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COPPERSTATE FARMS MANAGEMENT LLC WELFARE BENEFIT PLAN 401k Plan overview

Plan NameCOPPERSTATE FARMS MANAGEMENT LLC WELFARE BENEFIT PLAN
Plan identification number 501

COPPERSTATE FARMS MANAGEMENT LLC WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

COPPERSTATE FARMS MANAGEMENT LLC has sponsored the creation of one or more 401k plans.

Company Name:COPPERSTATE FARMS MANAGEMENT LLC
Employer identification number (EIN):320503605
NAIC Classification:325410

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COPPERSTATE FARMS MANAGEMENT LLC WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-12-01ERICA DRISKELL2023-03-24
5012020-12-01ERICA DRISKELL2022-03-23
5012019-12-01SIOBAHN CARRAGHER2021-04-22
5012018-12-01
5012017-12-01

Plan Statistics for COPPERSTATE FARMS MANAGEMENT LLC WELFARE BENEFIT PLAN

401k plan membership statisitcs for COPPERSTATE FARMS MANAGEMENT LLC WELFARE BENEFIT PLAN

Measure Date Value
2021: COPPERSTATE FARMS MANAGEMENT LLC WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-12-01231
Total number of active participants reported on line 7a of the Form 55002021-12-01616
Number of retired or separated participants receiving benefits2021-12-010
Number of other retired or separated participants entitled to future benefits2021-12-010
Total of all active and inactive participants2021-12-01616
Number of employers contributing to the scheme2021-12-010
2020: COPPERSTATE FARMS MANAGEMENT LLC WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-12-01274
Total number of active participants reported on line 7a of the Form 55002020-12-01231
Number of retired or separated participants receiving benefits2020-12-010
Number of other retired or separated participants entitled to future benefits2020-12-010
Total of all active and inactive participants2020-12-01231
Number of employers contributing to the scheme2020-12-010
2019: COPPERSTATE FARMS MANAGEMENT LLC WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-12-01233
Total number of active participants reported on line 7a of the Form 55002019-12-01273
Number of retired or separated participants receiving benefits2019-12-011
Number of other retired or separated participants entitled to future benefits2019-12-010
Total of all active and inactive participants2019-12-01274
Number of employers contributing to the scheme2019-12-010
2018: COPPERSTATE FARMS MANAGEMENT LLC WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-12-01171
Total number of active participants reported on line 7a of the Form 55002018-12-01232
Number of retired or separated participants receiving benefits2018-12-012
Number of other retired or separated participants entitled to future benefits2018-12-010
Total of all active and inactive participants2018-12-01234
2017: COPPERSTATE FARMS MANAGEMENT LLC WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-12-01161
Total number of active participants reported on line 7a of the Form 55002017-12-01183
Number of retired or separated participants receiving benefits2017-12-012
Number of other retired or separated participants entitled to future benefits2017-12-010
Total of all active and inactive participants2017-12-01185

Form 5500 Responses for COPPERSTATE FARMS MANAGEMENT LLC WELFARE BENEFIT PLAN

2021: COPPERSTATE FARMS MANAGEMENT LLC WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-12-01Type of plan entitySingle employer plan
2021-12-01Plan funding arrangement – InsuranceYes
2021-12-01Plan funding arrangement – General assets of the sponsorYes
2021-12-01Plan benefit arrangement – InsuranceYes
2021-12-01Plan benefit arrangement – General assets of the sponsorYes
2020: COPPERSTATE FARMS MANAGEMENT LLC WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-12-01Type of plan entitySingle employer plan
2020-12-01Plan funding arrangement – InsuranceYes
2020-12-01Plan funding arrangement – General assets of the sponsorYes
2020-12-01Plan benefit arrangement – InsuranceYes
2020-12-01Plan benefit arrangement – General assets of the sponsorYes
2019: COPPERSTATE FARMS MANAGEMENT LLC WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-12-01Type of plan entitySingle employer plan
2019-12-01Plan funding arrangement – InsuranceYes
2019-12-01Plan funding arrangement – General assets of the sponsorYes
2019-12-01Plan benefit arrangement – InsuranceYes
2019-12-01Plan benefit arrangement – General assets of the sponsorYes
2018: COPPERSTATE FARMS MANAGEMENT LLC WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-12-01Type of plan entitySingle employer plan
2018-12-01Submission has been amendedNo
2018-12-01This submission is the final filingNo
2018-12-01This return/report is a short plan year return/report (less than 12 months)No
2018-12-01Plan is a collectively bargained planNo
2018-12-01Plan funding arrangement – InsuranceYes
2018-12-01Plan funding arrangement – General assets of the sponsorYes
2018-12-01Plan benefit arrangement – InsuranceYes
2018-12-01Plan benefit arrangement – General assets of the sponsorYes
2017: COPPERSTATE FARMS MANAGEMENT LLC WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-12-01Type of plan entitySingle employer plan
2017-12-01First time form 5500 has been submittedYes
2017-12-01Submission has been amendedNo
2017-12-01This submission is the final filingNo
2017-12-01This return/report is a short plan year return/report (less than 12 months)No
2017-12-01Plan is a collectively bargained planNo
2017-12-01Plan funding arrangement – InsuranceYes
2017-12-01Plan funding arrangement – General assets of the sponsorYes
2017-12-01Plan benefit arrangement – InsuranceYes
2017-12-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number309340
Policy instance 1
Insurance contract or identification number309340
Number of Individuals Covered616
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Total amount of commissions paid to insurance brokerUSD $36,134
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $290,403
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,134
Amount paid for insurance broker fees0
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30106190
Policy instance 2
Insurance contract or identification number30106190
Number of Individuals Covered303
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Total amount of commissions paid to insurance brokerUSD $4,896
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $48,874
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,896
Amount paid for insurance broker fees0
Insurance broker organization code?3
DELTA DENTAL OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53597 )
Policy contract number1002
Policy instance 3
Insurance contract or identification number1002
Number of Individuals Covered638
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Total amount of commissions paid to insurance brokerUSD $19,392
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,392
Amount paid for insurance broker fees0
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number903367
Policy instance 1
Insurance contract or identification number903367
Number of Individuals Covered542
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Total amount of commissions paid to insurance brokerUSD $54,761
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $375,181
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $54,761
Amount paid for insurance broker fees0
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number903367
Policy instance 1
Insurance contract or identification number903367
Number of Individuals Covered506
Insurance policy start date2019-12-01
Insurance policy end date2020-11-30
Total amount of commissions paid to insurance brokerUSD $48,949
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $357,740
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $48,949
Amount paid for insurance broker fees0
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number903367
Policy instance 1
Insurance contract or identification number903367
Number of Individuals Covered232
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $14,872
Total amount of fees paid to insurance companyUSD $1,731
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS, EMPLOYEE ASSSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $111,327
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,872
Amount paid for insurance broker fees1731
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number921810
Policy instance 2
Insurance contract or identification number921810
Number of Individuals Covered128
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $2,768
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,055
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,768
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number903367
Policy instance 1
Insurance contract or identification number903367
Number of Individuals Covered170
Insurance policy start date2017-12-01
Insurance policy end date2018-11-30
Total amount of commissions paid to insurance brokerUSD $20,364
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS, EMPLOYEE ASSSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $132,193
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5487239
Policy instance 2
Insurance contract or identification number5487239
Number of Individuals Covered116
Insurance policy start date2017-12-01
Insurance policy end date2018-11-30
Total amount of commissions paid to insurance brokerUSD $2,167
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,665
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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