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| Plan Name | KIM INTERNATIONAL CORPORATION HEALTH & WELFARE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | KIM INTERNATIONAL CORPORATION |
| Employer identification number (EIN): | 274213808 |
| NAIC Classification: | 423940 |
| NAIC Description: | Jewelry, Watch, Precious Stone, and Precious Metal Merchant Wholesalers |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2020-09-01 | RHIANA BARR | 2021-06-02 | ||
| 501 | 2019-09-01 | RHIANA BARR | 2021-01-27 | ||
| 501 | 2018-09-01 | CHRIS TEDFORD | 2020-02-26 |
| 2020: KIM INTERNATIONAL CORPORATION HEALTH & WELFARE PLAN 2020 form 5500 responses | ||
|---|---|---|
| 2020-09-01 | Type of plan entity | Single employer plan |
| 2020-09-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2020-09-01 | Plan funding arrangement – Insurance | Yes |
| 2020-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: KIM INTERNATIONAL CORPORATION HEALTH & WELFARE PLAN 2019 form 5500 responses | ||
| 2019-09-01 | Type of plan entity | Single employer plan |
| 2019-09-01 | Plan funding arrangement – Insurance | Yes |
| 2019-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: KIM INTERNATIONAL CORPORATION HEALTH & WELFARE PLAN 2018 form 5500 responses | ||
| 2018-09-01 | Type of plan entity | Single employer plan |
| 2018-09-01 | First time form 5500 has been submitted | Yes |
| 2018-09-01 | Plan funding arrangement – Insurance | Yes |
| 2018-09-01 | Plan benefit arrangement – Insurance | Yes |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) | |
| Policy contract number | 149879 |
| Policy instance | 1 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |
| Policy contract number | GLUG0BL7M |
| Policy instance | 2 |
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) | |
| Policy contract number | 281922 |
| Policy instance | 1 |
| BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 281922 |
| Policy instance | 1 |
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