arrangement – InsuranceYes
2015-11-01Plan funding arrangement – TrustYes
2015-11-01Plan benefit arrangement – InsuranceYes
2015-11-01Plan benefit arrangement - TrustYes
2014: EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2014 form 5500 responses
2014-11-01Type of plan entitySingle employer plan
2014-11-01Submission has been amendedNo
2014-11-01This submission is the final filingNo
2014-11-01This return/report is a short plan year return/report (less than 12 months)No
2014-11-01Plan is a collectively bargained planNo
2014-11-01Plan funding arrangement – InsuranceYes
2014-11-01Plan funding arrangement – TrustYes
2014-11-01Plan benefit arrangement – InsuranceYes
2014-11-01Plan benefit arrangement - TrustYes
2014-04-01Type of plan entitySingle employer plan
2014-04-01Plan is a collectively bargained planYes
2014-04-01Plan funding arrangement – InsuranceYes
2014-04-01Plan benefit arrangement – InsuranceYes
2013: EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2013 form 5500 responses
2013-11-01Type of plan entitySingle employer plan
2013-11-01Submission has been amendedNo
2013-11-01This submission is the final filingNo
2013-11-01This return/report is a short plan year return/report (less than 12 months)No
2013-11-01Plan is a collectively bargained planNo
2013-11-01Plan funding arrangement – InsuranceYes
2013-11-01Plan funding arrangement – TrustYes
2013-11-01Plan benefit arrangement – InsuranceYes
2013-11-01Plan benefit arrangement - TrustYes
2013-04-01Type of plan entitySingle employer plan
2013-04-01Plan is a collectively bargained planYes
2013-04-01Plan funding arrangement – InsuranceYes
2013-04-01Plan benefit arrangement – InsuranceYes
2012: EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2012 form 5500 responses
2012-11-01Type of plan entitySingle employer plan
2012-11-01Submission has been amendedNo
2012-11-01This submission is the final filingNo
2012-11-01This return/report is a short plan year return/report (less than 12 months)No
2012-11-01Plan is a collectively bargained planNo
2012-11-01Plan funding arrangement – InsuranceYes
2012-11-01Plan funding arrangement – TrustYes
2012-11-01Plan benefit arrangement – InsuranceYes
2012-11-01Plan benefit arrangement - TrustYes
2012-04-01Type of plan entitySingle employer plan
2012-04-01Plan is a collectively bargained planYes
2012-04-01Plan funding arrangement – InsuranceYes
2012-04-01Plan benefit arrangement – InsuranceYes
2011: EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2011 form 5500 responses
2011-11-01Type of plan entitySingle employer plan
2011-11-01Submission has been amendedNo
2011-11-01This submission is the final filingNo
2011-11-01This return/report is a short plan year return/report (less than 12 months)No
2011-11-01Plan is a collectively bargained planNo
2011-11-01Plan funding arrangement – InsuranceYes
2011-11-01Plan funding arrangement – TrustYes
2011-11-01Plan benefit arrangement – InsuranceYes
2011-11-01Plan benefit arrangement - TrustYes
2010: EJB MOTORS, INC. DBA BRENNER NISSAN GROUP HEALTH PLAN 2010 form 5500 responses
2010-11-01Type of plan entitySingle employer plan
2010-11-01First time form 5500 has been submittedYes
2010-11-01Submission has been amendedNo
2010-11-01This submission is the final filingNo
2010-11-01This return/report is a short plan year return/report (less than 12 months)No
2010-11-01Plan is a collectively bargained planNo
2010-11-01Plan funding arrangement – InsuranceYes
2010-11-01Plan funding arrangement – TrustYes
2010-11-01Plan benefit arrangement – InsuranceYes
2010-11-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BW66
Policy instance 5
Insurance contract or identification numberG000BW66
Number of Individuals Covered72
Insurance policy start date2021-11-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $1,815
Total amount of fees paid to insurance companyUSD $494
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $18,155
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,815
Amount paid for insurance broker fees494
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BW66
Policy instance 4
Insurance contract or identification numberG000BW66
Number of Individuals Covered72
Insurance policy start date2021-11-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $1,294
Total amount of fees paid to insurance companyUSD $462
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $12,936
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,294
Amount paid for insurance broker fees462
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BW66
Policy instance 3
Insurance contract or identification numberG000BW66
Number of Individuals Covered72
Insurance policy start date2021-11-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $747
Total amount of fees paid to insurance companyUSD $468
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 CarrierUSD $7,472
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $747
Amount paid for insurance broker fees468
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?3
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number090558
Policy instance 2
Insurance contract or identification number090558
Number of Individuals Covered43
Insurance policy start date2021-11-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $123
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $3,813
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $123
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerNONE
Insurance broker organization code?3
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30800004
Policy instance 1
Insurance contract or identification number30800004
Number of Individuals Covered60
Insurance policy start date2021-11-01
Insurance policy end date2022-10-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $210,201
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30800004
Policy instance 1
Insurance contract or identification number30800004
