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| Plan Name | KOREAN COMMUNITY SERVICES HEALTH AND WELFARE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | KOREAN COMMUNITY SERVICES |
| Employer identification number (EIN): | 953245254 |
| NAIC Classification: | 624100 |
| NAIC Description: | Individual and Family Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2024-01-01 | ANNA KEIDERLING | |||
| 501 | 2023-09-01 | ||||
| 501 | 2023-09-01 | ANNA KEIDERLING | |||
| 501 | 2022-09-01 | ||||
| 501 | 2022-09-01 | ANNA KEIDERLING |
| 2023: KOREAN COMMUNITY SERVICES HEALTH AND WELFARE PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-09-01 | Type of plan entity | Single employer plan |
| 2023-09-01 | Submission has been amended | No |
| 2023-09-01 | This submission is the final filing | No |
| 2023-09-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2023-09-01 | Plan is a collectively bargained plan | No |
| 2023-09-01 | Plan funding arrangement – Insurance | Yes |
| 2023-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: KOREAN COMMUNITY SERVICES HEALTH AND WELFARE PLAN 2022 form 5500 responses | ||
| 2022-09-01 | Type of plan entity | Single employer plan |
| 2022-09-01 | First time form 5500 has been submitted | Yes |
| 2022-09-01 | Submission has been amended | No |
| 2022-09-01 | This submission is the final filing | No |
| 2022-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-09-01 | Plan is a collectively bargained plan | No |
| 2022-09-01 | Plan funding arrangement – Insurance | Yes |
| 2022-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | M2W86 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 331341 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 410261 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| HOLMAN FAMILY COUNSELING, INC. (National Association of Insurance Commissioners NAIC id number: 00000 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 19961 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 4 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 410261 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOLMAN FAMILY COUNSELING, INC. (National Association of Insurance Commissioners NAIC id number: 00000 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 19961 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 331341 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | M2W86 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 4 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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