401k Plan data: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN plan

GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 401k Plan overview

Plan Name	GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN
Plan identification number	502

GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision Other welfare benefit cover

401k Sponsoring company profile

GRAYSON PONTIAC, INC. has sponsored the creation of one or more 401k plans.

Company Name: GRAYSON PONTIAC, INC.

Employer identification number (EIN): 621020018

NAIC Classification: 441110
NAIC Description: New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2022-05-01 ART GRAYSON 2023-12-06
502 2021-05-01 ART GRAYSON 2022-10-27
502 2020-05-01 ART GRAYSON 2021-10-11
502 2019-05-01 ART GRAYSON 2021-02-09
502 2018-05-01 ART GRAYSON 2019-11-18
502 2017-05-01
502 2016-05-01
502 2015-05-01
502 2014-05-01
502 2013-05-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
502	2022-05-01	ART GRAYSON	2023-12-06
502	2021-05-01	ART GRAYSON	2022-10-27
502	2020-05-01	ART GRAYSON	2021-10-11
502	2019-05-01	ART GRAYSON	2021-02-09
502	2018-05-01	ART GRAYSON	2019-11-18
502	2017-05-01
502	2016-05-01
502	2015-05-01
502	2014-05-01
502	2013-05-01

Plan Statistics for GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN

401k plan membership statisitcs for GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN

Measure Date Value
2022: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-05-01 123
Total number of active participants reported on line 7a of the Form 5500 2022-05-01 126
Total of all active and inactive participants 2022-05-01 126
2021: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-05-01 126
Total number of active participants reported on line 7a of the Form 5500 2021-05-01 123
Total of all active and inactive participants 2021-05-01 123
2020: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-05-01 203
Total number of active participants reported on line 7a of the Form 5500 2020-05-01 126
Total of all active and inactive participants 2020-05-01 126
2019: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-05-01 124
Total number of active participants reported on line 7a of the Form 5500 2019-05-01 203
Total of all active and inactive participants 2019-05-01 203
2018: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-05-01 119
Total number of active participants reported on line 7a of the Form 5500 2018-05-01 122
Number of retired or separated participants receiving benefits 2018-05-01 2
Total of all active and inactive participants 2018-05-01 124
2017: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-05-01 114
Total number of active participants reported on line 7a of the Form 5500 2017-05-01 118
Number of retired or separated participants receiving benefits 2017-05-01 1
Total of all active and inactive participants 2017-05-01 119
2016: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-05-01 99
Total number of active participants reported on line 7a of the Form 5500 2016-05-01 111
Number of retired or separated participants receiving benefits 2016-05-01 3
Total of all active and inactive participants 2016-05-01 114
2015: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-05-01 109
Total number of active participants reported on line 7a of the Form 5500 2015-05-01 99
Total of all active and inactive participants 2015-05-01 99
2014: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-05-01 91
Total number of active participants reported on line 7a of the Form 5500 2014-05-01 108
Number of retired or separated participants receiving benefits 2014-05-01 1
Total of all active and inactive participants 2014-05-01 109
2013: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-05-01 84
Total number of active participants reported on line 7a of the Form 5500 2013-05-01 91
Total of all active and inactive participants 2013-05-01 91

Measure	Date	Value
2022: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-05-01	123
Total number of active participants reported on line 7a of the Form 5500	2022-05-01	126
Total of all active and inactive participants	2022-05-01	126
2021: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-05-01	126
Total number of active participants reported on line 7a of the Form 5500	2021-05-01	123
Total of all active and inactive participants	2021-05-01	123
2020: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-05-01	203
Total number of active participants reported on line 7a of the Form 5500	2020-05-01	126
Total of all active and inactive participants	2020-05-01	126
2019: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-05-01	124
Total number of active participants reported on line 7a of the Form 5500	2019-05-01	203
Total of all active and inactive participants	2019-05-01	203
2018: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-05-01	119
Total number of active participants reported on line 7a of the Form 5500	2018-05-01	122
Number of retired or separated participants receiving benefits	2018-05-01	2
Total of all active and inactive participants	2018-05-01	124
2017: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-05-01	114
Total number of active participants reported on line 7a of the Form 5500	2017-05-01	118
Number of retired or separated participants receiving benefits	2017-05-01	1
Total of all active and inactive participants	2017-05-01	119
2016: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-05-01	99
Total number of active participants reported on line 7a of the Form 5500	2016-05-01	111
Number of retired or separated participants receiving benefits	2016-05-01	3
Total of all active and inactive participants	2016-05-01	114
2015: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-05-01	109
Total number of active participants reported on line 7a of the Form 5500	2015-05-01	99
Total of all active and inactive participants	2015-05-01	99
2014: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-05-01	91
Total number of active participants reported on line 7a of the Form 5500	2014-05-01	108
Number of retired or separated participants receiving benefits	2014-05-01	1
Total of all active and inactive participants	2014-05-01	109
2013: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-05-01	84
Total number of active participants reported on line 7a of the Form 5500	2013-05-01	91
Total of all active and inactive participants	2013-05-01	91

