401k Plan data: GRUPO ANTOLIN PRIMERA AUTOMOTIVE SYSTEMS HEALTH plan

GRUPO ANTOLIN PRIMERA AUTOMOTIVE SYSTEMS HEALTH 401k Plan overview

Plan Name	GRUPO ANTOLIN PRIMERA AUTOMOTIVE SYSTEMS HEALTH
Plan identification number	501

GRUPO ANTOLIN PRIMERA AUTOMOTIVE SYSTEMS HEALTH 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

GRUPO ANTOLIN PRIMERA AUTOMOTIVE SYSTEMS, LLC has sponsored the creation of one or more 401k plans.

Company Name: GRUPO ANTOLIN PRIMERA AUTOMOTIVE SYSTEMS, LLC

Employer identification number (EIN): 383440879

NAIC Classification: 336300

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GRUPO ANTOLIN PRIMERA AUTOMOTIVE SYSTEMS HEALTH

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-09-01 YOLANDA GREEN 2025-01-23
501 2022-09-01 YOLANDA GREEN 2024-02-28
501 2021-09-01 YOLANDA GREEN 2023-01-05
501 2020-09-01 YOLANDA GREEN 2022-03-01
501 2019-09-01 YOLANDA GREEN 2021-03-10
501 2018-09-01 YOLANDA M. GREEN 2020-02-18
501 2017-09-01
501 2016-09-01 YOLANDA GREEN 2018-12-13
501 2015-09-01 YOLANDA GREEN 2018-12-13
501 2014-09-01 YOLANDA GREEN 2018-12-13
501 2013-09-01
501 2012-09-01
501 2011-09-01
501 2010-09-01
501 2009-09-01
501 2008-09-01
501 2007-09-01
501 2006-09-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-09-01	YOLANDA GREEN	2025-01-23
501	2022-09-01	YOLANDA GREEN	2024-02-28
501	2021-09-01	YOLANDA GREEN	2023-01-05
501	2020-09-01	YOLANDA GREEN	2022-03-01
501	2019-09-01	YOLANDA GREEN	2021-03-10
501	2018-09-01	YOLANDA M. GREEN	2020-02-18
501	2017-09-01
501	2016-09-01	YOLANDA GREEN	2018-12-13
501	2015-09-01	YOLANDA GREEN	2018-12-13
501	2014-09-01	YOLANDA GREEN	2018-12-13
501	2013-09-01
501	2012-09-01
501	2011-09-01
501	2010-09-01
501	2009-09-01
501	2008-09-01
501	2007-09-01
501	2006-09-01

