401k Plan data: NORDSTROM AUTOMOTIVE 401(K) PLAN plan

NORDSTROM AUTOMOTIVE 401(K) PLAN 401k Plan overview

Plan Name	NORDSTROM AUTOMOTIVE 401(K) PLAN
Plan identification number	001

NORDSTROM AUTOMOTIVE 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

NORDSTROM CHEVROLET OLDSMOBILE has sponsored the creation of one or more 401k plans.

Company Name: NORDSTROM CHEVROLET OLDSMOBILE

Employer identification number (EIN): 521769589

NAIC Classification: 441110
NAIC Description: New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORDSTROM AUTOMOTIVE 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01 SHARON WORTH 2020-07-16
001 2017-01-01 LAURIE WAUGH 2018-07-27 LAURIE WAUGH 2018-07-27
001 2016-01-01 LAURIE WAUGH 2017-07-27 LAURIE WAUGH 2017-07-27
001 2015-01-01 LAURIE WAUGH 2016-07-14 LAURIE WAUGH 2016-07-14
001 2014-01-01 LAURIE WAUGH
001 2013-01-01 LAURIE WAUGH LAURIE WAUGH 2014-09-09
001 2012-01-01 LAURIE WAUGH
001 2009-01-01 LAURIE WAUGH
001 2009-01-01 LAURIE WAUGH

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01	SHARON WORTH	2020-07-16
001	2017-01-01	LAURIE WAUGH	2018-07-27	LAURIE WAUGH	2018-07-27
001	2016-01-01	LAURIE WAUGH	2017-07-27	LAURIE WAUGH	2017-07-27
001	2015-01-01	LAURIE WAUGH	2016-07-14	LAURIE WAUGH	2016-07-14
001	2014-01-01	LAURIE WAUGH
001	2013-01-01	LAURIE WAUGH		LAURIE WAUGH	2014-09-09
001	2012-01-01	LAURIE WAUGH
001	2009-01-01	LAURIE WAUGH
001	2009-01-01	LAURIE WAUGH

Plan Statistics for NORDSTROM AUTOMOTIVE 401(K) PLAN

401k plan membership statisitcs for NORDSTROM AUTOMOTIVE 401(K) PLAN

Measure Date Value
2014: NORDSTROM AUTOMOTIVE 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 85
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 63
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 12
Total of all active and inactive participants 2014-01-01 75
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 75
Number of participants with account balances 2014-01-01 44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 4
2013: NORDSTROM AUTOMOTIVE 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 68
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 57
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 13
Total of all active and inactive participants 2013-01-01 70
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 1
Total participants 2013-01-01 71
Number of participants with account balances 2013-01-01 44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 4
2012: NORDSTROM AUTOMOTIVE 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 71
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 59
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 12
Total of all active and inactive participants 2012-01-01 71
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 71
Number of participants with account balances 2012-01-01 59
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 7
2009: NORDSTROM AUTOMOTIVE 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 102
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 63
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 45
Total of all active and inactive participants 2009-01-01 108
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 108
Number of participants with account balances 2009-01-01 92
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2014: NORDSTROM AUTOMOTIVE 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	85
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	63
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	12
Total of all active and inactive participants	2014-01-01	75
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	75
Number of participants with account balances	2014-01-01	44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	4
2013: NORDSTROM AUTOMOTIVE 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	68
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	57
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	13
Total of all active and inactive participants	2013-01-01	70
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	1
Total participants	2013-01-01	71
Number of participants with account balances	2013-01-01	44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	4
2012: NORDSTROM AUTOMOTIVE 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	71
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	59
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	12
Total of all active and inactive participants	2012-01-01	71
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	71
Number of participants with account balances	2012-01-01	59
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	7
2009: NORDSTROM AUTOMOTIVE 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	102
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	63
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	45
Total of all active and inactive participants	2009-01-01	108
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	108
Number of participants with account balances	2009-01-01	92
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on NORDSTROM AUTOMOTIVE 401(K) PLAN

