401k Plan data: SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT plan

SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 401k Plan overview

Plan Name	SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT
Plan identification number	502

SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

MERCEDES-BENZ USA, LLC has sponsored the creation of one or more 401k plans.

Company Name: MERCEDES-BENZ USA, LLC

Employer identification number (EIN): 222375138

NAIC Classification: 423100

Additional information about MERCEDES-BENZ USA, LLC

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2000-06-07

Company Identification Number: 0706961523

Legal Registered Office Address: 1 MERCEDES BENZ DR

SANDY SPRINGS
United States of America (USA)
30328

More information about MERCEDES-BENZ USA, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2017-01-01
502 2017-01-01 STEVEN SLIWICKI 2019-12-10
502 2016-01-01
502 2015-01-01
502 2015-01-01
502 2014-01-01 VALERIE ROSS
502 2013-01-01 MARYANNE DILLON
502 2012-01-01 MARYANNE DILLON
502 2011-01-01 MARYANNE DILLON
502 2009-01-01 MARYANNE DILLON

Plan Statistics for SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT

401k plan membership statisitcs for SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT

Measure Date Value
2017: SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2017 401k membership
Total participants, beginning-of-year 2017-01-01 5,927
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 0
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 0
Total participants 2017-01-01 0
2016: SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2016 401k membership
Total participants, beginning-of-year 2016-01-01 3,407
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 3,717
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 3,717
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 3,717
2015: SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1,592
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1,685
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 1,685
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 1,685
2014: SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2014 401k membership
Total participants, beginning-of-year 2014-01-01 1,584
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 1,592
Total of all active and inactive participants 2014-01-01 1,592
Total participants 2014-01-01 1,592
2013: SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2013 401k membership
Total participants, beginning-of-year 2013-01-01 1,544
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 1,584
Total of all active and inactive participants 2013-01-01 1,584
Total participants 2013-01-01 1,584
2012: SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1,486
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1,544
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 1,544
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 1,544
2011: SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,475
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1,486
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 1,486
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 1,486
2009: SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1,617
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1,521
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 1,521
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 1,521

Measure	Date	Value
2017: SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2017 401k membership
Total participants, beginning-of-year	2017-01-01	5,927
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	0
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	0
Total participants	2017-01-01	0
2016: SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2016 401k membership
Total participants, beginning-of-year	2016-01-01	3,407
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	3,717
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	3,717
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	3,717
2015: SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,592
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1,685
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	1,685
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	1,685
2014: SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2014 401k membership
Total participants, beginning-of-year	2014-01-01	1,584
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1,592
Total of all active and inactive participants	2014-01-01	1,592
Total participants	2014-01-01	1,592
2013: SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2013 401k membership
Total participants, beginning-of-year	2013-01-01	1,544
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	1,584
Total of all active and inactive participants	2013-01-01	1,584
Total participants	2013-01-01	1,584
2012: SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1,486
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1,544
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	1,544
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	1,544
2011: SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,475
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1,486
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	1,486
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	1,486
2009: SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,617
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,521
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	1,521
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	1,521

Form 5500 Responses for SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT

2017: SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 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: SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 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: SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
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
2014: SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: SUPPLEMENTAL LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	66788
Policy instance	1
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	66788
Policy instance	1
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	066788
Policy instance	1
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	066788
Policy instance	1
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	066788
Policy instance	1
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	066788
Policy instance	1
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number	066788
Policy instance	1

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Company Name:	MERCEDES-BENZ USA, LLC
Employer identification number (EIN):	222375138
NAIC Classification:	423100

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2000-06-07
Company Identification Number:	0706961523
Legal Registered Office Address:	1 MERCEDES BENZ DR SANDY SPRINGS United States of America (USA) 30328

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
502	2017-01-01
502	2017-01-01	STEVEN SLIWICKI	2019-12-10
502	2016-01-01
502	2015-01-01
502	2015-01-01
502	2014-01-01	VALERIE ROSS
502	2013-01-01	MARYANNE DILLON
502	2012-01-01	MARYANNE DILLON
502	2011-01-01	MARYANNE DILLON
502	2009-01-01	MARYANNE DILLON