401k Plan data: SAS AUTOMOTIVE USA, INC. PLAN plan

SAS AUTOMOTIVE USA, INC. PLAN 401k Plan overview

Plan Name	SAS AUTOMOTIVE USA, INC. PLAN
Plan identification number	502

SAS AUTOMOTIVE USA, INC. PLAN 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 Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

SAS AUTOMOTIVE USA, INC. has sponsored the creation of one or more 401k plans.

Company Name: SAS AUTOMOTIVE USA, INC.

Employer identification number (EIN): 203634107

NAIC Classification: 336300

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SAS AUTOMOTIVE USA, INC. PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2023-09-01 MICHELLE SHEMANSKI 2025-01-24

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2023-09-01	MICHELLE SHEMANSKI	2025-01-24

Form 5500 Responses for SAS AUTOMOTIVE USA, INC. PLAN

2023: SAS AUTOMOTIVE USA, INC. PLAN 2023 form 5500 responses
2023-09-01	Type of plan entity	Single employer plan
2023-09-01	First time form 5500 has been submitted	Yes
2023-09-01	Plan is a collectively bargained plan	Yes
2023-09-01	Plan funding arrangement – Insurance	Yes
2023-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-09-01	Plan benefit arrangement – Insurance	Yes
2023-09-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

7037245

Policy instance

Insurance contract or identification number	7037245
Number of Individuals Covered	179
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $27,580
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $928,525
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

11520

Policy instance

Insurance contract or identification number	11520
Number of Individuals Covered	493
Insurance policy start date	2023-09-01
Insurance policy end date	2024-08-31
Total amount of commissions paid to insurance broker	USD $5,883
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RENAISSANCE LIFE & HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61700 )

Policy contract number

V11520

Policy instance

Insurance contract or identification number	V11520
Number of Individuals Covered	482
Insurance policy start date	2023-09-01
Insurance policy end date	2024-08-31
Total amount of commissions paid to insurance broker	USD $1,458
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

961760

Policy instance

Insurance contract or identification number	961760
Number of Individuals Covered	592
Insurance policy start date	2023-09-01
Insurance policy end date	2024-08-31
Total amount of commissions paid to insurance broker	USD $22,159
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $318,648
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	SAS AUTOMOTIVE USA, INC.
Employer identification number (EIN):	203634107
NAIC Classification:	336300