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| Plan Name | KBS BUILDERS, INC. EMPLOYEE GROUP MEDICAL PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | KBS BUILDERS, INC. |
| Employer identification number (EIN): | 465213161 |
| NAIC Classification: | 321900 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2018-07-01 | MATT MOSHER | 2020-01-08 | MATT MOSHER | 2020-01-08 |
| 501 | 2018-07-01 | MATT MOSHER | 2020-01-08 | ||
| 501 | 2018-03-01 | DIANA PARSONS | 2019-12-06 | MATT MOSHER | 2019-12-06 |
| 501 | 2017-07-01 | MATTHEW MOSHER | 2019-04-03 |
| Measure | Date | Value |
|---|---|---|
| 2018: KBS BUILDERS, INC. EMPLOYEE GROUP MEDICAL PLAN 2018 401k membership | ||
| Total participants, beginning-of-year | 2018-07-01 | 99 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-07-01 | 100 |
| Total of all active and inactive participants | 2018-07-01 | 100 |
| Total participants, beginning-of-year | 2018-03-01 | 83 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-03-01 | 112 |
| Total of all active and inactive participants | 2018-03-01 | 112 |
| 2017: KBS BUILDERS, INC. EMPLOYEE GROUP MEDICAL PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-07-01 | 142 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-07-01 | 99 |
| Total of all active and inactive participants | 2017-07-01 | 99 |
| 2018: KBS BUILDERS, INC. EMPLOYEE GROUP MEDICAL PLAN 2018 form 5500 responses | ||
|---|---|---|
| 2018-07-01 | Type of plan entity | Single employer plan |
| 2018-07-01 | Plan funding arrangement – Insurance | Yes |
| 2018-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018-03-01 | Type of plan entity | Single employer plan |
| 2018-03-01 | First time form 5500 has been submitted | Yes |
| 2018-03-01 | Plan funding arrangement – Insurance | Yes |
| 2018-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: KBS BUILDERS, INC. EMPLOYEE GROUP MEDICAL PLAN 2017 form 5500 responses | ||
| 2017-07-01 | Type of plan entity | Single employer plan |
| 2017-07-01 | First time form 5500 has been submitted | Yes |
| 2017-07-01 | Plan funding arrangement – Insurance | Yes |
| 2017-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |||||||||||||||||||||||||
| Policy contract number | 00622981 | ||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||
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| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |||||||||||||||||||||||||
| Policy contract number | GL 146651 | ||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||
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