401k Plan data: R.K. CHEVROLET, INC. SECONDARY EMPLOYEE BENEFIT PLAN & TRUST plan

R.K. CHEVROLET, INC. SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 401k Plan overview

Plan Name	R.K. CHEVROLET, INC. SECONDARY EMPLOYEE BENEFIT PLAN & TRUST
Plan identification number	501

R.K. CHEVROLET, INC. SECONDARY EMPLOYEE BENEFIT PLAN & TRUST Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

R K CHEVROLET, INC. has sponsored the creation of one or more 401k plans.

Company Name: R K CHEVROLET, INC.

Employer identification number (EIN): 540761740

NAIC Classification: 441110
NAIC Description: New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan R.K. CHEVROLET, INC. SECONDARY EMPLOYEE BENEFIT PLAN & TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-12-01
501 2013-12-01 TOM KLINE
501 2013-03-01 TOM KLINE

Plan Statistics for R.K. CHEVROLET, INC. SECONDARY EMPLOYEE BENEFIT PLAN & TRUST

401k plan membership statisitcs for R.K. CHEVROLET, INC. SECONDARY EMPLOYEE BENEFIT PLAN & TRUST

Measure Date Value
2022: R.K. CHEVROLET, INC. SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2022 401k membership
Total participants, beginning-of-year 2022-12-01 109
Total number of active participants reported on line 7a of the Form 5500 2022-12-01 116
Number of retired or separated participants receiving benefits 2022-12-01 0
Number of other retired or separated participants entitled to future benefits 2022-12-01 0
Total of all active and inactive participants 2022-12-01 116
2013: R.K. CHEVROLET, INC. SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2013 401k membership
Total participants, beginning-of-year 2013-12-01 62
Total number of active participants reported on line 7a of the Form 5500 2013-12-01 70
Total of all active and inactive participants 2013-12-01 70
Total participants, beginning-of-year 2013-03-01 64
Total number of active participants reported on line 7a of the Form 5500 2013-03-01 62
Total of all active and inactive participants 2013-03-01 62

Measure	Date	Value
2022: R.K. CHEVROLET, INC. SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2022 401k membership
Total participants, beginning-of-year	2022-12-01	109
Total number of active participants reported on line 7a of the Form 5500	2022-12-01	116
Number of retired or separated participants receiving benefits	2022-12-01	0
Number of other retired or separated participants entitled to future benefits	2022-12-01	0
Total of all active and inactive participants	2022-12-01	116
2013: R.K. CHEVROLET, INC. SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2013 401k membership
Total participants, beginning-of-year	2013-12-01	62
Total number of active participants reported on line 7a of the Form 5500	2013-12-01	70
Total of all active and inactive participants	2013-12-01	70
Total participants, beginning-of-year	2013-03-01	64
Total number of active participants reported on line 7a of the Form 5500	2013-03-01	62
Total of all active and inactive participants	2013-03-01	62

Financial Data on R.K. CHEVROLET, INC. SECONDARY EMPLOYEE BENEFIT PLAN & TRUST

Measure	Date	Value
2014 : R.K. CHEVROLET, INC. SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2014 401k financial data
Transfers to/from the plan	2014-11-30	$-11,877
Total income from all sources	2014-11-30	$562,111
Expenses. Total of all expenses incurred	2014-11-30	$560,308
Benefits paid (including direct rollovers)	2014-11-30	$527,791
Total plan assets at end of year	2014-11-30	$0
Total plan assets at beginning of year	2014-11-30	$10,074
Value of fidelity bond covering the plan	2014-11-30	$500,000
Expenses. Other expenses not covered elsewhere	2014-11-30	$32,517
Net income (gross income less expenses)	2014-11-30	$1,803
Net plan assets at end of year (total assets less liabilities)	2014-11-30	$0
Net plan assets at beginning of year (total assets less liabilities)	2014-11-30	$10,074
Total contributions received or receivable from employer(s)	2014-11-30	$562,111
2013 : R.K. CHEVROLET, INC. SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2013 401k financial data
Total income from all sources	2013-11-30	$385,089
Expenses. Total of all expenses incurred	2013-11-30	$375,015
Benefits paid (including direct rollovers)	2013-11-30	$353,218
Total plan assets at end of year	2013-11-30	$10,074
Total plan assets at beginning of year	2013-11-30	$0
Value of fidelity bond covering the plan	2013-11-30	$500,000
Expenses. Other expenses not covered elsewhere	2013-11-30	$21,797
Net income (gross income less expenses)	2013-11-30	$10,074
Net plan assets at end of year (total assets less liabilities)	2013-11-30	$10,074
Net plan assets at beginning of year (total assets less liabilities)	2013-11-30	$0
Total contributions received or receivable from employer(s)	2013-11-30	$385,089

Form 5500 Responses for R.K. CHEVROLET, INC. SECONDARY EMPLOYEE BENEFIT PLAN & TRUST

2022: R.K. CHEVROLET, INC. SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2022 form 5500 responses
2022-12-01	Type of plan entity	Single employer plan
2022-12-01	Submission has been amended	No
2022-12-01	This submission is the final filing	No
2022-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-12-01	Plan is a collectively bargained plan	No
2022-12-01	Plan funding arrangement – Insurance	Yes
2022-12-01	Plan benefit arrangement – Insurance	Yes
2013: R.K. CHEVROLET, INC. SECONDARY EMPLOYEE BENEFIT PLAN & TRUST 2013 form 5500 responses
2013-12-01	Type of plan entity	Single employer plan
2013-12-01	This submission is the final filing	Yes
2013-12-01	Plan funding arrangement – Insurance	Yes
2013-12-01	Plan funding arrangement – Trust	Yes
2013-12-01	Plan benefit arrangement – Insurance	Yes
2013-12-01	Plan benefit arrangement - Trust	Yes
2013-03-01	Type of plan entity	Single employer plan
2013-03-01	First time form 5500 has been submitted	Yes
2013-03-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2013-03-01	Plan funding arrangement – Insurance	Yes
2013-03-01	Plan funding arrangement – Trust	Yes
2013-03-01	Plan benefit arrangement – Insurance	Yes
2013-03-01	Plan benefit arrangement - Trust	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

00027711

Policy instance

Insurance contract or identification number	00027711
Number of Individuals Covered	141
Insurance policy start date	2022-12-01
Insurance policy end date	2023-11-30
Total amount of commissions paid to insurance broker	USD $25,357
Total amount of fees paid to insurance company	USD $736
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	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENT CANCER CRITICAL ILLNESS
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 $133,859
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,904
Amount paid for insurance broker fees	736
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 )

Policy contract number

2651

Policy instance

Insurance contract or identification number	2651
Number of Individuals Covered	2651
Insurance policy start date	2022-12-01
Insurance policy end date	2023-11-30
Total amount of commissions paid to insurance broker	USD $13,750
Total amount of fees paid to insurance company	USD $0
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	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 $392,405
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,750
Insurance broker organization code?	3

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Company Name:	R K CHEVROLET, INC.
Employer identification number (EIN):	540761740
NAIC Classification:	441110
NAIC Description:	New Car Dealers