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| Plan Name | KOTIS DESIGN HEALTH AND WELFARE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| 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
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2021-11-01 | JULI BURLESON | 2023-07-12 | ||
| 501 | 2020-11-01 | JULI BURLESON | 2022-02-25 | ||
| 501 | 2019-11-01 | JULI BURLESON | 2021-08-02 | ||
| 501 | 2016-11-01 | ||||
| 501 | 2016-11-01 | JULI BURLESON | 2021-08-03 | ||
| 501 | 2015-11-01 | NATALIE SCHERWIN |
| Measure | Date | Value |
|---|---|---|
| 2021: KOTIS DESIGN HEALTH AND WELFARE PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-11-01 | 148 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-11-01 | 185 |
| Number of retired or separated participants receiving benefits | 2021-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-11-01 | 0 |
| Total of all active and inactive participants | 2021-11-01 | 185 |
| Number of employers contributing to the scheme | 2021-11-01 | 0 |
| 2020: KOTIS DESIGN HEALTH AND WELFARE PLAN 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-11-01 | 126 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-11-01 | 148 |
| Number of retired or separated participants receiving benefits | 2020-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-11-01 | 0 |
| Total of all active and inactive participants | 2020-11-01 | 148 |
| Number of employers contributing to the scheme | 2020-11-01 | 0 |
| 2019: KOTIS DESIGN HEALTH AND WELFARE PLAN 2019 401k membership | ||
| Total participants, beginning-of-year | 2019-11-01 | 119 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-11-01 | 126 |
| Number of retired or separated participants receiving benefits | 2019-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-11-01 | 0 |
| Total of all active and inactive participants | 2019-11-01 | 126 |
| Number of employers contributing to the scheme | 2019-11-01 | 0 |
| 2016: KOTIS DESIGN HEALTH AND WELFARE PLAN 2016 401k membership | ||
| Total participants, beginning-of-year | 2016-11-01 | 108 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-11-01 | 113 |
| Number of retired or separated participants receiving benefits | 2016-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-11-01 | 0 |
| Total of all active and inactive participants | 2016-11-01 | 113 |
| Number of employers contributing to the scheme | 2016-11-01 | 0 |
| 2015: KOTIS DESIGN HEALTH AND WELFARE PLAN 2015 401k membership | ||
| Total participants, beginning-of-year | 2015-11-01 | 123 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-11-01 | 106 |
| Number of retired or separated participants receiving benefits | 2015-11-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2015-11-01 | 0 |
| Total of all active and inactive participants | 2015-11-01 | 108 |
| 2021: KOTIS DESIGN HEALTH AND WELFARE PLAN 2021 form 5500 responses | ||
|---|---|---|
| 2021-11-01 | Type of plan entity | Single employer plan |
| 2021-11-01 | Plan funding arrangement – Insurance | Yes |
| 2021-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: KOTIS DESIGN HEALTH AND WELFARE PLAN 2020 form 5500 responses | ||
| 2020-11-01 | Type of plan entity | Single employer plan |
| 2020-11-01 | Plan funding arrangement – Insurance | Yes |
| 2020-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: KOTIS DESIGN HEALTH AND WELFARE PLAN 2019 form 5500 responses | ||
| 2019-11-01 | Type of plan entity | Single employer plan |
| 2019-11-01 | Plan funding arrangement – Insurance | Yes |
| 2019-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: KOTIS DESIGN HEALTH AND WELFARE PLAN 2016 form 5500 responses | ||
| 2016-11-01 | Type of plan entity | Single employer plan |
| 2016-11-01 | Submission has been amended | Yes |
| 2016-11-01 | Plan funding arrangement – Insurance | Yes |
| 2016-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: KOTIS DESIGN HEALTH AND WELFARE PLAN 2015 form 5500 responses | ||
| 2015-11-01 | Type of plan entity | Single employer plan |
| 2015-11-01 | First time form 5500 has been submitted | Yes |
| 2015-11-01 | Submission has been amended | No |
| 2015-11-01 | This submission is the final filing | No |
| 2015-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-11-01 | Plan is a collectively bargained plan | No |
| 2015-11-01 | Plan funding arrangement – Insurance | Yes |
| 2015-11-01 | Plan benefit arrangement – Insurance | Yes |
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) | |
| Policy contract number | 751217 |
| Policy instance | 2 |
| REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 ) | |
| Policy contract number | 10019253 |
| Policy instance | 1 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 751215 |
| Policy instance | 3 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 751215 |
| Policy instance | 3 |
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) | |
| Policy contract number | 751217 |
| Policy instance | 2 |
| REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 ) | |
| Policy contract number | 10019253 |
| Policy instance | 1 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 751215 |
| Policy instance | 4 |
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) | |
| Policy contract number | 751217 |
| Policy instance | 3 |
| REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 ) | |
| Policy contract number | 10019253 |
| Policy instance | 1 |
| WELLSPRING FAMILY SERVICES, EAP (National Association of Insurance Commissioners NAIC id number: 62419 ) | |
| Policy contract number | 00 |
| Policy instance | 2 |
| WELLSPRING FAMILY SERVICES, EAP (National Association of Insurance Commissioners NAIC id number: 62419 ) | |
| Policy contract number | 00 |
| Policy instance | 3 |
| REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 ) | |
| Policy contract number | 10019253 |
| Policy instance | 2 |
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) | |
| Policy contract number | WA301011 |
| Policy instance | 1 |