Number of Individuals Covered57
Insurance policy start date2020-11-01
Insurance policy end date2021-10-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $200,374
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number090558
Policy instance 2
Insurance contract or identification number090558
Number of Individuals Covered0
Insurance policy start date2020-11-01
Insurance policy end date2021-10-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BW66
Policy instance 3
Insurance contract or identification numberG000BW66
Number of Individuals Covered69
Insurance policy start date2020-11-01
Insurance policy end date2021-10-31
Total amount of commissions paid to insurance brokerUSD $481
Total amount of fees paid to insurance companyUSD $273
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 CarrierUSD $4,807
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $481
Amount paid for insurance broker fees273
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BW66
Policy instance 4
Insurance contract or identification numberG000BW66
Number of Individuals Covered68
Insurance policy start date2020-11-01
Insurance policy end date2021-10-31
Total amount of commissions paid to insurance brokerUSD $817
Total amount of fees paid to insurance companyUSD $270
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $8,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $817
Amount paid for insurance broker fees270
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BW66
Policy instance 5
Insurance contract or identification numberG000BW66
Number of Individuals Covered68
Insurance policy start date2020-11-01
Insurance policy end date2021-10-31
Total amount of commissions paid to insurance brokerUSD $1,142
Total amount of fees paid to insurance companyUSD $270
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $11,415
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,142
Amount paid for insurance broker fees270
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?3
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract number44825
Policy instance 4
Insurance contract or identification number44825
Number of Individuals Covered10
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
Total amount of commissions paid to insurance brokerUSD $1,010
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $9,853
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $997
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerNONE
Insurance broker organization code?3
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract number55668
Policy instance 3
Insurance contract or identification number55668
Number of Individuals Covered8
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
Total amount of commissions paid to insurance brokerUSD $1,391
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $9,196
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $655
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerNONE
Insurance broker organization code?3
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30800004
Policy instance 1
Insurance contract or identification number30800004
Number of Individuals Covered68
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $235,687
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number090558
Policy instance 2
Insurance contract or identification number090558
Number of Individuals Covered0
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number090558
Policy instance 2
Insurance contract or identification number090558
Number of Individuals Covered55
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $133
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $4,410
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $133
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerNONE
Insurance broker organization code?3
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberGENESIS
Policy instance 1
Insurance contract or identification numberGENESIS
Number of Individuals Covered69
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $222,514
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract number55668
Policy instance 3
Insurance contract or identification number55668
Number of Individuals Covered7
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $561
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $11,702
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,007
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerNONE
Insurance broker organization code?3
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract number44825
Policy instance 4
Insurance contract or identification number44825
Number of Individuals Covered9
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $1,600
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $9,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $815
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerNONE
Insurance broker organization code?3
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract number96555
Policy instance 5
Insurance contract or identification number96555
Number of Individuals Covered0
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract number45277
Policy instance 4
Insurance contract or identification number45277
Number of Individuals Covered0
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )
Policy contract number44825
Policy instance 3
Insurance contract or identification number44825
Number of Individuals Covered0
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number02896197
Policy instance 2
Insurance contract or identification number02896197
Number of Individuals Covered0
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberGENESIS
Policy instance 1
Insurance contract or identification numberGENESIS
Number of Individuals Covered75
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $287,682
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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