401k Plan data: EUROMOTORS INC WELFARE PLAN plan

EUROMOTORS INC WELFARE PLAN 401k Plan overview

Plan Name	EUROMOTORS INC WELFARE PLAN
Plan identification number	503

EUROMOTORS INC WELFARE 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

401k Sponsoring company profile

EUROMOTORS, INC. D/B/A MERCEDES BENZ OF SAN FRANCISCO has sponsored the creation of one or more 401k plans.

Company Name: EUROMOTORS, INC. D/B/A MERCEDES BENZ OF SAN FRANCISCO

Employer identification number (EIN): 941565174

NAIC Classification: 441110
NAIC Description: New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EUROMOTORS INC WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2004-01-01 NASIM KEYNEJAD 2024-02-22

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2004-01-01	NASIM KEYNEJAD	2024-02-22

Plan Statistics for EUROMOTORS INC WELFARE PLAN

401k plan membership statisitcs for EUROMOTORS INC WELFARE PLAN

Measure Date Value
2004: EUROMOTORS INC WELFARE PLAN 2004 401k membership
Total participants, beginning-of-year 2004-01-01 130
Total number of active participants reported on line 7a of the Form 5500 2004-01-01 0
Number of retired or separated participants receiving benefits 2004-01-01 0
Number of other retired or separated participants entitled to future benefits 2004-01-01 0
Total of all active and inactive participants 2004-01-01 0
Number of employers contributing to the scheme 2004-01-01 0

Measure	Date	Value
2004: EUROMOTORS INC WELFARE PLAN 2004 401k membership
Total participants, beginning-of-year	2004-01-01	130
Total number of active participants reported on line 7a of the Form 5500	2004-01-01	0
Number of retired or separated participants receiving benefits	2004-01-01	0
Number of other retired or separated participants entitled to future benefits	2004-01-01	0
Total of all active and inactive participants	2004-01-01	0
Number of employers contributing to the scheme	2004-01-01	0

Form 5500 Responses for EUROMOTORS INC WELFARE PLAN

2004: EUROMOTORS INC WELFARE PLAN 2004 form 5500 responses
2004-01-01	Type of plan entity	Single employer plan
2004-01-01	Submission has been amended	Yes
2004-01-01	This submission is the final filing	Yes
2004-01-01	Plan funding arrangement – Insurance	Yes
2004-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05557457

Policy instance

Insurance contract or identification number	KM05557457
Number of Individuals Covered	130
Insurance policy start date	2004-01-01
Insurance policy end date	2004-12-31
Total amount of commissions paid to insurance broker	USD $5,059
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,806
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 )

Policy contract number

2017

Policy instance

Insurance contract or identification number	2017
Number of Individuals Covered	130
Insurance policy start date	2004-01-01
Insurance policy end date	2004-12-31
Total amount of commissions paid to insurance broker	USD $7,623
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $137,156
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

00507077

Policy instance

Insurance contract or identification number	00507077
Number of Individuals Covered	130
Insurance policy start date	2004-01-01
Insurance policy end date	2004-12-31
Total amount of commissions paid to insurance broker	USD $1,045
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,310
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN FIDELITY ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60410 )

Policy contract number

C-8

Policy instance

Insurance contract or identification number	C-8
Number of Individuals Covered	1
Insurance policy start date	2004-01-01
Insurance policy end date	2004-12-31
Total amount of commissions paid to insurance broker	USD $36
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	CANCER
Welfare Benefit Premiums Paid to Carrier	USD $360
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )

Policy contract number

Policy instance

Insurance contract or identification number	C9
Number of Individuals Covered	1
Insurance policy start date	2004-01-01
Insurance policy end date	2004-12-31
Total amount of commissions paid to insurance broker	USD $26
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	CANCER
Welfare Benefit Premiums Paid to Carrier	USD $553
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )

Policy contract number

G-103

Policy instance

Insurance contract or identification number	G-103
Number of Individuals Covered	12
Insurance policy start date	2004-01-01
Insurance policy end date	2004-12-31
Total amount of commissions paid to insurance broker	USD $958
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,425
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

40770A/64076A

Policy instance

Insurance contract or identification number	40770A/64076A
Number of Individuals Covered	70
Insurance policy start date	2004-01-01
Insurance policy end date	2004-12-31
Total amount of commissions paid to insurance broker	USD $15,162
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $517,291
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

38037-0000

Policy instance

Insurance contract or identification number	38037-0000
Number of Individuals Covered	138
Insurance policy start date	2004-01-01
Insurance policy end date	2004-12-31
Total amount of commissions paid to insurance broker	USD $10,814
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $304,430
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	EUROMOTORS, INC. D/B/A MERCEDES BENZ OF SAN FRANCISCO
Employer identification number (EIN):	941565174
NAIC Classification:	441110
NAIC Description:	New Car Dealers