401k Plan data: WILLIS CADILLAC INC. SHORT TERM DISABILITY PLAN plan

WILLIS CADILLAC INC. SHORT TERM DISABILITY PLAN 401k Plan overview

Plan Name	WILLIS CADILLAC INC. SHORT TERM DISABILITY PLAN
Plan identification number	505

WILLIS CADILLAC INC. SHORT TERM DISABILITY PLAN Benefits

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

401k Sponsoring company profile

WILLIS CADILLAC, INC. has sponsored the creation of one or more 401k plans.

Company Name: WILLIS CADILLAC, INC.

Employer identification number (EIN): 420800348

NAIC Classification: 441110
NAIC Description: New Car Dealers

Additional information about WILLIS CADILLAC, INC.

Jurisdiction of Incorporation: Iowa Secretary of State Business Entities

Incorporation Date: 1958-01-30

Company Identification Number: 004403

Legal Registered Office Address: 2121 NW 100TH ST

DES MOINES
United States of America (USA)
50325

More information about WILLIS CADILLAC, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WILLIS CADILLAC INC. SHORT TERM DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2019-01-01
505 2019-01-01 JONATHAN HOLSTROM 2021-09-23

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
505	2019-01-01
505	2019-01-01	JONATHAN HOLSTROM	2021-09-23

Plan Statistics for WILLIS CADILLAC INC. SHORT TERM DISABILITY PLAN

401k plan membership statisitcs for WILLIS CADILLAC INC. SHORT TERM DISABILITY PLAN

Measure Date Value
2019: WILLIS CADILLAC INC. SHORT TERM DISABILITY PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 95
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 108
Total of all active and inactive participants 2019-01-01 108
Total participants 2019-01-01 108
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0

Measure	Date	Value
2019: WILLIS CADILLAC INC. SHORT TERM DISABILITY PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	95
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	108
Total of all active and inactive participants	2019-01-01	108
Total participants	2019-01-01	108
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0

Form 5500 Responses for WILLIS CADILLAC INC. SHORT TERM DISABILITY PLAN

2019: WILLIS CADILLAC INC. SHORT TERM DISABILITY PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	First time form 5500 has been submitted	Yes
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

880723

Policy instance

Insurance contract or identification number	880723
Number of Individuals Covered	108
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $5,881
Are there contracts with allocated funds for individual policies?	0
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,881
Amount paid for insurance broker fees	1470
Total amount of fees paid to insurance company	USD $1,470

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Company Name:	WILLIS CADILLAC, INC.
Employer identification number (EIN):	420800348
NAIC Classification:	441110
NAIC Description:	New Car Dealers

Jurisdiction of Incorporation:	Iowa Secretary of State Business Entities
Incorporation Date:	1958-01-30
Company Identification Number:	004403
Legal Registered Office Address:	2121 NW 100TH ST DES MOINES United States of America (USA) 50325