401k Plan data: CHESROWN CHEVROLET BUICK GMC 401K PLAN plan

CHESROWN CHEVROLET BUICK GMC 401K PLAN 401k Plan overview

Plan Name	CHESROWN CHEVROLET BUICK GMC 401K PLAN
Plan identification number	001

CHESROWN CHEVROLET BUICK GMC 401K PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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

401k Sponsoring company profile

CHESROWN CHEVROLET BUICK GMC, INC. has sponsored the creation of one or more 401k plans.

Company Name: CHESROWN CHEVROLET BUICK GMC, INC.

Employer identification number (EIN): 311029587

NAIC Classification: 441110
NAIC Description: New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHESROWN CHEVROLET BUICK GMC 401K PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01 KIMBERLY BLOOM 2019-10-14
001 2017-01-01 KIMBERLY BLOOM 2018-10-10
001 2016-01-01 JAMES GILL 2017-10-12
001 2015-01-01 JAMES GILL 2016-06-21
001 2014-01-01 JAMES GILL 2015-07-09
001 2013-01-01 JAMES GILL 2014-09-11
001 2012-01-01 JAMES GILL 2013-10-14
001 2011-01-01 JAMES GILL
001 2009-01-01 JAMES GILL

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-01-01
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01	KIMBERLY BLOOM	2019-10-14
001	2017-01-01	KIMBERLY BLOOM	2018-10-10
001	2016-01-01	JAMES GILL	2017-10-12
001	2015-01-01	JAMES GILL	2016-06-21
001	2014-01-01	JAMES GILL	2015-07-09
001	2013-01-01	JAMES GILL	2014-09-11
001	2012-01-01	JAMES GILL	2013-10-14
001	2011-01-01	JAMES GILL
001	2009-01-01	JAMES GILL

Plan Statistics for CHESROWN CHEVROLET BUICK GMC 401K PLAN

401k plan membership statisitcs for CHESROWN CHEVROLET BUICK GMC 401K PLAN

Measure Date Value
2020: CHESROWN CHEVROLET BUICK GMC 401K PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 109
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 71
Number of retired or separated participants receiving benefits 2020-01-01 4
Number of other retired or separated participants entitled to future benefits 2020-01-01 14
Total of all active and inactive participants 2020-01-01 89
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 89
Number of participants with account balances 2020-01-01 62
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 6
2019: CHESROWN CHEVROLET BUICK GMC 401K PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 123
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 91
Number of retired or separated participants receiving benefits 2019-01-01 1
Number of other retired or separated participants entitled to future benefits 2019-01-01 13
Total of all active and inactive participants 2019-01-01 105
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 105
Number of participants with account balances 2019-01-01 59
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 2
2011: CHESROWN CHEVROLET BUICK GMC 401K PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 36
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 27
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 8
Total of all active and inactive participants 2011-01-01 35
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 35
Number of participants with account balances 2011-01-01 26
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: CHESROWN CHEVROLET BUICK GMC 401K PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 43
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 24
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 7
Total of all active and inactive participants 2009-01-01 31
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 31
Number of participants with account balances 2009-01-01 27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 6

Measure	Date	Value
2020: CHESROWN CHEVROLET BUICK GMC 401K PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	109
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	71
Number of retired or separated participants receiving benefits	2020-01-01	4
Number of other retired or separated participants entitled to future benefits	2020-01-01	14
Total of all active and inactive participants	2020-01-01	89
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	89
Number of participants with account balances	2020-01-01	62
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	6
2019: CHESROWN CHEVROLET BUICK GMC 401K PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	123
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	91
Number of retired or separated participants receiving benefits	2019-01-01	1
Number of other retired or separated participants entitled to future benefits	2019-01-01	13
Total of all active and inactive participants	2019-01-01	105
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	105
Number of participants with account balances	2019-01-01	59
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	2
2011: CHESROWN CHEVROLET BUICK GMC 401K PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	36
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	27
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	8
Total of all active and inactive participants	2011-01-01	35
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	35
Number of participants with account balances	2011-01-01	26
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: CHESROWN CHEVROLET BUICK GMC 401K PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	43
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	24
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	7
Total of all active and inactive participants	2009-01-01	31
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	31
Number of participants with account balances	2009-01-01	27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	6

