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LIFE INSURANCE AND AD&D INSURANCE 401k Plan overview

Plan NameLIFE INSURANCE AND AD&D INSURANCE
Plan identification number 501

LIFE INSURANCE AND AD&D INSURANCE Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance

401k Sponsoring company profile

EMPORIA WHOLESALE COFFEE COMPANY has sponsored the creation of one or more 401k plans.

Company Name:EMPORIA WHOLESALE COFFEE COMPANY
Employer identification number (EIN):480209630
NAIC Classification:424400

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LIFE INSURANCE AND AD&D INSURANCE

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012017-01-01DAVID C. EVANS
5012016-01-01DAVID C. EVANS
5012015-01-01DAVID C. EVANS
5012014-01-01DAVID C. EVANS
5012013-01-01DAVID C. EVANS
5012012-01-01DAVID C. EVANS
5012011-01-01DAVID C. EVANS
5012009-01-01DAVID C. EVANS

Plan Statistics for LIFE INSURANCE AND AD&D INSURANCE

401k plan membership statisitcs for LIFE INSURANCE AND AD&D INSURANCE

Measure Date Value
2022: LIFE INSURANCE AND AD&D INSURANCE 2022 401k membership
Total participants, beginning-of-year2022-01-01124
Total number of active participants reported on line 7a of the Form 55002022-01-01118
Total of all active and inactive participants2022-01-01118
2021: LIFE INSURANCE AND AD&D INSURANCE 2021 401k membership
Total participants, beginning-of-year2021-01-01126
Total number of active participants reported on line 7a of the Form 55002021-01-01124
Total of all active and inactive participants2021-01-01124
2020: LIFE INSURANCE AND AD&D INSURANCE 2020 401k membership
Total participants, beginning-of-year2020-01-01120
Total number of active participants reported on line 7a of the Form 55002020-01-01126
Total of all active and inactive participants2020-01-01126
2019: LIFE INSURANCE AND AD&D INSURANCE 2019 401k membership
Total participants, beginning-of-year2019-01-01122
Total number of active participants reported on line 7a of the Form 55002019-01-01120
Total of all active and inactive participants2019-01-01120
2017: LIFE INSURANCE AND AD&D INSURANCE 2017 401k membership
Total participants, beginning-of-year2017-01-01130
Total number of active participants reported on line 7a of the Form 55002017-01-01123
Total of all active and inactive participants2017-01-01123
2016: LIFE INSURANCE AND AD&D INSURANCE 2016 401k membership
Total participants, beginning-of-year2016-01-01128
Total number of active participants reported on line 7a of the Form 55002016-01-01130
Total of all active and inactive participants2016-01-01130
2015: LIFE INSURANCE AND AD&D INSURANCE 2015 401k membership
Total participants, beginning-of-year2015-01-01123
Total number of active participants reported on line 7a of the Form 55002015-01-01128
Total of all active and inactive participants2015-01-01128
2014: LIFE INSURANCE AND AD&D INSURANCE 2014 401k membership
Total participants, beginning-of-year2014-01-01124
Total number of active participants reported on line 7a of the Form 55002014-01-01123
Total of all active and inactive participants2014-01-01123
2013: LIFE INSURANCE AND AD&D INSURANCE 2013 401k membership
Total participants, beginning-of-year2013-01-01134
Total number of active participants reported on line 7a of the Form 55002013-01-01124
Total of all active and inactive participants2013-01-01124
2012: LIFE INSURANCE AND AD&D INSURANCE 2012 401k membership
Total participants, beginning-of-year2012-01-01136
Total number of active participants reported on line 7a of the Form 55002012-01-01135
Total of all active and inactive participants2012-01-01135
Total participants2012-01-01135
2011: LIFE INSURANCE AND AD&D INSURANCE 2011 401k membership
Total participants, beginning-of-year2011-01-01143
Total number of active participants reported on line 7a of the Form 55002011-01-01136
Total of all active and inactive participants2011-01-01136
Total participants2011-01-01136
2009: LIFE INSURANCE AND AD&D INSURANCE 2009 401k membership
Total participants, beginning-of-year2009-01-01157
Total number of active participants reported on line 7a of the Form 55002009-01-01147
Total of all active and inactive participants2009-01-01147
Total participants2009-01-01147