Form 5500 Responses for GRUPO ANTOLIN PRIMERA AUTOMOTIVE SYSTEMS HEALTH

2023: GRUPO ANTOLIN PRIMERA AUTOMOTIVE SYSTEMS HEALTH 2023 form 5500 responses
2023-09-01	Type of plan entity	Single employer plan
2023-09-01	Plan funding arrangement – Insurance	Yes
2023-09-01	Plan benefit arrangement – Insurance	Yes
2022: GRUPO ANTOLIN PRIMERA AUTOMOTIVE SYSTEMS HEALTH 2022 form 5500 responses
2022-09-01	Type of plan entity	Single employer plan
2022-09-01	Plan funding arrangement – Insurance	Yes
2022-09-01	Plan benefit arrangement – Insurance	Yes
2021: GRUPO ANTOLIN PRIMERA AUTOMOTIVE SYSTEMS HEALTH 2021 form 5500 responses
2021-09-01	Type of plan entity	Single employer plan
2021-09-01	Plan funding arrangement – Insurance	Yes
2021-09-01	Plan benefit arrangement – Insurance	Yes
2020: GRUPO ANTOLIN PRIMERA AUTOMOTIVE SYSTEMS HEALTH 2020 form 5500 responses
2020-09-01	Type of plan entity	Single employer plan
2020-09-01	Plan funding arrangement – Insurance	Yes
2020-09-01	Plan benefit arrangement – Insurance	Yes
2019: GRUPO ANTOLIN PRIMERA AUTOMOTIVE SYSTEMS HEALTH 2019 form 5500 responses
2019-09-01	Type of plan entity	Single employer plan
2019-09-01	Plan funding arrangement – Insurance	Yes
2019-09-01	Plan benefit arrangement – Insurance	Yes
2018: GRUPO ANTOLIN PRIMERA AUTOMOTIVE SYSTEMS HEALTH 2018 form 5500 responses
2018-09-01	Type of plan entity	Single employer plan
2018-09-01	Plan funding arrangement – Insurance	Yes
2018-09-01	Plan benefit arrangement – Insurance	Yes
2017: GRUPO ANTOLIN PRIMERA AUTOMOTIVE SYSTEMS HEALTH 2017 form 5500 responses
2017-09-01	Type of plan entity	Single employer plan
2017-09-01	Plan funding arrangement – Insurance	Yes
2017-09-01	Plan benefit arrangement – Insurance	Yes
2016: GRUPO ANTOLIN PRIMERA AUTOMOTIVE SYSTEMS HEALTH 2016 form 5500 responses
2016-09-01	Type of plan entity	Single employer plan
2016-09-01	Submission has been amended	No
2016-09-01	This submission is the final filing	No
2016-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-09-01	Plan is a collectively bargained plan	No
2016-09-01	Plan funding arrangement – Insurance	Yes
2016-09-01	Plan benefit arrangement – Insurance	Yes
2015: GRUPO ANTOLIN PRIMERA AUTOMOTIVE SYSTEMS HEALTH 2015 form 5500 responses
2015-09-01	Type of plan entity	Single employer plan
2015-09-01	Submission has been amended	No
2015-09-01	This submission is the final filing	No
2015-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-09-01	Plan is a collectively bargained plan	No
2015-09-01	Plan funding arrangement – Insurance	Yes
2015-09-01	Plan benefit arrangement – Insurance	Yes
2014: GRUPO ANTOLIN PRIMERA AUTOMOTIVE SYSTEMS HEALTH 2014 form 5500 responses
2014-09-01	Type of plan entity	Single employer plan
2014-09-01	Submission has been amended	No
2014-09-01	This submission is the final filing	No
2014-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-09-01	Plan is a collectively bargained plan	No
2014-09-01	Plan funding arrangement – Insurance	Yes
2014-09-01	Plan benefit arrangement – Insurance	Yes
2013: GRUPO ANTOLIN PRIMERA AUTOMOTIVE SYSTEMS HEALTH 2013 form 5500 responses
2013-09-01	Type of plan entity	Single employer plan
2013-09-01	Submission has been amended	No
2013-09-01	This submission is the final filing	No
2013-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-09-01	Plan is a collectively bargained plan	No
2013-09-01	Plan funding arrangement – Insurance	Yes
2013-09-01	Plan benefit arrangement – Insurance	Yes
2012: GRUPO ANTOLIN PRIMERA AUTOMOTIVE SYSTEMS HEALTH 2012 form 5500 responses
2012-09-01	Type of plan entity	Single employer plan
2012-09-01	Submission has been amended	No
2012-09-01	This submission is the final filing	No
2012-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-09-01	Plan is a collectively bargained plan	No
2012-09-01	Plan funding arrangement – Insurance	Yes
2012-09-01	Plan benefit arrangement – Insurance	Yes
2011: GRUPO ANTOLIN PRIMERA AUTOMOTIVE SYSTEMS HEALTH 2011 form 5500 responses
2011-09-01	Type of plan entity	Single employer plan
2011-09-01	Submission has been amended	No
2011-09-01	This submission is the final filing	No
2011-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-09-01	Plan is a collectively bargained plan	No
2011-09-01	Plan funding arrangement – Insurance	Yes
2011-09-01	Plan benefit arrangement – Insurance	Yes
2010: GRUPO ANTOLIN PRIMERA AUTOMOTIVE SYSTEMS HEALTH 2010 form 5500 responses
2010-09-01	Type of plan entity	Single employer plan
2010-09-01	Submission has been amended	No
2010-09-01	This submission is the final filing	No
2010-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-09-01	Plan is a collectively bargained plan	No
2010-09-01	Plan funding arrangement – Insurance	Yes
2010-09-01	Plan benefit arrangement – Insurance	Yes
2009: GRUPO ANTOLIN PRIMERA AUTOMOTIVE SYSTEMS HEALTH 2009 form 5500 responses
2009-09-01	Type of plan entity	Single employer plan
2009-09-01	Submission has been amended	No
2009-09-01	This submission is the final filing	No
2009-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-09-01	Plan is a collectively bargained plan	No
2009-09-01	Plan funding arrangement – Insurance	Yes
2009-09-01	Plan benefit arrangement – Insurance	Yes
2008: GRUPO ANTOLIN PRIMERA AUTOMOTIVE SYSTEMS HEALTH 2008 form 5500 responses
2008-09-01	Type of plan entity	Single employer plan
2008-09-01	Submission has been amended	No
2008-09-01	This submission is the final filing	No
2008-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-09-01	Plan is a collectively bargained plan	No
2008-09-01	Plan funding arrangement – Insurance	Yes
2008-09-01	Plan benefit arrangement – Insurance	Yes
2007: GRUPO ANTOLIN PRIMERA AUTOMOTIVE SYSTEMS HEALTH 2007 form 5500 responses
2007-09-01	Type of plan entity	Single employer plan
2007-09-01	Submission has been amended	No
2007-09-01	This submission is the final filing	No
2007-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2007-09-01	Plan is a collectively bargained plan	No
2007-09-01	Plan funding arrangement – Insurance	Yes
2007-09-01	Plan benefit arrangement – Insurance	Yes
2006: GRUPO ANTOLIN PRIMERA AUTOMOTIVE SYSTEMS HEALTH 2006 form 5500 responses
2006-09-01	Type of plan entity	Single employer plan
2006-09-01	First time form 5500 has been submitted	Yes
2006-09-01	Submission has been amended	No
2006-09-01	This submission is the final filing	No
2006-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2006-09-01	Plan is a collectively bargained plan	No
2006-09-01	Plan funding arrangement – Insurance	Yes
2006-09-01	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

