401k Plan data: MERCEDES-BENZ OF SEATTLE MEDICAL PLAN plan

MERCEDES-BENZ OF SEATTLE MEDICAL PLAN 401k Plan overview

Plan Name	MERCEDES-BENZ OF SEATTLE MEDICAL PLAN
Plan identification number	501

MERCEDES-BENZ OF SEATTLE MEDICAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Other welfare benefit cover

401k Sponsoring company profile

SEATTLE AUTO MANAGEMENT DBA has sponsored the creation of one or more 401k plans.

Company Name: SEATTLE AUTO MANAGEMENT DBA

Employer identification number (EIN): 453663003

NAIC Classification: 441110
NAIC Description: New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MERCEDES-BENZ OF SEATTLE MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-01-01 SAMANTHA HICKS
501 2016-01-01 SAMANTHA HICKS
501 2015-01-01 SAMANTHA HICKS

Plan id#	Filing Submission Date	Name of Administrator
501	2017-01-01	SAMANTHA HICKS
501	2016-01-01	SAMANTHA HICKS
501	2015-01-01	SAMANTHA HICKS

Plan Statistics for MERCEDES-BENZ OF SEATTLE MEDICAL PLAN

401k plan membership statisitcs for MERCEDES-BENZ OF SEATTLE MEDICAL PLAN

Measure Date Value
2017: MERCEDES-BENZ OF SEATTLE MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 145
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 136
Total of all active and inactive participants 2017-01-01 136
2016: MERCEDES-BENZ OF SEATTLE MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 155
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 145
Total of all active and inactive participants 2016-01-01 145
2015: MERCEDES-BENZ OF SEATTLE MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 154
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 155
Total of all active and inactive participants 2015-01-01 155

Measure	Date	Value
2017: MERCEDES-BENZ OF SEATTLE MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	145
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	136
Total of all active and inactive participants	2017-01-01	136
2016: MERCEDES-BENZ OF SEATTLE MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	155
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	145
Total of all active and inactive participants	2016-01-01	145
2015: MERCEDES-BENZ OF SEATTLE MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	154
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	155
Total of all active and inactive participants	2015-01-01	155

Form 5500 Responses for MERCEDES-BENZ OF SEATTLE MEDICAL PLAN

2017: MERCEDES-BENZ OF SEATTLE MEDICAL PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: MERCEDES-BENZ OF SEATTLE MEDICAL PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: MERCEDES-BENZ OF SEATTLE MEDICAL PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	First time form 5500 has been submitted	Yes
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

LIFEWISE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 94188 )

Policy contract number

WA400124

Policy instance

Insurance contract or identification number	WA400124
Number of Individuals Covered	145
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $3,055
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	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 $209,782
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	3055
Additional information about fees paid to insurance broker	ENHANCED COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF WA, INC.

PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )

Policy contract number

4003509

Policy instance

Insurance contract or identification number	4003509
Number of Individuals Covered	188
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $51,175
Total amount of fees paid to insurance company	USD $545
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 $653,530
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $51,175
Amount paid for insurance broker fees	545
Additional information about fees paid to insurance broker	PREFERRED PRODUCER PROGRAM
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF WA INC.

LIFEWISE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 94188 )

Policy contract number

WA4001249999

Policy instance

Insurance contract or identification number	WA4001249999
Number of Individuals Covered	147
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
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	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 $146,112
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )

Policy contract number

4003509

Policy instance

Insurance contract or identification number	4003509
Number of Individuals Covered	155
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $52,555
Total amount of fees paid to insurance company	USD $454
Are there contracts with allocated funds for individual policies?	No
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 $669,491
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $52,555
Amount paid for insurance broker fees	454
Additional information about fees paid to insurance broker	PREFERRED PRODUCER PROGRAM
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF WA INC. - SEATTLE

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Company Name:	SEATTLE AUTO MANAGEMENT DBA
Employer identification number (EIN):	453663003
NAIC Classification:	441110
NAIC Description:	New Car Dealers