401k Plan data: SYSTEMS AUTOMOTIVE INTERIORS, LLC WELFARE BENEFIT PLAN plan

SYSTEMS AUTOMOTIVE INTERIORS, LLC WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	SYSTEMS AUTOMOTIVE INTERIORS, LLC WELFARE BENEFIT PLAN
Plan identification number	501

SYSTEMS AUTOMOTIVE INTERIORS, LLC WELFARE BENEFIT 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
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.
Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

SYSTEMS AUTOMOTIVE INTERIORS, LLC has sponsored the creation of one or more 401k plans.

Company Name: SYSTEMS AUTOMOTIVE INTERIORS, LLC

Employer identification number (EIN): 452901746

NAIC Classification: 336300

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SYSTEMS AUTOMOTIVE INTERIORS, LLC WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-10-01
501 2017-10-01
501 2016-10-01 JOSHUA ASHAKA JOSHUA ASHAKA 2018-05-03
501 2015-10-01 JOSHUA ASHAKA JOSHUA ASHAKA 2017-07-14
501 2014-10-01 JOSHUA ASHAKA JOSHUA ASHAKA 2016-07-11

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2021-10-01
501	2017-10-01
501	2016-10-01	JOSHUA ASHAKA	JOSHUA ASHAKA	2018-05-03
501	2015-10-01	JOSHUA ASHAKA	JOSHUA ASHAKA	2017-07-14
501	2014-10-01	JOSHUA ASHAKA	JOSHUA ASHAKA	2016-07-11

Plan Statistics for SYSTEMS AUTOMOTIVE INTERIORS, LLC WELFARE BENEFIT PLAN

401k plan membership statisitcs for SYSTEMS AUTOMOTIVE INTERIORS, LLC WELFARE BENEFIT PLAN

Measure Date Value
2021: SYSTEMS AUTOMOTIVE INTERIORS, LLC WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-10-01 154
Total number of active participants reported on line 7a of the Form 5500 2021-10-01 197
Number of retired or separated participants receiving benefits 2021-10-01 0
Number of other retired or separated participants entitled to future benefits 2021-10-01 0
Total of all active and inactive participants 2021-10-01 197
2017: SYSTEMS AUTOMOTIVE INTERIORS, LLC WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-10-01 111
Total number of active participants reported on line 7a of the Form 5500 2017-10-01 95
Number of retired or separated participants receiving benefits 2017-10-01 0
Number of other retired or separated participants entitled to future benefits 2017-10-01 0
Total of all active and inactive participants 2017-10-01 95
2016: SYSTEMS AUTOMOTIVE INTERIORS, LLC WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-10-01 119
Total number of active participants reported on line 7a of the Form 5500 2016-10-01 105
Number of retired or separated participants receiving benefits 2016-10-01 0
Number of other retired or separated participants entitled to future benefits 2016-10-01 0
Total of all active and inactive participants 2016-10-01 105
2015: SYSTEMS AUTOMOTIVE INTERIORS, LLC WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-10-01 124
Total number of active participants reported on line 7a of the Form 5500 2015-10-01 119
Number of retired or separated participants receiving benefits 2015-10-01 0
Number of other retired or separated participants entitled to future benefits 2015-10-01 0
Total of all active and inactive participants 2015-10-01 119
2014: SYSTEMS AUTOMOTIVE INTERIORS, LLC WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-10-01 121
Total number of active participants reported on line 7a of the Form 5500 2014-10-01 118
Total of all active and inactive participants 2014-10-01 118

Measure	Date	Value
2021: SYSTEMS AUTOMOTIVE INTERIORS, LLC WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-10-01	154
Total number of active participants reported on line 7a of the Form 5500	2021-10-01	197
Number of retired or separated participants receiving benefits	2021-10-01	0
Number of other retired or separated participants entitled to future benefits	2021-10-01	0
Total of all active and inactive participants	2021-10-01	197
2017: SYSTEMS AUTOMOTIVE INTERIORS, LLC WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-10-01	111
Total number of active participants reported on line 7a of the Form 5500	2017-10-01	95
Number of retired or separated participants receiving benefits	2017-10-01	0
Number of other retired or separated participants entitled to future benefits	2017-10-01	0
Total of all active and inactive participants	2017-10-01	95
2016: SYSTEMS AUTOMOTIVE INTERIORS, LLC WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-10-01	119
Total number of active participants reported on line 7a of the Form 5500	2016-10-01	105
Number of retired or separated participants receiving benefits	2016-10-01	0
Number of other retired or separated participants entitled to future benefits	2016-10-01	0
Total of all active and inactive participants	2016-10-01	105
2015: SYSTEMS AUTOMOTIVE INTERIORS, LLC WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-10-01	124
Total number of active participants reported on line 7a of the Form 5500	2015-10-01	119
Number of retired or separated participants receiving benefits	2015-10-01	0
Number of other retired or separated participants entitled to future benefits	2015-10-01	0
Total of all active and inactive participants	2015-10-01	119
2014: SYSTEMS AUTOMOTIVE INTERIORS, LLC WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-10-01	121
Total number of active participants reported on line 7a of the Form 5500	2014-10-01	118
Total of all active and inactive participants	2014-10-01	118