Form 5500 Responses for LIFE INSURANCE AND AD&D INSURANCE

2022: LIFE INSURANCE AND AD&D INSURANCE 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: LIFE INSURANCE AND AD&D INSURANCE 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: LIFE INSURANCE AND AD&D INSURANCE 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: LIFE INSURANCE AND AD&D INSURANCE 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2017: LIFE INSURANCE AND AD&D INSURANCE 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: LIFE INSURANCE AND AD&D INSURANCE 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: LIFE INSURANCE AND AD&D INSURANCE 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: LIFE INSURANCE AND AD&D INSURANCE 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: LIFE INSURANCE AND AD&D INSURANCE 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: LIFE INSURANCE AND AD&D INSURANCE 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: LIFE INSURANCE AND AD&D INSURANCE 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: LIFE INSURANCE AND AD&D INSURANCE 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

ADVANCE INSURANCE COMPANY OF KANSAS (National Association of Insurance Commissioners NAIC id number: 12143 )
Policy contract number00096450
Policy instance 1
Insurance contract or identification number00096450
Number of Individuals Covered118
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,670
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ADVANCE INSURANCE COMPANY OF KANSAS (National Association of Insurance Commissioners NAIC id number: 12143 )
Policy contract number00096450
Policy instance 1
Insurance contract or identification number00096450
Number of Individuals Covered124
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,354
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ADVANCE INSURANCE COMPANY OF KANSAS (National Association of Insurance Commissioners NAIC id number: 12143 )
Policy contract number00096450
Policy instance 1
Insurance contract or identification number00096450
Number of Individuals Covered126
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,449
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ADVANCE INSURANCE COMPANY OF KANSAS (National Association of Insurance Commissioners NAIC id number: 12143 )
Policy contract number00096450
Policy instance 1
Insurance contract or identification number00096450
Number of Individuals Covered120
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,417
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ADVANCE INSURANCE COMPANY OF KANSAS (National Association of Insurance Commissioners NAIC id number: 12143 )
Policy contract number00096450
Policy instance 1
Insurance contract or identification number00096450
Number of Individuals Covered123
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,489
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameADVANCE INSURANCE COMPANY OF KANSAS
ADVANCE INSURANCE COMPANY OF KANSAS (National Association of Insurance Commissioners NAIC id number: 12143 )
Policy contract number00096450
Policy instance 1
Insurance contract or identification number00096450
Number of Individuals Covered130
Insurance policy start date2016-01-01
Insurance policy end date2016-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,453
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameADVANCE INSURANCE COMPANY OF KANSAS
ADVANCE INSURANCE COMPANY OF KANSAS (National Association of Insurance Commissioners NAIC id number: 12143 )
Policy contract number00096450
Policy instance 1
Insurance contract or identification number00096450
Number of Individuals Covered128
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,200
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameADVANCE INSURANCE COMPANY OF KANSAS
ADVANCE INSURANCE COMPANY OF KANSAS (National Association of Insurance Commissioners NAIC id number: 12143 )
Policy contract number00096450
Policy instance 1
Insurance contract or identification number00096450
Number of Individuals Covered123
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,020
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameADVANCE INSURANCE COMPANY OF KANSAS
ADVANCE INSURANCE COMPANY OF KANSAS (National Association of Insurance Commissioners NAIC id number: 12143 )
Policy contract number00096450
Policy instance 1
Insurance contract or identification number00096450
Number of Individuals Covered124
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,013
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameADVANCE INSURANCE COMPANY OF KANSAS
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010072524
Policy instance 1
Insurance contract or identification number000010072524
Number of Individuals Covered135
Insurance policy start date2012-01-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $330
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $2,552
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $330
Insurance broker organization code?3
Insurance broker nameIMA INC
ADVANCE INSURANCE COMPANY OF KANSAS (National Association of Insurance Commissioners NAIC id number: 12143 )
Policy contract number00096450
Policy instance 2
Insurance contract or identification number00096450
Number of Individuals Covered134
Insurance policy start date2012-09-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,058
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameADVANCE INSURANCE COMPANY OF KANSAS
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010072524
Policy instance 1
Insurance contract or identification number000010072524
Number of Individuals Covered136
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $501
Total amount of fees paid to insurance companyUSD $100
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,697
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010072524
Policy instance 1
Insurance contract or identification number000010072524
Number of Individuals Covered143
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $630
Total amount of fees paid to insurance companyUSD $109
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $4,975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $630
Amount paid for insurance broker fees109
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameIMA OF KANSAS INC

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