401k Plan data: VAN HORN AUTOMOTIVE GROUP, INC. GROUP INCOME PROTECTION PLAN plan

VAN HORN AUTOMOTIVE GROUP, INC. GROUP INCOME PROTECTION PLAN 401k Plan overview

Plan Name	VAN HORN AUTOMOTIVE GROUP, INC. GROUP INCOME PROTECTION PLAN
Plan identification number	503

VAN HORN AUTOMOTIVE GROUP, INC. GROUP INCOME PROTECTION PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Temporary disability (accident and sickness)

401k Sponsoring company profile

VAN HORN AUTOMOTIVE GROUP, INC. has sponsored the creation of one or more 401k plans.

Company Name: VAN HORN AUTOMOTIVE GROUP, INC.

Employer identification number (EIN): 391578477

NAIC Classification: 441120
NAIC Description: Used Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VAN HORN AUTOMOTIVE GROUP, INC. GROUP INCOME PROTECTION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2011-11-01 BASIL BUCHKO
503 2010-11-01 BASIL BUCHKO
503 2009-11-01 BASIL BUCHKO
503 2008-11-01 BASIL BUCHKO

Plan id#	Filing Submission Date	Name of Administrator
503	2011-11-01	BASIL BUCHKO
503	2010-11-01	BASIL BUCHKO
503	2009-11-01	BASIL BUCHKO
503	2008-11-01	BASIL BUCHKO

Plan Statistics for VAN HORN AUTOMOTIVE GROUP, INC. GROUP INCOME PROTECTION PLAN

401k plan membership statisitcs for VAN HORN AUTOMOTIVE GROUP, INC. GROUP INCOME PROTECTION PLAN

Measure Date Value
2011: VAN HORN AUTOMOTIVE GROUP, INC. GROUP INCOME PROTECTION PLAN 2011 401k membership
Total participants, beginning-of-year 2011-11-01 165
Total number of active participants reported on line 7a of the Form 5500 2011-11-01 0
Number of retired or separated participants receiving benefits 2011-11-01 0
Number of other retired or separated participants entitled to future benefits 2011-11-01 0
Total of all active and inactive participants 2011-11-01 0
2010: VAN HORN AUTOMOTIVE GROUP, INC. GROUP INCOME PROTECTION PLAN 2010 401k membership
Total participants, beginning-of-year 2010-11-01 136
Total number of active participants reported on line 7a of the Form 5500 2010-11-01 165
Number of retired or separated participants receiving benefits 2010-11-01 0
Number of other retired or separated participants entitled to future benefits 2010-11-01 0
Total of all active and inactive participants 2010-11-01 165
2009: VAN HORN AUTOMOTIVE GROUP, INC. GROUP INCOME PROTECTION PLAN 2009 401k membership
Total participants, beginning-of-year 2009-11-01 120
Total number of active participants reported on line 7a of the Form 5500 2009-11-01 136
Number of retired or separated participants receiving benefits 2009-11-01 0
Number of other retired or separated participants entitled to future benefits 2009-11-01 0
Total of all active and inactive participants 2009-11-01 136
2008: VAN HORN AUTOMOTIVE GROUP, INC. GROUP INCOME PROTECTION PLAN 2008 401k membership
Total participants, beginning-of-year 2008-11-01 118
Total number of active participants reported on line 7a of the Form 5500 2008-11-01 120
Number of retired or separated participants receiving benefits 2008-11-01 0
Number of other retired or separated participants entitled to future benefits 2008-11-01 0
Total of all active and inactive participants 2008-11-01 120

Measure	Date	Value
2011: VAN HORN AUTOMOTIVE GROUP, INC. GROUP INCOME PROTECTION PLAN 2011 401k membership
Total participants, beginning-of-year	2011-11-01	165
Total number of active participants reported on line 7a of the Form 5500	2011-11-01	0
Number of retired or separated participants receiving benefits	2011-11-01	0
Number of other retired or separated participants entitled to future benefits	2011-11-01	0
Total of all active and inactive participants	2011-11-01	0
2010: VAN HORN AUTOMOTIVE GROUP, INC. GROUP INCOME PROTECTION PLAN 2010 401k membership
Total participants, beginning-of-year	2010-11-01	136
Total number of active participants reported on line 7a of the Form 5500	2010-11-01	165
Number of retired or separated participants receiving benefits	2010-11-01	0
Number of other retired or separated participants entitled to future benefits	2010-11-01	0
Total of all active and inactive participants	2010-11-01	165
2009: VAN HORN AUTOMOTIVE GROUP, INC. GROUP INCOME PROTECTION PLAN 2009 401k membership
Total participants, beginning-of-year	2009-11-01	120
Total number of active participants reported on line 7a of the Form 5500	2009-11-01	136
Number of retired or separated participants receiving benefits	2009-11-01	0
Number of other retired or separated participants entitled to future benefits	2009-11-01	0
Total of all active and inactive participants	2009-11-01	136
2008: VAN HORN AUTOMOTIVE GROUP, INC. GROUP INCOME PROTECTION PLAN 2008 401k membership
Total participants, beginning-of-year	2008-11-01	118
Total number of active participants reported on line 7a of the Form 5500	2008-11-01	120
Number of retired or separated participants receiving benefits	2008-11-01	0
Number of other retired or separated participants entitled to future benefits	2008-11-01	0
Total of all active and inactive participants	2008-11-01	120

