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KOTIS DESIGN HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameKOTIS DESIGN HEALTH AND WELFARE PLAN
Plan identification number 501

KOTIS DESIGN HEALTH AND WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Death benefits (include travel accident but not life insurance)
  • 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

KOTIS DESIGN, LLC has sponsored the creation of one or more 401k plans.

Company Name:KOTIS DESIGN, LLC
Employer identification number (EIN):331071366
NAIC Classification:448190
NAIC Description:Other Clothing Stores

Additional information about KOTIS DESIGN, LLC

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division
Incorporation Date: 2003-10-01
Company Identification Number: 602329276
Legal Registered Office Address: 711 CAPITOL WAY S STE 204

OLYMPIA
United States of America (USA)
985011267

More information about KOTIS DESIGN, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KOTIS DESIGN HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-11-01JULI BURLESON2023-07-12
5012020-11-01JULI BURLESON2022-02-25
5012019-11-01JULI BURLESON2021-08-02
5012016-11-01
5012016-11-01JULI BURLESON2021-08-03
5012015-11-01NATALIE SCHERWIN

Plan Statistics for KOTIS DESIGN HEALTH AND WELFARE PLAN

401k plan membership statisitcs for KOTIS DESIGN HEALTH AND WELFARE PLAN

Measure Date Value
2021: KOTIS DESIGN HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-11-01148
Total number of active participants reported on line 7a of the Form 55002021-11-01185
Number of retired or separated participants receiving benefits2021-11-010
Number of other retired or separated participants entitled to future benefits2021-11-010
Total of all active and inactive participants2021-11-01185
Number of employers contributing to the scheme2021-11-010
2020: KOTIS DESIGN HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-11-01126
Total number of active participants reported on line 7a of the Form 55002020-11-01148
Number of retired or separated participants receiving benefits2020-11-010
Number of other retired or separated participants entitled to future benefits2020-11-010
Total of all active and inactive participants2020-11-01148
Number of employers contributing to the scheme2020-11-010
2019: KOTIS DESIGN HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-11-01119
Total number of active participants reported on line 7a of the Form 55002019-11-01126
Number of retired or separated participants receiving benefits2019-11-010
Number of other retired or separated participants entitled to future benefits2019-11-010
Total of all active and inactive participants2019-11-01126
Number of employers contributing to the scheme2019-11-010
2016: KOTIS DESIGN HEALTH AND WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-11-01108
Total number of active participants reported on line 7a of the Form 55002016-11-01113
Number of retired or separated participants receiving benefits2016-11-010
Number of other retired or separated participants entitled to future benefits2016-11-010
Total of all active and inactive participants2016-11-01113
Number of employers contributing to the scheme2016-11-010
2015: KOTIS DESIGN HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-11-01123
Total number of active participants reported on line 7a of the Form 55002015-11-01106
Number of retired or separated participants receiving benefits2015-11-012
Number of other retired or separated participants entitled to future benefits2015-11-010
Total of all active and inactive participants2015-11-01108

Form 5500 Responses for KOTIS DESIGN HEALTH AND WELFARE PLAN

2021: KOTIS DESIGN HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-11-01Type of plan entitySingle employer plan
2021-11-01Plan funding arrangement – InsuranceYes
2021-11-01Plan benefit arrangement – InsuranceYes
2020: KOTIS DESIGN HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-11-01Type of plan entitySingle employer plan
2020-11-01Plan funding arrangement – InsuranceYes
2020-11-01Plan benefit arrangement – InsuranceYes
2019: KOTIS DESIGN HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-11-01Type of plan entitySingle employer plan
2019-11-01Plan funding arrangement – InsuranceYes
2019-11-01Plan benefit arrangement – InsuranceYes
2016: KOTIS DESIGN HEALTH AND WELFARE PLAN 2016 form 5500 responses
2016-11-01Type of plan entitySingle employer plan
2016-11-01Submission has been amendedYes
2016-11-01Plan funding arrangement – InsuranceYes
2016-11-01Plan benefit arrangement – InsuranceYes
2015: KOTIS DESIGN HEALTH AND WELFARE PLAN 2015 form 5500 responses
2015-11-01Type of plan entitySingle employer plan
2015-11-01First time form 5500 has been submittedYes
2015-11-01Submission has been amendedNo
2015-11-01This submission is the final filingNo
2015-11-01This return/report is a short plan year return/report (less than 12 months)No
2015-11-01Plan is a collectively bargained planNo
2015-11-01Plan funding arrangement – InsuranceYes
2015-11-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 )
Policy contract number751217
Policy instance 2
REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 )
Policy contract number10019253
Policy instance 1
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number751215
Policy instance 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number751215
Policy instance 3
STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 )
Policy contract number751217
Policy instance 2
REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 )
Policy contract number10019253
Policy instance 1
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number751215
Policy instance 4
STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 )
Policy contract number751217
Policy instance 3
REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 )
Policy contract number10019253
Policy instance 1
WELLSPRING FAMILY SERVICES, EAP (National Association of Insurance Commissioners NAIC id number: 62419 )
Policy contract number00
Policy instance 2
WELLSPRING FAMILY SERVICES, EAP (National Association of Insurance Commissioners NAIC id number: 62419 )
Policy contract number00
Policy instance 3
REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 )
Policy contract number10019253
Policy instance 2
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract numberWA301011
Policy instance 1

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