401k Plan data: NUTRA BLEND, LLC GROUP LIFE PLAN plan

NUTRA BLEND, LLC GROUP LIFE PLAN 401k Plan overview

Plan Name	NUTRA BLEND, LLC GROUP LIFE PLAN
Plan identification number	502

NUTRA BLEND, LLC GROUP LIFE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

NUTRA-BLEND, LLC has sponsored the creation of one or more 401k plans.

Company Name: NUTRA-BLEND, LLC

Employer identification number (EIN): 431699920

NAIC Classification: 115210
NAIC Description: Support Activities for Animal Production

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NUTRA BLEND, LLC GROUP LIFE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2012-01-01 FILED WITH AUTHORIZED SIGNATURE
502 2011-01-01 ROBERT C. TOMASCHKO
502 2010-01-01 MATTHEW OSBORNE
502 2009-01-01 CRAIG BONET

Plan id#	Filing Submission Date	Name of Administrator
502	2012-01-01	FILED WITH AUTHORIZED SIGNATURE
502	2011-01-01	ROBERT C. TOMASCHKO
502	2010-01-01	MATTHEW OSBORNE
502	2009-01-01	CRAIG BONET

Plan Statistics for NUTRA BLEND, LLC GROUP LIFE PLAN

401k plan membership statisitcs for NUTRA BLEND, LLC GROUP LIFE PLAN

Measure Date Value
2012: NUTRA BLEND, LLC GROUP LIFE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 281
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 0
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 0
2011: NUTRA BLEND, LLC GROUP LIFE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 284
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 271
Total of all active and inactive participants 2011-01-01 271
Total participants 2011-01-01 271
2010: NUTRA BLEND, LLC GROUP LIFE PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 153
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 163
Number of retired or separated participants receiving benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 163
2009: NUTRA BLEND, LLC GROUP LIFE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 162
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 153
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 153

Measure	Date	Value
2012: NUTRA BLEND, LLC GROUP LIFE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	281
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	0
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	0
2011: NUTRA BLEND, LLC GROUP LIFE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	284
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	271
Total of all active and inactive participants	2011-01-01	271
Total participants	2011-01-01	271
2010: NUTRA BLEND, LLC GROUP LIFE PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	153
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	163
Number of retired or separated participants receiving benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	163
2009: NUTRA BLEND, LLC GROUP LIFE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	162
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	153
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	153

Form 5500 Responses for NUTRA BLEND, LLC GROUP LIFE PLAN

2012: NUTRA BLEND, LLC GROUP LIFE PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	Yes
2012-01-01	This submission is the final filing	Yes
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: NUTRA BLEND, LLC GROUP LIFE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: NUTRA BLEND, LLC GROUP LIFE PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: NUTRA BLEND, LLC GROUP LIFE PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX961451*

Policy instance

Insurance contract or identification number	FLX961451*
Number of Individuals Covered	341
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $164,108
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $137,923
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $164,108
Insurance broker organization code?	3
Insurance broker name	AON CONSULTING INC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 961544*

Policy instance

Insurance contract or identification number	OK 961544*
Number of Individuals Covered	341
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $16,755
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $14,038
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,755
Insurance broker organization code?	3
Insurance broker name	AON CONSULTING INC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX961451

Policy instance

Insurance contract or identification number	FLX961451
Number of Individuals Covered	271
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $52,663
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 961544

Policy instance

Insurance contract or identification number	OK 961544
Number of Individuals Covered	271
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Other welfare benefits provided	BASIC AD&D
Welfare Benefit Premiums Paid to Carrier	USD $8,109
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00400000

Policy instance

Insurance contract or identification number	00400000
Number of Individuals Covered	163
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,750
Total amount of fees paid to insurance company	USD $1,865
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $40,916
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	NUTRA-BLEND, LLC
Employer identification number (EIN):	431699920
NAIC Classification:	115210
NAIC Description:	Support Activities for Animal Production