Form 5500 Responses for GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN

2022: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2022 form 5500 responses
2022-05-01	Type of plan entity	Single employer plan
2022-05-01	Plan funding arrangement – Insurance	Yes
2022-05-01	Plan benefit arrangement – Insurance	Yes
2021: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2021 form 5500 responses
2021-05-01	Type of plan entity	Single employer plan
2021-05-01	Plan funding arrangement – Insurance	Yes
2021-05-01	Plan benefit arrangement – Insurance	Yes
2020: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2020 form 5500 responses
2020-05-01	Type of plan entity	Single employer plan
2020-05-01	Plan funding arrangement – Insurance	Yes
2020-05-01	Plan benefit arrangement – Insurance	Yes
2019: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2019 form 5500 responses
2019-05-01	Type of plan entity	Single employer plan
2019-05-01	Plan funding arrangement – Insurance	Yes
2019-05-01	Plan benefit arrangement – Insurance	Yes
2018: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2018 form 5500 responses
2018-05-01	Type of plan entity	Single employer plan
2018-05-01	Plan funding arrangement – Insurance	Yes
2018-05-01	Plan benefit arrangement – Insurance	Yes
2017: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2017 form 5500 responses
2017-05-01	Type of plan entity	Single employer plan
2017-05-01	Plan funding arrangement – Insurance	Yes
2017-05-01	Plan benefit arrangement – Insurance	Yes
2016: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2016 form 5500 responses
2016-05-01	Type of plan entity	Single employer plan
2016-05-01	Plan funding arrangement – Insurance	Yes
2016-05-01	Plan benefit arrangement – Insurance	Yes
2015: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2015 form 5500 responses
2015-05-01	Type of plan entity	Single employer plan
2015-05-01	Plan funding arrangement – Insurance	Yes
2015-05-01	Plan benefit arrangement – Insurance	Yes
2014: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2014 form 5500 responses
2014-05-01	Type of plan entity	Single employer plan
2014-05-01	Plan funding arrangement – Insurance	Yes
2014-05-01	Plan benefit arrangement – Insurance	Yes
2013: GRAYSON PONTIAC, INC. MEDICAL INSURANCE PLAN 2013 form 5500 responses
2013-05-01	Type of plan entity	Single employer plan
2013-05-01	Plan funding arrangement – Insurance	Yes
2013-05-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

838496

Policy instance

Insurance contract or identification number	838496
Number of Individuals Covered	126
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $56,061
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,055,437
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $56,061
Insurance broker organization code?	3

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

838496

Policy instance

Insurance contract or identification number	838496
Number of Individuals Covered	123
Insurance policy start date	2021-05-01
Insurance policy end date	2022-04-30
Total amount of commissions paid to insurance broker	USD $50,448
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $964,039
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $50,448
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

838496

Policy instance

Insurance contract or identification number	838496
Number of Individuals Covered	126
Insurance policy start date	2020-05-01
Insurance policy end date	2021-04-30
Total amount of commissions paid to insurance broker	USD $48,395
Total amount of fees paid to insurance company	USD $1,000
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $918,591
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $48,395
Amount paid for insurance broker fees	1000
Additional information about fees paid to insurance broker	BONUSES
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

911322

Policy instance

Insurance contract or identification number	911322
Number of Individuals Covered	203
Insurance policy start date	2019-05-01
Insurance policy end date	2020-04-30
Total amount of commissions paid to insurance broker	USD $54,120
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $937,633
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $54,120
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

911322

Policy instance

Insurance contract or identification number	911322
Number of Individuals Covered	296
Insurance policy start date	2018-05-01
Insurance policy end date	2019-04-30
Total amount of commissions paid to insurance broker	USD $6,020
Total amount of fees paid to insurance company	USD $42,358
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $840,372
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,020
Amount paid for insurance broker fees	42358
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

911322

Policy instance

Insurance contract or identification number	911322
Number of Individuals Covered	287
Insurance policy start date	2017-05-01
Insurance policy end date	2018-04-30
Total amount of commissions paid to insurance broker	USD $1,252
Total amount of fees paid to insurance company	USD $40,446
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $768,934
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,252
Amount paid for insurance broker fees	40446
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3
Insurance broker name	TATE INSURANCE GROUP

BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )

Policy contract number

117540

Policy instance

Insurance contract or identification number	117540
Number of Individuals Covered	176
Insurance policy start date	2015-05-01
Insurance policy end date	2016-04-30
Total amount of commissions paid to insurance broker	USD $40,066
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $642,562
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,066
Insurance broker organization code?	3
Insurance broker name	SCOTT TATE

HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC. (National Association of Insurance Commissioners NAIC id number: 95519 )

Policy contract number

719260

Policy instance

Insurance contract or identification number	719260
Number of Individuals Covered	109
Insurance policy start date	2014-05-01
Insurance policy end date	2015-04-30
Total amount of commissions paid to insurance broker	USD $33,279
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $665,576
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,279
Insurance broker organization code?	3
Insurance broker name	TATE INSURANCE GROUP

BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )

Policy contract number

117540

Policy instance

Insurance contract or identification number	117540
Number of Individuals Covered	179
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Total amount of commissions paid to insurance broker	USD $36,042
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $605,647
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,900
Insurance broker organization code?	3
Insurance broker name	BRUCE MORGAN

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Company Name:	GRAYSON PONTIAC, INC.
Employer identification number (EIN):	621020018
NAIC Classification:	441110
NAIC Description:	New Car Dealers