Financial Data on CHESROWN CHEVROLET BUICK GMC 401K PLAN

Measure	Date	Value
2020 : CHESROWN CHEVROLET BUICK GMC 401K PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$1,823
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$13,858
Total income from all sources (including contributions)	2020-12-31	$691,823
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$291,777
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$257,668
Expenses. Certain deemed distributions of participant loans	2020-12-31	$4,339
Value of total corrective distributions	2020-12-31	$13,858
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$346,009
Value of total assets at end of year	2020-12-31	$3,056,337
Value of total assets at beginning of year	2020-12-31	$2,668,326
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$15,912
Total interest from all sources	2020-12-31	$4,792
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$88,724
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$88,724
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$250,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$273,872
Participant contributions at end of year	2020-12-31	$83,915
Participant contributions at beginning of year	2020-12-31	$74,256
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2020-12-31	$2,563
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2020-12-31	$290
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2020-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-12-31	$13,858
Other income not declared elsewhere	2020-12-31	$13,858
Administrative expenses (other) incurred	2020-12-31	$6,910
Liabilities. Value of operating payables at end of year	2020-12-31	$300
Liabilities. Value of operating payables at beginning of year	2020-12-31	$0
Total non interest bearing cash at end of year	2020-12-31	$6,958
Total non interest bearing cash at beginning of year	2020-12-31	$4,497
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$400,046
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$3,054,514
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$2,654,468
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Investment advisory and management fees	2020-12-31	$9,002
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$2,761,206
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$2,439,847
Interest on participant loans	2020-12-31	$4,792
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-12-31	$201,695
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-12-31	$149,436
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-12-31	$149,436
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$238,440
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$72,137
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$257,668
Liabilities. Value of benefit claims payable at end of year	2020-12-31	$1,523
Liabilities. Value of benefit claims payable at beginning of year	2020-12-31	$0
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	DIXON HUGHES GOODMAN LLP
Accountancy firm EIN	2020-12-31	560747981
2019 : CHESROWN CHEVROLET BUICK GMC 401K PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$13,858
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$751,936
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$139,200
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$107,052
Expenses. Certain deemed distributions of participant loans	2019-12-31	$19,185
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$336,449
Value of total assets at end of year	2019-12-31	$2,668,326
Value of total assets at beginning of year	2019-12-31	$2,041,732
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$12,963
Total interest from all sources	2019-12-31	$4,633
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$70,253
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$70,253
Administrative expenses professional fees incurred	2019-12-31	$5,169
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$250,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$261,078
Participant contributions at end of year	2019-12-31	$74,256
Participant contributions at beginning of year	2019-12-31	$68,974
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-12-31	$290
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$13,858
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$0
Total non interest bearing cash at end of year	2019-12-31	$4,497
Total non interest bearing cash at beginning of year	2019-12-31	$4,866
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$612,736
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$2,654,468
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$2,041,732
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Investment advisory and management fees	2019-12-31	$7,794
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$2,439,847
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$1,838,494
Interest on participant loans	2019-12-31	$4,633
Interest earned on other investments	2019-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$149,436
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$129,398
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$129,398
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$340,601
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$75,371
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$107,052
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	DIXON HUGHES GOODMAN LLP
Accountancy firm EIN	2019-12-31	560747981
2011 : CHESROWN CHEVROLET BUICK GMC 401K PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$48,336
Expenses. Total of all expenses incurred	2011-12-31	$64,330
Benefits paid (including direct rollovers)	2011-12-31	$63,330
Total plan assets at end of year	2011-12-31	$495,229
Total plan assets at beginning of year	2011-12-31	$511,223
Value of fidelity bond covering the plan	2011-12-31	$500,000
Total contributions received or receivable from participants	2011-12-31	$75,799
Other income received	2011-12-31	$-27,463
Net income (gross income less expenses)	2011-12-31	$-15,994
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$495,229
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$511,223
Assets. Value of participant loans	2011-12-31	$12,329
Value of certain deemed distributions of participant loans	2011-12-31	$1,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : CHESROWN CHEVROLET BUICK GMC 401K PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$100,289
Expenses. Total of all expenses incurred	2010-12-31	$138,702
Benefits paid (including direct rollovers)	2010-12-31	$138,702
Total plan assets at end of year	2010-12-31	$511,223
Total plan assets at beginning of year	2010-12-31	$549,636
Value of fidelity bond covering the plan	2010-12-31	$500,000
Total contributions received or receivable from participants	2010-12-31	$36,800
Other income received	2010-12-31	$63,489
Net income (gross income less expenses)	2010-12-31	$-38,413
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$511,223
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$549,636
Assets. Value of participant loans	2010-12-31	$16,154
Total contributions received or receivable from employer(s)	2010-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : CHESROWN CHEVROLET BUICK GMC 401K PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for CHESROWN CHEVROLET BUICK GMC 401K PLAN

2020: CHESROWN CHEVROLET BUICK GMC 401K PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: CHESROWN CHEVROLET BUICK GMC 401K PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2011: CHESROWN CHEVROLET BUICK GMC 401K PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: CHESROWN CHEVROLET BUICK GMC 401K PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

GAP-B2-QD48

Policy instance

Insurance contract or identification number	GAP-B2-QD48
Number of Individuals Covered	26
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $4
Total amount of fees paid to insurance company	USD $1
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

GAP-B2-QD48

Policy instance

Insurance contract or identification number	GAP-B2-QD48
Number of Individuals Covered	36
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	ADMINISTRATIVE
Insurance broker organization code?	3
Insurance broker name	EDWARD SOMMER

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Company Name:	CHESROWN CHEVROLET BUICK GMC, INC.
Employer identification number (EIN):	311029587
NAIC Classification:	441110
NAIC Description:	New Car Dealers