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WABASH COFFEE, INC. LIFE INSURANCE PLAN 401k Plan overview

Plan NameWABASH COFFEE, INC. LIFE INSURANCE PLAN
Plan identification number 502

WABASH COFFEE, INC. LIFE INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Temporary disability (accident and sickness)
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

WABASH COFFEE, INC. has sponsored the creation of one or more 401k plans.

Company Name:WABASH COFFEE, INC.
Employer identification number (EIN):350860800
NAIC Classification:424400

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WABASH COFFEE, INC. LIFE INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022013-01-01
5022012-01-01RON DIX
5022011-01-01RON DIX

Plan Statistics for WABASH COFFEE, INC. LIFE INSURANCE PLAN

401k plan membership statisitcs for WABASH COFFEE, INC. LIFE INSURANCE PLAN

Measure Date Value
2013: WABASH COFFEE, INC. LIFE INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0196
Total number of active participants reported on line 7a of the Form 55002013-01-0195
Number of retired or separated participants receiving benefits2013-01-010
Total of all active and inactive participants2013-01-0195
2012: WABASH COFFEE, INC. LIFE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01103
Total number of active participants reported on line 7a of the Form 55002012-01-0198
Total of all active and inactive participants2012-01-0198
2011: WABASH COFFEE, INC. LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01105
Total number of active participants reported on line 7a of the Form 55002011-01-01104
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01104

Form 5500 Responses for WABASH COFFEE, INC. LIFE INSURANCE PLAN

2013: WABASH COFFEE, INC. LIFE INSURANCE PLAN 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: WABASH COFFEE, INC. LIFE INSURANCE PLAN 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: WABASH COFFEE, INC. LIFE INSURANCE PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberFO18385
Policy instance 1
Insurance contract or identification numberFO18385
Number of Individuals Covered94
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,021
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 $8,325
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,021
Insurance broker organization code?3
Insurance broker nameTOTAL BENEFIT SOLUTIONS LLC
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberFO18385
Policy instance 1
Insurance contract or identification numberFO18385
Number of Individuals Covered98
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $798
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 $8,477
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $798
Insurance broker organization code?3
Insurance broker nameTOTAL BENEFIT SOLUTIONS LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10110305
Policy instance 1
Insurance contract or identification number10110305
Number of Individuals Covered104
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $980
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 $8,175
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 number10110305
Policy instance 1
Insurance contract or identification number10110305
Number of Individuals Covered105
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,095
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 $8,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,095
Insurance broker organization code?3
Insurance broker nameTOTAL BENEFIT SOLUTIONS LLC

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