401k Plan data: NEW HOLLAND AUTO GROUP HEALTH AND WELFARE PLAN plan

NEW HOLLAND AUTO GROUP HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	NEW HOLLAND AUTO GROUP HEALTH AND WELFARE PLAN
Plan identification number	501

NEW HOLLAND AUTO GROUP HEALTH AND WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

BEANS CLASS FORD MERCURY INC., DBA NEW HOLLAND AUTO GROUP has sponsored the creation of one or more 401k plans.

Company Name: BEANS CLASS FORD MERCURY INC., DBA NEW HOLLAND AUTO GROUP

Employer identification number (EIN): 232187895

NAIC Classification: 441110
NAIC Description: New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NEW HOLLAND AUTO GROUP HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-07-01 KAREN KASE
501 2014-07-01 KAREN A KASE

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2015-07-01	KAREN KASE
501	2014-07-01	KAREN A KASE

Plan Statistics for NEW HOLLAND AUTO GROUP HEALTH AND WELFARE PLAN

401k plan membership statisitcs for NEW HOLLAND AUTO GROUP HEALTH AND WELFARE PLAN

Measure Date Value
2015: NEW HOLLAND AUTO GROUP HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-07-01 113
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 0
Number of retired or separated participants receiving benefits 2015-07-01 0
Number of other retired or separated participants entitled to future benefits 2015-07-01 0
Total of all active and inactive participants 2015-07-01 0
2014: NEW HOLLAND AUTO GROUP HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-07-01 102
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 113
Number of retired or separated participants receiving benefits 2014-07-01 0
Number of other retired or separated participants entitled to future benefits 2014-07-01 0
Total of all active and inactive participants 2014-07-01 113

Measure	Date	Value
2015: NEW HOLLAND AUTO GROUP HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-07-01	113
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	0
Number of retired or separated participants receiving benefits	2015-07-01	0
Number of other retired or separated participants entitled to future benefits	2015-07-01	0
Total of all active and inactive participants	2015-07-01	0
2014: NEW HOLLAND AUTO GROUP HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-07-01	102
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	113
Number of retired or separated participants receiving benefits	2014-07-01	0
Number of other retired or separated participants entitled to future benefits	2014-07-01	0
Total of all active and inactive participants	2014-07-01	113

Form 5500 Responses for NEW HOLLAND AUTO GROUP HEALTH AND WELFARE PLAN

2015: NEW HOLLAND AUTO GROUP HEALTH AND WELFARE PLAN 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Submission has been amended	No
2015-07-01	This submission is the final filing	Yes
2015-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-07-01	Plan is a collectively bargained plan	No
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2014: NEW HOLLAND AUTO GROUP HEALTH AND WELFARE PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	First time form 5500 has been submitted	Yes
2014-07-01	Submission has been amended	No
2014-07-01	This submission is the final filing	No
2014-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-07-01	Plan is a collectively bargained plan	No
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HEALTHAMERICA OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 95060 )

Policy contract number

1809820000

Policy instance

Insurance contract or identification number	1809820000
Number of Individuals Covered	222
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $25,957
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?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $741,615
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	25957
Additional information about fees paid to insurance broker	DIRECT COMPENSATION
Insurance broker organization code?	3
Insurance broker name	EMERSON REID AND COMPANY, INC.

HEALTHAMERICA OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 95060 )

Policy contract number

1809820000

Policy instance

Insurance contract or identification number	1809820000
Number of Individuals Covered	205
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $20,099
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?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $574,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	20099
Additional information about fees paid to insurance broker	DIRECT COMPENSATION
Insurance broker organization code?	3
Insurance broker name	EMERSON REID AND COMPANY, INC.

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Company Name:	BEANS CLASS FORD MERCURY INC., DBA NEW HOLLAND AUTO GROUP
Employer identification number (EIN):	232187895
NAIC Classification:	441110
NAIC Description:	New Car Dealers