953602

Policy instance

Insurance contract or identification number	953602
Number of Individuals Covered	141
Insurance policy start date	2023-09-01
Insurance policy end date	2024-08-31
Total amount of commissions paid to insurance broker	USD $7,904
Total amount of fees paid to insurance company	USD $1,447
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
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	ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $77,884
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

447

Policy instance

Insurance contract or identification number	447
Number of Individuals Covered	200
Insurance policy start date	2023-09-01
Insurance policy end date	2024-08-31
Total amount of commissions paid to insurance broker	USD $5,385
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

264689

Policy instance

Insurance contract or identification number	264689
Number of Individuals Covered	134
Insurance policy start date	2023-09-01
Insurance policy end date	2024-08-31
Total amount of commissions paid to insurance broker	USD $32,205
Total amount of fees paid to insurance company	USD $840
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10071451001

Policy instance

Insurance contract or identification number	10071451001
Number of Individuals Covered	193
Insurance policy start date	2023-09-01
Insurance policy end date	2024-08-31
Total amount of commissions paid to insurance broker	USD $1,191
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,831
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

264689

Policy instance

Insurance contract or identification number	264689
Number of Individuals Covered	56
Insurance policy start date	2023-09-01
Insurance policy end date	2024-08-31
Total amount of commissions paid to insurance broker	USD $14,523
Total amount of fees paid to insurance company	USD $425
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

264689

Policy instance

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

Policy contract number

8208

Policy instance

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10071451001

Policy instance

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

Policy contract number

447

Policy instance

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

264689

Policy instance

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

Policy contract number

953602

Policy instance

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

Policy contract number

264689

Policy instance

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10071451001

Policy instance

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

264689

Policy instance

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

Policy contract number

953602

Policy instance

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

Policy contract number

8208

Policy instance

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

Policy contract number

264689

Policy instance

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10071451001

Policy instance

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

264689

Policy instance

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

Policy contract number

8208

Policy instance

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

Policy contract number

953602

Policy instance

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

Policy contract number

264689

Policy instance

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

Policy contract number

953602

Policy instance

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10071451001

Policy instance

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

264689

Policy instance

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

Policy contract number

8208

Policy instance

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

Policy contract number

8208

Policy instance

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10244487

Policy instance

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

264689

Policy instance

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10071451001

Policy instance

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

Policy contract number

7031707

Policy instance

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

Policy contract number

8208

Policy instance

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

Policy contract number

8208

Policy instance

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

264689

Policy instance

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

Policy contract number

498235

Policy instance

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10071451001

Policy instance

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

Policy contract number

264689

Policy instance

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

Policy contract number

447/8208

Policy instance

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

Policy contract number

498235

Policy instance

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

264689/0001

Policy instance

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

8606

Policy instance

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

Policy contract number

447/8208

Policy instance

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

8606

Policy instance

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

264689/0001

Policy instance

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

264689/0001

Policy instance

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

Policy contract number

447/8208

Policy instance

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

8606

Policy instance

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

Policy contract number

447/8208

Policy instance

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10094272

Policy instance

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

8606

Policy instance

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

264689/0001

Policy instance

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

264689/0001

Policy instance

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10094272

Policy instance

GOLDEN DENTAL PLAN (National Association of Insurance Commissioners NAIC id number: 11113 )

Policy contract number

Policy instance

GOLDEN DENTAL PLAN (National Association of Insurance Commissioners NAIC id number: 11113 )

Policy contract number

Policy instance

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10094272

Policy instance

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

264689/0001

Policy instance

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10094272

Policy instance

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

Policy contract number

401043

Policy instance

GOLDEN DENTAL PLAN (National Association of Insurance Commissioners NAIC id number: 11113 )

Policy contract number

Policy instance

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

264689/0001

Policy instance

GOLDEN DENTAL PLAN (National Association of Insurance Commissioners NAIC id number: 11113 )

Policy contract number

Policy instance

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

264689/0001

Policy instance

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

Policy contract number

401043

Policy instance

Potentially related plans

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Company Name:	GRUPO ANTOLIN PRIMERA AUTOMOTIVE SYSTEMS, LLC
Employer identification number (EIN):	383440879
NAIC Classification:	336300