Measure	Date	Value
2014 : NORDSTROM AUTOMOTIVE 401(K) PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$1,488
Total income from all sources	2014-12-31	$188,476
Expenses. Total of all expenses incurred	2014-12-31	$112,896
Benefits paid (including direct rollovers)	2014-12-31	$112,896
Total plan assets at end of year	2014-12-31	$1,987,992
Total plan assets at beginning of year	2014-12-31	$1,910,924
Value of fidelity bond covering the plan	2014-12-31	$500,000
Total contributions received or receivable from participants	2014-12-31	$121,091
Expenses. Other expenses not covered elsewhere	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$2,833
Other income received	2014-12-31	$64,552
Net income (gross income less expenses)	2014-12-31	$75,580
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$1,987,992
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$1,910,924
Assets. Value of participant loans	2014-12-31	$0
Total contributions received or receivable from employer(s)	2014-12-31	$0
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2014-12-31	$0
Minimum employer required contribution for this plan year	2014-12-31	$0
Amount contributed by the employer to the plan for this plan year	2014-12-31	$0
2013 : NORDSTROM AUTOMOTIVE 401(K) PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total income from all sources	2013-12-31	$395,486
Expenses. Total of all expenses incurred	2013-12-31	$64,443
Benefits paid (including direct rollovers)	2013-12-31	$64,443
Total plan assets at end of year	2013-12-31	$1,910,924
Total plan assets at beginning of year	2013-12-31	$1,579,881
Value of fidelity bond covering the plan	2013-12-31	$500,000
Total contributions received or receivable from participants	2013-12-31	$126,067
Expenses. Other expenses not covered elsewhere	2013-12-31	$0
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$269,419
Net income (gross income less expenses)	2013-12-31	$331,043
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$1,910,924
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$1,579,881
Assets. Value of participant loans	2013-12-31	$0
Total contributions received or receivable from employer(s)	2013-12-31	$0
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2013-12-31	$0
Minimum employer required contribution for this plan year	2013-12-31	$0
Amount contributed by the employer to the plan for this plan year	2013-12-31	$0
2012 : NORDSTROM AUTOMOTIVE 401(K) PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$365,107
Expenses. Total of all expenses incurred	2012-12-31	$963,597
Benefits paid (including direct rollovers)	2012-12-31	$961,021
Total plan assets at end of year	2012-12-31	$1,579,881
Total plan assets at beginning of year	2012-12-31	$2,178,371
Value of fidelity bond covering the plan	2012-12-31	$500,000
Total contributions received or receivable from participants	2012-12-31	$158,285
Expenses. Other expenses not covered elsewhere	2012-12-31	$0
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$206,822
Net income (gross income less expenses)	2012-12-31	$-598,490
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$1,579,881
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$2,178,371
Assets. Value of participant loans	2012-12-31	$0
Total contributions received or receivable from employer(s)	2012-12-31	$0
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$2,576
Funding deficiency by the employer to the plan for this plan year	2012-12-31	$0
Minimum employer required contribution for this plan year	2012-12-31	$0
Amount contributed by the employer to the plan for this plan year	2012-12-31	$0
2010 : NORDSTROM AUTOMOTIVE 401(K) PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$406,611
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$513,346
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$513,346
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$184,415
Value of total assets at end of year	2010-12-31	$2,184,063
Value of total assets at beginning of year	2010-12-31	$2,290,798
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$0
Total interest from all sources	2010-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$500,000
If this is an individual account plan, was there a blackout period	2010-12-31	Yes
Funding deficiency by the employer to the plan for this plan year	2010-12-31	$0
Minimum employer required contribution for this plan year	2010-12-31	$0
Amount contributed by the employer to the plan for this plan year	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$183,328
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$1,087
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$-106,735
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$2,184,063
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$2,290,798
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$2,184,063
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$2,290,798
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$0
Net investment gain/loss from pooled separate accounts	2010-12-31	$222,196
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$513,346
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2010-12-31	Yes
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	LARSON ALLEN LLP
Accountancy firm EIN	2010-12-31	410746749
2009 : NORDSTROM AUTOMOTIVE 401(K) PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for NORDSTROM AUTOMOTIVE 401(K) PLAN

2014: NORDSTROM AUTOMOTIVE 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: NORDSTROM AUTOMOTIVE 401(K) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: NORDSTROM AUTOMOTIVE 401(K) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2009: NORDSTROM AUTOMOTIVE 401(K) PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-822094

Policy instance

Insurance contract or identification number	GA-822094
Number of Individuals Covered	44
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,788
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?	Yes
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,788
Insurance broker organization code?	3
Insurance broker name	CETERA ADVISORS LLC

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-822094

Policy instance

Insurance contract or identification number	GA-822094
Number of Individuals Covered	44
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,254
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?	Yes
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,254
Insurance broker organization code?	3
Insurance broker name	CETERA ADVISORS LLC

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-822094

Policy instance

Insurance contract or identification number	GA-822094
Number of Individuals Covered	59
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,124
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?	Yes
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,124
Insurance broker organization code?	3
Insurance broker name	MULTI-FINANCIAL SEC CORP

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-822094

Policy instance

Insurance contract or identification number	GA-822094
Number of Individuals Covered	96
Insurance policy start date	2010-07-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $20,433
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?	Yes
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	NORDSTROM CHEVROLET OLDSMOBILE
Employer identification number (EIN):	521769589
NAIC Classification:	441110
NAIC Description:	New Car Dealers