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| Plan Name | MOBIS WELFARE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | MOBIS PARTS AMERICA LLC |
| Employer identification number (EIN): | 200262739 |
| NAIC Classification: | 441300 |
| NAIC Description: | Automotive Parts, Accessories, and Tire Stores |
Additional information about MOBIS PARTS AMERICA LLC
| Jurisdiction of Incorporation: | State of Delaware Division of Corporations |
| Incorporation Date: | |
| Company Identification Number: | 3709264 |
More information about MOBIS PARTS AMERICA LLC
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2021-08-01 | ||||
| 501 | 2009-01-01 | SHERRY THOMAS | |||
| 501 | 2009-01-01 | SHERRY THOMAS | |||
| 501 | 2009-01-01 | SHERRY THOMAS | |||
| 501 | 2009-01-01 | SHERRY THOMAS |
| Measure | Date | Value |
|---|---|---|
| 2021: MOBIS WELFARE BENEFIT PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-08-01 | 750 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-08-01 | 814 |
| Total of all active and inactive participants | 2021-08-01 | 814 |
| Total participants | 2021-08-01 | 814 |
| 2009: MOBIS WELFARE BENEFIT PLAN 2009 401k membership | ||
| Total participants, beginning-of-year | 2009-01-01 | 87 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 298 |
| Total of all active and inactive participants | 2009-01-01 | 298 |
| Total participants | 2009-01-01 | 298 |
| 2021: MOBIS WELFARE BENEFIT PLAN 2021 form 5500 responses | ||
|---|---|---|
| 2021-08-01 | Type of plan entity | Single employer plan |
| 2021-08-01 | This submission is the final filing | Yes |
| 2021-08-01 | Plan funding arrangement – Insurance | Yes |
| 2021-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: MOBIS WELFARE BENEFIT PLAN 2009 form 5500 responses | ||
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | First time form 5500 has been submitted | Yes |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 ) | |||||||||||||||||||||||||||||
| Policy contract number | L03420 | ||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||
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| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) | |||||||||||||||||||||||||||||
| Policy contract number | 275186 | ||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||
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| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) | |||||||||||||||||||||||||||||
| Policy contract number | 275186 | ||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||
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