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LAVAZZA PREMIUM COFFEES, CORP. 401(K) PLAN 401k Plan overview

Plan NameLAVAZZA PREMIUM COFFEES, CORP. 401(K) PLAN
Plan identification number 001

LAVAZZA PREMIUM COFFEES, CORP. 401(K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

LAVAZZA PREMIUM COFFEES, CORP. has sponsored the creation of one or more 401k plans.

Company Name:LAVAZZA PREMIUM COFFEES, CORP.
Employer identification number (EIN):522297469
NAIC Classification:311900
NAIC Description: Other Food Manufacturing

Additional information about LAVAZZA PREMIUM COFFEES, CORP.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2015-04-16
Company Identification Number: 0802196882
Legal Registered Office Address: 120 WALL ST FL 27

NEW YORK
United States of America (USA)
10005

More information about LAVAZZA PREMIUM COFFEES, CORP.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LAVAZZA PREMIUM COFFEES, CORP. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01
0012021-01-01
0012020-01-01
0012019-01-01SHEETAL LOCHAN2020-04-20
0012018-01-01SHEETAL LOCHAN2019-09-20
0012017-01-01ROSEMARIE LUGO2018-10-09
0012016-01-01ROSEMARIE LUGO2017-10-16
0012014-01-01ADAM DONNELLY2015-07-12
0012014-01-01FRAN GAUL2015-10-15 FRAN GAUL2015-10-15
0012013-01-01CARL PIRANEO2014-07-30 CARL PIRANEO2014-07-30
0012012-01-01ADAM DONNELLY2013-07-09
0012011-01-01ADAM DONNELLY2012-05-09 ADAM DONNELLY2012-05-09
0012010-01-01ADAM DONNELLY2011-06-15 ADAM DONNELLY2011-06-15

Plan Statistics for LAVAZZA PREMIUM COFFEES, CORP. 401(K) PLAN

401k plan membership statisitcs for LAVAZZA PREMIUM COFFEES, CORP. 401(K) PLAN

Measure Date Value
2022: LAVAZZA PREMIUM COFFEES, CORP. 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01115
Total number of active participants reported on line 7a of the Form 55002022-01-010
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-010
Number of participants with account balances2022-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: LAVAZZA PREMIUM COFFEES, CORP. 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01121
Total number of active participants reported on line 7a of the Form 55002021-01-0193
Number of retired or separated participants receiving benefits2021-01-015
Number of other retired or separated participants entitled to future benefits2021-01-0122
Total of all active and inactive participants2021-01-01120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01120
Number of participants with account balances2021-01-0197
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: LAVAZZA PREMIUM COFFEES, CORP. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01122
Total number of active participants reported on line 7a of the Form 55002020-01-0198
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0121
Total of all active and inactive participants2020-01-01119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01119
Number of participants with account balances2020-01-0192
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010

