401k Plan data: KIA GEORGIA, INC. EMPLOYEE WELFARE BENEFIT PLAN plan

KIA GEORGIA, INC. EMPLOYEE WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	KIA GEORGIA, INC. EMPLOYEE WELFARE BENEFIT PLAN
Plan identification number	501

KIA GEORGIA, INC. EMPLOYEE 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 Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

KIA GEORGIA, INC. has sponsored the creation of one or more 401k plans.

Company Name: KIA GEORGIA, INC.

Employer identification number (EIN): 205762938

NAIC Classification: 336100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KIA GEORGIA, INC. EMPLOYEE WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2024-01-01 ALLISON MIMS
501 2023-01-01
501 2023-01-01 WENDY BEARD
501 2022-01-01
501 2022-01-01 WENDY BEARD
501 2021-01-01
501 2021-01-01 WENDY BEARD

Form 5500 Responses for KIA GEORGIA, INC. EMPLOYEE WELFARE BENEFIT PLAN

2023: KIA GEORGIA, INC. EMPLOYEE WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2022: KIA GEORGIA, INC. EMPLOYEE WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: KIA GEORGIA, INC. EMPLOYEE WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	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

942558

Policy instance

Insurance contract or identification number	942558
Number of Individuals Covered	2931
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $27,751
Total amount of fees paid to insurance company	USD $10,000
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $2,680,288
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )

Policy contract number

GA8374

Policy instance

Insurance contract or identification number	GA8374
Number of Individuals Covered	6311
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $23,736
Total amount of fees paid to insurance company	USD $-22,954
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,545,840
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )

Policy contract number

GA8374

Policy instance

Insurance contract or identification number	GA8374
Number of Individuals Covered	6275
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $77,677
Total amount of fees paid to insurance company	USD $-75,120
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	COBRA SERVICES
Welfare Benefit Premiums Paid to Carrier	USD $8,331,538
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

942558

Policy instance

Insurance contract or identification number	942558
Number of Individuals Covered	2795
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $26,106
Total amount of fees paid to insurance company	USD $15,000
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $2,389,723
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )

Policy contract number

GA8374

Policy instance

Insurance contract or identification number	GA8374
Number of Individuals Covered	6170
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $30,430
Total amount of fees paid to insurance company	USD $46,632
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,423,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )

Policy contract number

GA8374

Policy instance

Insurance contract or identification number	GA8374
Number of Individuals Covered	6090
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $65,933
Total amount of fees paid to insurance company	USD $101,039
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	COBRA SERVICES
Welfare Benefit Premiums Paid to Carrier	USD $5,249,970
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

942558

Policy instance

BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )

Policy contract number

GA8374

Policy instance

BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )

Policy contract number

GA8374

Policy instance

GREATER GEORGIA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97217 )

Policy contract number

GA1986

Policy instance

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Company Name:	KIA GEORGIA, INC.
Employer identification number (EIN):	205762938
NAIC Classification:	336100

Plan id#	Filing Submission Date	Name of Administrator
501	2024-01-01	ALLISON MIMS
501	2023-01-01
501	2023-01-01	WENDY BEARD
501	2022-01-01
501	2022-01-01	WENDY BEARD
501	2021-01-01
501	2021-01-01	WENDY BEARD