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| Plan Name | KI BOIS COMMUNITY ACTION FOUNDATION EMPLOYEE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | KI BOIS COMMUNITY ACTION FOUNDATION, INC. |
| Employer identification number (EIN): | 730770231 |
| 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 | 2023-01-01 | TOM MARLATT | 2024-07-16 | ||
| 501 | 2022-01-01 | TOM MARLATT | 2023-07-19 | ||
| 501 | 2021-01-01 | TOM MARLATT | 2022-06-23 | ||
| 501 | 2020-01-01 | TOM MARLATT | 2021-08-24 | ||
| 501 | 2019-01-01 | TOM MARLATT | 2020-09-11 | ||
| 501 | 2018-01-01 | TOM MARLATT | 2019-10-01 | ||
| 501 | 2017-01-01 | TOM MARLATT | 2019-10-01 |
| 2023: KI BOIS COMMUNITY ACTION FOUNDATION EMPLOYEE BENEFIT PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022: KI BOIS COMMUNITY ACTION FOUNDATION EMPLOYEE BENEFIT PLAN 2022 form 5500 responses | ||
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: KI BOIS COMMUNITY ACTION FOUNDATION EMPLOYEE BENEFIT PLAN 2021 form 5500 responses | ||
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: KI BOIS COMMUNITY ACTION FOUNDATION EMPLOYEE BENEFIT PLAN 2020 form 5500 responses | ||
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: KI BOIS COMMUNITY ACTION FOUNDATION EMPLOYEE BENEFIT PLAN 2019 form 5500 responses | ||
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: KI BOIS COMMUNITY ACTION FOUNDATION EMPLOYEE BENEFIT PLAN 2018 form 5500 responses | ||
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: KI BOIS COMMUNITY ACTION FOUNDATION EMPLOYEE BENEFIT PLAN 2017 form 5500 responses | ||
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | First time form 5500 has been submitted | Yes |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| MONY (National Association of Insurance Commissioners NAIC id number: 78077 ) | |||||||||||||||||||||||
| Policy contract number | 006923 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
| |||||||||||||||||||||||
| MONY (National Association of Insurance Commissioners NAIC id number: 78077 ) | |||||||||||||||||||||||
| Policy contract number | 006923 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
| |||||||||||||||||||||||
| MONY (National Association of Insurance Commissioners NAIC id number: 78077 ) | |||||||||||||||||||||||
| Policy contract number | 006923 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |||||||||||||||||||||||
| Policy contract number | 00535085 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
| MONY (National Association of Insurance Commissioners NAIC id number: 78077 ) | |||||||||||||||||||||||
| Policy contract number | 006923 | ||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |||||||||||||||||||||||
| Policy contract number | 00535085 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |||||||||||||||||||||||
| Policy contract number | 00535085 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |||||||||||||||||||||||
| Policy contract number | 00535085 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
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