Form 5500 Responses for SYSTEMS AUTOMOTIVE INTERIORS, LLC WELFARE BENEFIT PLAN

2021: SYSTEMS AUTOMOTIVE INTERIORS, LLC WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-10-01	Type of plan entity	Single employer plan
2021-10-01	Submission has been amended	No
2021-10-01	This submission is the final filing	No
2021-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-10-01	Plan is a collectively bargained plan	No
2021-10-01	Plan funding arrangement – Insurance	Yes
2021-10-01	Plan benefit arrangement – Insurance	Yes
2017: SYSTEMS AUTOMOTIVE INTERIORS, LLC WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-10-01	Type of plan entity	Single employer plan
2017-10-01	Submission has been amended	No
2017-10-01	This submission is the final filing	No
2017-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-10-01	Plan is a collectively bargained plan	No
2017-10-01	Plan funding arrangement – Insurance	Yes
2017-10-01	Plan benefit arrangement – Insurance	Yes
2016: SYSTEMS AUTOMOTIVE INTERIORS, LLC WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-10-01	Type of plan entity	Single employer plan
2016-10-01	Submission has been amended	No
2016-10-01	This submission is the final filing	No
2016-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-10-01	Plan is a collectively bargained plan	No
2016-10-01	Plan funding arrangement – Insurance	Yes
2016-10-01	Plan benefit arrangement – Insurance	Yes
2015: SYSTEMS AUTOMOTIVE INTERIORS, LLC WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-10-01	Type of plan entity	Single employer plan
2015-10-01	Submission has been amended	No
2015-10-01	This submission is the final filing	No
2015-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-10-01	Plan is a collectively bargained plan	No
2015-10-01	Plan funding arrangement – Insurance	Yes
2015-10-01	Plan benefit arrangement – Insurance	Yes
2014: SYSTEMS AUTOMOTIVE INTERIORS, LLC WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-10-01	Type of plan entity	Single employer plan
2014-10-01	Submission has been amended	No
2014-10-01	This submission is the final filing	No
2014-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-10-01	Plan is a collectively bargained plan	No
2014-10-01	Plan funding arrangement – Insurance	Yes
2014-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF MS, INC. (National Association of Insurance Commissioners NAIC id number: 60111 )

Policy contract number

043773

Policy instance

Insurance contract or identification number	043773
Number of Individuals Covered	359
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $55,950
Total amount of fees paid to insurance company	USD $0
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 $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55,950
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E3834025

Policy instance

Insurance contract or identification number	E3834025
Number of Individuals Covered	93
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $17,413
Total amount of fees paid to insurance company	USD $2,865
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
Other welfare benefits provided	ACCIDENT, CANCER & CRITICAL ILLNESS
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 $76,024
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,690
Insurance broker organization code?	3
Amount paid for insurance broker fees	1009
Additional information about fees paid to insurance broker	FEES PAID

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1068082

Policy instance

Insurance contract or identification number	1068082
Number of Individuals Covered	349
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $29,632
Total amount of fees paid to insurance company	USD $2,163
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	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
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 $198,319
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,199
Amount paid for insurance broker fees	2163
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1068082

Policy instance

Insurance contract or identification number	1068082
Number of Individuals Covered	211
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $21,092
Total amount of fees paid to insurance company	USD $355
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $137,545
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E3834025

Policy instance

Insurance contract or identification number	E3834025
Number of Individuals Covered	73
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $8,740
Total amount of fees paid to insurance company	USD $1,979
Other welfare benefits provided	ACCIDENT, CANCER & CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $51,583
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

5W5135

Policy instance

Insurance contract or identification number	5W5135
Number of Individuals Covered	220
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $40,544
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $810,886
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	SYSTEMS AUTOMOTIVE INTERIORS, LLC
Employer identification number (EIN):	452901746
NAIC Classification:	336300