Financial Data on LAVAZZA PREMIUM COFFEES, CORP. 401(K) PLAN

Measure Date Value
2022 : LAVAZZA PREMIUM COFFEES, CORP. 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total transfer of assets from this plan2022-12-31$7,235,301
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$-348,026
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$821,863
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$816,666
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$1,177,805
Value of total assets at end of year2022-12-31$0
Value of total assets at beginning of year2022-12-31$8,405,190
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$5,197
Total interest from all sources2022-12-31$5,664
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31Yes
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$806,831
Participant contributions at end of year2022-12-31$0
Participant contributions at beginning of year2022-12-31$151,631
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$22,228
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-1,169,889
Value of net assets at end of year (total assets less liabilities)2022-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$8,405,190
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$167,757
Value of interest in pooled separate accounts at end of year2022-12-31$0
Value of interest in pooled separate accounts at beginning of year2022-12-31$1,074,554
Interest on participant loans2022-12-31$5,664
Value of interest in common/collective trusts at end of year2022-12-31$0
Value of interest in common/collective trusts at beginning of year2022-12-31$7,011,248
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-53,701
Net investment gain/loss from pooled separate accounts2022-12-31$-214,290
Net investment gain or loss from common/collective trusts2022-12-31$-1,263,504
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31Yes
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$348,746
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$816,666
Contract administrator fees2022-12-31$5,197
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32022-12-31Yes
Did the plan have assets held for investment2022-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31Yes
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31ERNST & YOUNG LLP
Accountancy firm EIN2022-12-31346565596
2021 : LAVAZZA PREMIUM COFFEES, CORP. 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$2,133,485
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$656,390
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$648,777
Value of total corrective distributions2021-12-31$2,182
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$1,057,158
Value of total assets at end of year2021-12-31$8,405,190
Value of total assets at beginning of year2021-12-31$6,928,095
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$5,431
Total interest from all sources2021-12-31$6,562
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$715,490
Participant contributions at end of year2021-12-31$151,631
Participant contributions at beginning of year2021-12-31$122,014
Participant contributions at end of year2021-12-31$0
Participant contributions at beginning of year2021-12-31$25,087
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$17,139
Total non interest bearing cash at end of year2021-12-31$0
Total non interest bearing cash at beginning of year2021-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$1,477,095
Value of net assets at end of year (total assets less liabilities)2021-12-31$8,405,190
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$6,928,095
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$167,757
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$256,667
Value of interest in pooled separate accounts at end of year2021-12-31$1,074,554
Value of interest in pooled separate accounts at beginning of year2021-12-31$675,660
Interest on participant loans2021-12-31$6,562
Value of interest in common/collective trusts at end of year2021-12-31$7,011,248
Value of interest in common/collective trusts at beginning of year2021-12-31$5,837,274
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$16,034
Net investment gain/loss from pooled separate accounts2021-12-31$188,986
Net investment gain or loss from common/collective trusts2021-12-31$864,745
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31Yes
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$324,529
Employer contributions (assets) at end of year2021-12-31$0
Employer contributions (assets) at beginning of year2021-12-31$11,393
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$648,777
Contract administrator fees2021-12-31$5,431
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31ERNST & YOUNG LLP
Accountancy firm EIN2021-12-31346565596
2020 : LAVAZZA PREMIUM COFFEES, CORP. 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$1,866,510
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$406,997
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$368,136
Expenses. Certain deemed distributions of participant loans2020-12-31$5,910
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$1,001,598
Value of total assets at end of year2020-12-31$6,928,095
Value of total assets at beginning of year2020-12-31$5,468,582
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$32,951
Total interest from all sources2020-12-31$6,275
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$50,000
If this is an individual account plan, was there a blackout period2020-12-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$706,736
Participant contributions at end of year2020-12-31$122,014
Participant contributions at beginning of year2020-12-31$95,463
Participant contributions at end of year2020-12-31$25,087
Participant contributions at beginning of year2020-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$17,065
Total non interest bearing cash at end of year2020-12-31$0
Total non interest bearing cash at beginning of year2020-12-31$1,140
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$1,459,513
Value of net assets at end of year (total assets less liabilities)2020-12-31$6,928,095
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$5,468,582
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$256,667
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$0
Value of interest in pooled separate accounts at end of year2020-12-31$675,660
Value of interest in pooled separate accounts at beginning of year2020-12-31$4,651,240
Interest on participant loans2020-12-31$6,275
Value of interest in common/collective trusts at end of year2020-12-31$5,837,274
Value of interest in common/collective trusts at beginning of year2020-12-31$720,739
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$39,249
Net investment gain/loss from pooled separate accounts2020-12-31$137,419
Net investment gain or loss from common/collective trusts2020-12-31$681,969
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31Yes
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$277,797
Employer contributions (assets) at end of year2020-12-31$11,393
Employer contributions (assets) at beginning of year2020-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$368,136
Contract administrator fees2020-12-31$32,951
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-12-31Yes
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31ERNST & YOUNG LLP
Accountancy firm EIN2020-12-31346565596

Form 5500 Responses for LAVAZZA PREMIUM COFFEES, CORP. 401(K) PLAN

2022: LAVAZZA PREMIUM COFFEES, CORP. 401(K) PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedYes
2022-01-01This submission is the final filingYes
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: LAVAZZA PREMIUM COFFEES, CORP. 401(K) PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: LAVAZZA PREMIUM COFFEES, CORP. 401(K) PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered85
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number630154
Policy instance 2
Insurance contract or identification number630154
Number of Individuals Covered85
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $862
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $862
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered121
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number630154
Policy instance 2
Insurance contract or identification number630154
Number of Individuals Covered121
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,168
Total amount of fees paid to insurance companyUSD $403
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,168
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number630154
Policy instance 1
Insurance contract or identification number630154
Number of Individuals Covered122
Insurance policy start date2020-06-15
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $2,763
Total amount of fees paid to insurance companyUSD $69
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,763
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3

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