401k Plan data: ELEKTROBIT AUTOMOTIVE AMERICAS, INC. GROUP HEALTH PLAN plan

ELEKTROBIT AUTOMOTIVE AMERICAS, INC. GROUP HEALTH PLAN 401k Plan overview

Plan Name	ELEKTROBIT AUTOMOTIVE AMERICAS, INC. GROUP HEALTH PLAN
Plan identification number	501

ELEKTROBIT AUTOMOTIVE AMERICAS, INC. GROUP HEALTH 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 Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

ELEKTROBIT AUTOMOTIVE AMERICAS, INC. has sponsored the creation of one or more 401k plans.

Company Name: ELEKTROBIT AUTOMOTIVE AMERICAS, INC.

Employer identification number (EIN): 464026178

NAIC Classification: 425110
NAIC Description: Business to Business Electronic Markets

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ELEKTROBIT AUTOMOTIVE AMERICAS, INC. GROUP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-05-01 JOHNATHAN ENGEL 2024-12-20
501 2022-05-01 JONATHAN ENGEL 2024-01-26
501 2021-05-01 JOHN MCKIE 2022-09-08
501 2020-05-01 JOHN MCKIE 2022-01-28
501 2019-05-01 JOHN MCKIE 2020-11-23
501 2018-05-01 JOHN MCKIE 2019-11-06
501 2017-05-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-05-01	JOHNATHAN ENGEL	2024-12-20
501	2022-05-01	JONATHAN ENGEL	2024-01-26
501	2021-05-01	JOHN MCKIE	2022-09-08
501	2020-05-01	JOHN MCKIE	2022-01-28
501	2019-05-01	JOHN MCKIE	2020-11-23
501	2018-05-01	JOHN MCKIE	2019-11-06
501	2017-05-01

Form 5500 Responses for ELEKTROBIT AUTOMOTIVE AMERICAS, INC. GROUP HEALTH PLAN

2023: ELEKTROBIT AUTOMOTIVE AMERICAS, INC. GROUP HEALTH PLAN 2023 form 5500 responses
2023-05-01	Type of plan entity	Single employer plan
2023-05-01	Plan funding arrangement – Insurance	Yes
2023-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-05-01	Plan benefit arrangement – Insurance	Yes
2023-05-01	Plan benefit arrangement – General assets of the sponsor	Yes
2022: ELEKTROBIT AUTOMOTIVE AMERICAS, INC. GROUP HEALTH PLAN 2022 form 5500 responses
2022-05-01	Type of plan entity	Single employer plan
2022-05-01	Plan funding arrangement – Insurance	Yes
2022-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-05-01	Plan benefit arrangement – Insurance	Yes
2022-05-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: ELEKTROBIT AUTOMOTIVE AMERICAS, INC. GROUP HEALTH PLAN 2021 form 5500 responses
2021-05-01	Type of plan entity	Single employer plan
2021-05-01	Plan funding arrangement – Insurance	Yes
2021-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-05-01	Plan benefit arrangement – Insurance	Yes
2021-05-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: ELEKTROBIT AUTOMOTIVE AMERICAS, INC. GROUP HEALTH PLAN 2020 form 5500 responses
2020-05-01	Type of plan entity	Single employer plan
2020-05-01	Plan funding arrangement – Insurance	Yes
2020-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-05-01	Plan benefit arrangement – Insurance	Yes
2020-05-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: ELEKTROBIT AUTOMOTIVE AMERICAS, INC. GROUP HEALTH PLAN 2019 form 5500 responses
2019-05-01	Type of plan entity	Single employer plan
2019-05-01	Plan funding arrangement – Insurance	Yes
2019-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-05-01	Plan benefit arrangement – Insurance	Yes
2019-05-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: ELEKTROBIT AUTOMOTIVE AMERICAS, INC. GROUP HEALTH PLAN 2018 form 5500 responses
2018-05-01	Type of plan entity	Single employer plan
2018-05-01	Plan funding arrangement – Insurance	Yes
2018-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-05-01	Plan benefit arrangement – Insurance	Yes
2018-05-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: ELEKTROBIT AUTOMOTIVE AMERICAS, INC. GROUP HEALTH PLAN 2017 form 5500 responses
2017-05-01	Type of plan entity	Single employer plan
2017-05-01	First time form 5500 has been submitted	Yes
2017-05-01	Plan funding arrangement – Insurance	Yes
2017-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-05-01	Plan benefit arrangement – Insurance	Yes
2017-05-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

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

Policy contract number

10141374

Policy instance

Insurance contract or identification number	10141374
Number of Individuals Covered	59
Insurance policy start date	2023-05-01
Insurance policy end date	2024-04-30
Total amount of commissions paid to insurance broker	USD $14,808
Total amount of fees paid to insurance company	USD $1,658
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 $74,041
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

5012B

Policy instance

Insurance contract or identification number	5012B
Number of Individuals Covered	1
Insurance policy start date	2023-05-01
Insurance policy end date	2024-04-30
Total amount of commissions paid to insurance broker	USD $350
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

ABL962021

Policy instance

Insurance contract or identification number	ABL962021
Number of Individuals Covered	130
Insurance policy start date	2023-05-01
Insurance policy end date	2024-04-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30013861

Policy instance

Insurance contract or identification number	30013861
Number of Individuals Covered	61
Insurance policy start date	2023-05-01
Insurance policy end date	2024-04-30
Total amount of commissions paid to insurance broker	USD $1,062
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,875
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )

Policy contract number

5984

Policy instance

Insurance contract or identification number	5984
Number of Individuals Covered	131
Insurance policy start date	2023-05-01
Insurance policy end date	2024-04-30
Total amount of commissions paid to insurance broker	USD $5,916
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?	Yes

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

5012B

Policy instance

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

Policy contract number

10141374

Policy instance

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )

Policy contract number

5984

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30013861

Policy instance

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

ABL962021

Policy instance

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

Policy contract number

10141374

Policy instance

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

5012B

Policy instance

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

ABL962021

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30013861

Policy instance

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )

Policy contract number

5984

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30013861

Policy instance

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

Policy contract number

10141374

Policy instance

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

5012B

Policy instance

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

ABL962021

Policy instance

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )

Policy contract number

5984

Policy instance

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )

Policy contract number

5984

Policy instance

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

Policy contract number

10141374

Policy instance

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

05012B001

Policy instance

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

ABL962021

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30013861

Policy instance

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )

Policy contract number

05984

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30013861

Policy instance

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

ABL962021

Policy instance

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

05012B

Policy instance

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

Policy contract number

10141374

Policy instance

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )

Policy contract number

5984

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30013861

Policy instance

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

ABL962021

Policy instance

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

05012B

Policy instance

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

Policy contract number

10141374

Policy instance

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Company Name:	ELEKTROBIT AUTOMOTIVE AMERICAS, INC.
Employer identification number (EIN):	464026178
NAIC Classification:	425110
NAIC Description:	Business to Business Electronic Markets