401k Plan data: US CAR, LLC DBA CAR TOWN KIA HEALTH AND WELFARE BENEFIT PLAN plan

US CAR, LLC DBA CAR TOWN KIA HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	US CAR, LLC DBA CAR TOWN KIA HEALTH AND WELFARE BENEFIT PLAN
Plan identification number	511

US CAR, LLC DBA CAR TOWN KIA HEALTH AND WELFARE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

US CAR LLC DBA CAR TOWN KIA has sponsored the creation of one or more 401k plans.

Company Name: US CAR LLC DBA CAR TOWN KIA

Employer identification number (EIN): 030463542

NAIC Classification: 441110
NAIC Description: New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan US CAR, LLC DBA CAR TOWN KIA HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
511 2018-01-01 EMMA ALLEN 2019-08-21
511 2018-01-01 EMMA ALLEN 2022-10-25
511 2017-01-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
511	2018-01-01	EMMA ALLEN	2019-08-21
511	2018-01-01	EMMA ALLEN	2022-10-25
511	2017-01-01

Plan Statistics for US CAR, LLC DBA CAR TOWN KIA HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for US CAR, LLC DBA CAR TOWN KIA HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2018: US CAR, LLC DBA CAR TOWN KIA HEALTH AND WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 102
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 92
Total of all active and inactive participants 2018-01-01 92
2017: US CAR, LLC DBA CAR TOWN KIA HEALTH AND WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 126
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 123
Total of all active and inactive participants 2017-01-01 123
Total participants 2017-01-01 123

Measure	Date	Value
2018: US CAR, LLC DBA CAR TOWN KIA HEALTH AND WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	102
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	92
Total of all active and inactive participants	2018-01-01	92
2017: US CAR, LLC DBA CAR TOWN KIA HEALTH AND WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	126
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	123
Total of all active and inactive participants	2017-01-01	123
Total participants	2017-01-01	123

Form 5500 Responses for US CAR, LLC DBA CAR TOWN KIA HEALTH AND WELFARE BENEFIT PLAN

2018: US CAR, LLC DBA CAR TOWN KIA HEALTH AND WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	Yes
2018-01-01	This submission is the final filing	Yes
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: US CAR, LLC DBA CAR TOWN KIA HEALTH AND WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	First time form 5500 has been submitted	Yes
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00473627

Policy instance

Insurance contract or identification number	00473627
Number of Individuals Covered	92
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,372
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $17,755
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,372
Insurance broker organization code?	3

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

00247066

Policy instance

Insurance contract or identification number	00247066
Number of Individuals Covered	73
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $16,648
Total amount of fees paid to insurance company	USD $3,080
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $347,452
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,648
Amount paid for insurance broker fees	3080
Insurance broker organization code?	3

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

0706190

Policy instance

Insurance contract or identification number	0706190
Number of Individuals Covered	78
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,463
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,463
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00473627

Policy instance

Insurance contract or identification number	00473627
Number of Individuals Covered	123
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,522
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $18,771
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,522
Insurance broker organization code?	3
Insurance broker name	ENERGY INSURANCE AGENCY

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

00247066

Policy instance

Insurance contract or identification number	00247066
Number of Individuals Covered	88
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $24,663
Total amount of fees paid to insurance company	USD $3,360
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $409,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,663
Amount paid for insurance broker fees	3360
Insurance broker organization code?	3
Insurance broker name	ENERGY INSURANCE AGENCY

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

0706190

Policy instance

Insurance contract or identification number	0706190
Number of Individuals Covered	101
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $5,505
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,505
Insurance broker organization code?	3
Insurance broker name	ENERGY INSURANCE AGENCY

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Company Name:	US CAR LLC DBA CAR TOWN KIA
Employer identification number (EIN):	030463542
NAIC Classification:	441110
NAIC Description:	New Car Dealers