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KTNA HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameKTNA HEALTH AND WELFARE PLAN
Plan identification number 503

KTNA HEALTH AND WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

KOTOBUKIYA TREVES, NORTH AMERICA has sponsored the creation of one or more 401k plans.

Company Name:KOTOBUKIYA TREVES, NORTH AMERICA
Employer identification number (EIN):680600082
NAIC Classification:336300

Form 5500 Filing Information

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

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032023-01-01ANDREIA MARQUES2024-07-12
5032022-01-01ANDREIA MARQUES2023-06-16
5032021-12-01ANDREIA MARQUES2022-10-14

Plan Statistics for KTNA HEALTH AND WELFARE PLAN

401k plan membership statisitcs for KTNA HEALTH AND WELFARE PLAN

Measure Date Value
2023: KTNA HEALTH AND WELFARE PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-01228
Total number of active participants reported on line 7a of the Form 55002023-01-01413
Number of retired or separated participants receiving benefits2023-01-010
Number of other retired or separated participants entitled to future benefits2023-01-010
Total of all active and inactive participants2023-01-01413
Number of employers contributing to the scheme2023-01-010
2022: KTNA HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01157
Total number of active participants reported on line 7a of the Form 55002022-01-01228
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01228
Number of employers contributing to the scheme2022-01-010
2021: KTNA HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-12-01100
Total number of active participants reported on line 7a of the Form 55002021-12-01157
Number of retired or separated participants receiving benefits2021-12-010
Number of other retired or separated participants entitled to future benefits2021-12-010
Total of all active and inactive participants2021-12-01157
Number of employers contributing to the scheme2021-12-010

Form 5500 Responses for KTNA HEALTH AND WELFARE PLAN

2023: KTNA HEALTH AND WELFARE PLAN 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – InsuranceYes
2022: KTNA HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: KTNA HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-12-01Type of plan entitySingle employer plan
2021-12-01First time form 5500 has been submittedYes
2021-12-01This return/report is a short plan year return/report (less than 12 months)Yes
2021-12-01Plan funding arrangement – InsuranceYes
2021-12-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number958140
Policy instance 1
Insurance contract or identification number958140
Number of Individuals Covered970
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $35,518
Total amount of fees paid to insurance companyUSD $44,117
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $385,616
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberVEAB100133
Policy instance 1
Insurance contract or identification numberVEAB100133
Number of Individuals Covered536
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $13,929
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $204,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,325
Amount paid for insurance broker fees0
Insurance broker organization code?3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberVEAB100133
Policy instance 1
Insurance contract or identification numberVEAB100133
Number of Individuals Covered157
Insurance policy start date2021-12-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $974
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $6,490
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $974
Amount paid for insurance broker fees0
Insurance broker organization code?3

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