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| Plan Name | VSP VISION |
| Plan identification number | 503 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | KIVA BRANDS INC. |
| Employer identification number (EIN): | 471787822 |
| NAIC Classification: | 541990 |
| NAIC Description: | All Other Professional, Scientific, and Technical Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 503 | 2020-01-01 | CATHERINE GONZALEZ | 2021-10-04 |
| Measure | Date | Value |
|---|---|---|
| 2020: VSP VISION 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-01-01 | 104 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 175 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 175 |
| Number of employers contributing to the scheme | 2020-01-01 | 0 |
| 2020: VSP VISION 2020 form 5500 responses | ||
|---|---|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | First time form 5500 has been submitted | Yes |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 30056208 |
| Policy instance | 1 |
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