Form 5500 Responses for VAN HORN AUTOMOTIVE GROUP, INC. GROUP INCOME PROTECTION PLAN

2011: VAN HORN AUTOMOTIVE GROUP, INC. GROUP INCOME PROTECTION PLAN 2011 form 5500 responses
2011-11-01	Type of plan entity	Single employer plan
2011-11-01	Submission has been amended	No
2011-11-01	This submission is the final filing	Yes
2011-11-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2011-11-01	Plan is a collectively bargained plan	No
2011-11-01	Plan funding arrangement – Insurance	Yes
2011-11-01	Plan benefit arrangement – Insurance	Yes
2010: VAN HORN AUTOMOTIVE GROUP, INC. GROUP INCOME PROTECTION PLAN 2010 form 5500 responses
2010-11-01	Type of plan entity	Single employer plan
2010-11-01	Submission has been amended	No
2010-11-01	This submission is the final filing	No
2010-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-11-01	Plan is a collectively bargained plan	No
2010-11-01	Plan funding arrangement – Insurance	Yes
2010-11-01	Plan benefit arrangement – Insurance	Yes
2009: VAN HORN AUTOMOTIVE GROUP, INC. GROUP INCOME PROTECTION PLAN 2009 form 5500 responses
2009-11-01	Type of plan entity	Single employer plan
2009-11-01	Submission has been amended	No
2009-11-01	This submission is the final filing	No
2009-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-11-01	Plan is a collectively bargained plan	No
2009-11-01	Plan funding arrangement – Insurance	Yes
2009-11-01	Plan benefit arrangement – Insurance	Yes
2008: VAN HORN AUTOMOTIVE GROUP, INC. GROUP INCOME PROTECTION PLAN 2008 form 5500 responses
2008-11-01	Type of plan entity	Single employer plan
2008-11-01	First time form 5500 has been submitted	Yes
2008-11-01	Submission has been amended	No
2008-11-01	This submission is the final filing	No
2008-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-11-01	Plan is a collectively bargained plan	No
2008-11-01	Plan funding arrangement – Insurance	Yes
2008-11-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010001648

Policy instance

Insurance contract or identification number	000010001648
Number of Individuals Covered	0
Insurance policy start date	2011-11-01
Insurance policy end date	2012-07-31
Total amount of commissions paid to insurance broker	USD $2,070
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?	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	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
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 $21,875
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010001648

Policy instance

Insurance contract or identification number	000010001648
Number of Individuals Covered	165
Insurance policy start date	2010-11-01
Insurance policy end date	2011-10-31
Total amount of commissions paid to insurance broker	USD $1,939
Total amount of fees paid to insurance company	USD $385
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	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
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 $20,791
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,939
Insurance broker organization code?	3
Amount paid for insurance broker fees	385
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker name	BENECO OF WISCONSIN INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010001648

Policy instance

Insurance contract or identification number	000010001648
Number of Individuals Covered	136
Insurance policy start date	2009-11-01
Insurance policy end date	2010-10-31
Total amount of commissions paid to insurance broker	USD $1,981
Total amount of fees paid to insurance company	USD $415
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	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
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 $18,867
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,787
Amount paid for insurance broker fees	415
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	BENEFITS INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

000010001648

Policy instance

Insurance contract or identification number	000010001648
Number of Individuals Covered	120
Insurance policy start date	2008-11-01
Insurance policy end date	2009-10-31
Total amount of commissions paid to insurance broker	USD $1,809
Total amount of fees paid to insurance company	USD $256
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	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
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 $16,130
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,190
Amount paid for insurance broker fees	256
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	WILLIS OF WI INC

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Company Name:	VAN HORN AUTOMOTIVE GROUP, INC.
Employer identification number (EIN):	391578477
NAIC Classification:	441120
NAIC Description:	Used Car Dealers