401k Plan data: KUMHO TIRE GROUP ANCILLARY BENEFITS plan

KUMHO TIRE GROUP ANCILLARY BENEFITS 401k Plan overview

Plan Name	KUMHO TIRE GROUP ANCILLARY BENEFITS
Plan identification number	502

KUMHO TIRE GROUP ANCILLARY BENEFITS Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

KUMHO TIRE GEORGIA has sponsored the creation of one or more 401k plans.

Company Name: KUMHO TIRE GEORGIA

Employer identification number (EIN): 261953088

NAIC Classification: 326200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KUMHO TIRE GROUP ANCILLARY BENEFITS

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2017-04-01 KATHERINE PAYNE
502 2016-04-01 KATHERINE PAYNE

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2017-04-01	KATHERINE PAYNE
502	2016-04-01	KATHERINE PAYNE

Plan Statistics for KUMHO TIRE GROUP ANCILLARY BENEFITS

401k plan membership statisitcs for KUMHO TIRE GROUP ANCILLARY BENEFITS

Measure Date Value
2017: KUMHO TIRE GROUP ANCILLARY BENEFITS 2017 401k membership
Total participants, beginning-of-year 2017-04-01 386
Total number of active participants reported on line 7a of the Form 5500 2017-04-01 0
Number of retired or separated participants receiving benefits 2017-04-01 0
Number of other retired or separated participants entitled to future benefits 2017-04-01 0
Total of all active and inactive participants 2017-04-01 0
2016: KUMHO TIRE GROUP ANCILLARY BENEFITS 2016 401k membership
Total participants, beginning-of-year 2016-04-01 209
Total number of active participants reported on line 7a of the Form 5500 2016-04-01 386
Number of retired or separated participants receiving benefits 2016-04-01 0
Number of other retired or separated participants entitled to future benefits 2016-04-01 0
Total of all active and inactive participants 2016-04-01 386

Measure	Date	Value
2017: KUMHO TIRE GROUP ANCILLARY BENEFITS 2017 401k membership
Total participants, beginning-of-year	2017-04-01	386
Total number of active participants reported on line 7a of the Form 5500	2017-04-01	0
Number of retired or separated participants receiving benefits	2017-04-01	0
Number of other retired or separated participants entitled to future benefits	2017-04-01	0
Total of all active and inactive participants	2017-04-01	0
2016: KUMHO TIRE GROUP ANCILLARY BENEFITS 2016 401k membership
Total participants, beginning-of-year	2016-04-01	209
Total number of active participants reported on line 7a of the Form 5500	2016-04-01	386
Number of retired or separated participants receiving benefits	2016-04-01	0
Number of other retired or separated participants entitled to future benefits	2016-04-01	0
Total of all active and inactive participants	2016-04-01	386

Form 5500 Responses for KUMHO TIRE GROUP ANCILLARY BENEFITS

2017: KUMHO TIRE GROUP ANCILLARY BENEFITS 2017 form 5500 responses
2017-04-01	Type of plan entity	Single employer plan
2017-04-01	Submission has been amended	No
2017-04-01	This submission is the final filing	Yes
2017-04-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2017-04-01	Plan is a collectively bargained plan	No
2017-04-01	Plan funding arrangement – Insurance	Yes
2017-04-01	Plan benefit arrangement – Insurance	Yes
2016: KUMHO TIRE GROUP ANCILLARY BENEFITS 2016 form 5500 responses
2016-04-01	Type of plan entity	Single employer plan
2016-04-01	First time form 5500 has been submitted	Yes
2016-04-01	Submission has been amended	No
2016-04-01	This submission is the final filing	No
2016-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-04-01	Plan is a collectively bargained plan	No
2016-04-01	Plan funding arrangement – Insurance	Yes
2016-04-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

1052781

Policy instance

Insurance contract or identification number	1052781
Number of Individuals Covered	375
Insurance policy start date	2017-04-01
Insurance policy end date	2017-10-31
Total amount of commissions paid to insurance broker	USD $8,782
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	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D
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 $58,845
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,782
Insurance broker organization code?	3
Insurance broker name	BB&T INSURANCE SERVICES, INC.

Potentially related plans

KUMHO TIRE U.S.A., INC. 401(K) PLAN [EIN = 952954744]

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Company Name:	KUMHO TIRE GEORGIA
Employer identification number (EIN):	261953088
NAIC Classification:	326200