401k Plan data: MARC MILLER BUICK GMC EMPLOYEE BENEFIT PLAN plan

MARC MILLER BUICK GMC EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	MARC MILLER BUICK GMC EMPLOYEE BENEFIT PLAN
Plan identification number	501

MARC MILLER BUICK GMC EMPLOYEE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

MARC MILLER BUICK-PONTIAC-GMC, INC. has sponsored the creation of one or more 401k plans.

Company Name: MARC MILLER BUICK-PONTIAC-GMC, INC.

Employer identification number (EIN): 730777699

NAIC Classification: 441110
NAIC Description: New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MARC MILLER BUICK GMC EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-05-01 WILLIAM MARC MILLER 2024-10-23

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-05-01	WILLIAM MARC MILLER	2024-10-23

Form 5500 Responses for MARC MILLER BUICK GMC EMPLOYEE BENEFIT PLAN

2023: MARC MILLER BUICK GMC EMPLOYEE BENEFIT PLAN 2023 form 5500 responses
2023-05-01	Type of plan entity	Single employer plan
2023-05-01	First time form 5500 has been submitted	Yes
2023-05-01	Plan funding arrangement – Insurance	Yes
2023-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-05-01	Plan benefit arrangement – Insurance	Yes
2023-05-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

114445

Policy instance

Insurance contract or identification number	114445
Number of Individuals Covered	96
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $34,324
Total amount of fees paid to insurance company	USD $1,196
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $686,472
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05999469

Policy instance

Insurance contract or identification number	KM05999469
Number of Individuals Covered	119
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $2,279
Total amount of fees paid to insurance company	USD $544
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $42,134
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 number

15837

Policy instance

Insurance contract or identification number	15837
Number of Individuals Covered	51
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $8,002
Total amount of fees paid to insurance company	USD $1,555
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $76,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30026305

Policy instance

Insurance contract or identification number	30026305
Number of Individuals Covered	47
Insurance policy start date	2023-05-01
Insurance policy end date	2024-04-30
Total amount of commissions paid to insurance broker	USD $1,038
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,314
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

19607

Policy instance

Insurance contract or identification number	19607
Number of Individuals Covered	118
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $6,820
Total amount of fees paid to insurance company	USD $24
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $34,072
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	MARC MILLER BUICK-PONTIAC-GMC, INC.
Employer identification number (EIN):	730777699
NAIC Classification:	441110
NAIC Description:	New Car Dealers