401k Plan data: WINDSET FARMS (CALIFORNIA), INC HEALTH & WELFARE plan

WINDSET FARMS (CALIFORNIA), INC HEALTH & WELFARE 401k Plan overview

Plan Name	WINDSET FARMS (CALIFORNIA), INC HEALTH & WELFARE
Plan identification number	501

WINDSET FARMS (CALIFORNIA), INC HEALTH & WELFARE Benefits

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

WINDSET FARMS (CALIFORNIA), INC. has sponsored the creation of one or more 401k plans.

Company Name: WINDSET FARMS (CALIFORNIA), INC.

Employer identification number (EIN): 680678683

NAIC Classification: 111400
NAIC Description: Greenhouse, Nursery, and Floriculture Production

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WINDSET FARMS (CALIFORNIA), INC HEALTH & WELFARE

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2019-06-01 ROBERT PULIDO 2020-11-09
501 2018-06-01 ROBERT PULIDO 2020-01-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2019-06-01	ROBERT PULIDO	2020-11-09
501	2018-06-01	ROBERT PULIDO	2020-01-14

Plan Statistics for WINDSET FARMS (CALIFORNIA), INC HEALTH & WELFARE

401k plan membership statisitcs for WINDSET FARMS (CALIFORNIA), INC HEALTH & WELFARE

Measure Date Value
2019: WINDSET FARMS (CALIFORNIA), INC HEALTH & WELFARE 2019 401k membership
Total participants, beginning-of-year 2019-06-01 107
Total number of active participants reported on line 7a of the Form 5500 2019-06-01 86
Number of retired or separated participants receiving benefits 2019-06-01 0
Number of other retired or separated participants entitled to future benefits 2019-06-01 0
Total of all active and inactive participants 2019-06-01 86
Number of employers contributing to the scheme 2019-06-01 0
2018: WINDSET FARMS (CALIFORNIA), INC HEALTH & WELFARE 2018 401k membership
Total participants, beginning-of-year 2018-06-01 113
Total number of active participants reported on line 7a of the Form 5500 2018-06-01 97
Number of retired or separated participants receiving benefits 2018-06-01 0
Number of other retired or separated participants entitled to future benefits 2018-06-01 0
Total of all active and inactive participants 2018-06-01 97
Number of employers contributing to the scheme 2018-06-01 0

Measure	Date	Value
2019: WINDSET FARMS (CALIFORNIA), INC HEALTH & WELFARE 2019 401k membership
Total participants, beginning-of-year	2019-06-01	107
Total number of active participants reported on line 7a of the Form 5500	2019-06-01	86
Number of retired or separated participants receiving benefits	2019-06-01	0
Number of other retired or separated participants entitled to future benefits	2019-06-01	0
Total of all active and inactive participants	2019-06-01	86
Number of employers contributing to the scheme	2019-06-01	0
2018: WINDSET FARMS (CALIFORNIA), INC HEALTH & WELFARE 2018 401k membership
Total participants, beginning-of-year	2018-06-01	113
Total number of active participants reported on line 7a of the Form 5500	2018-06-01	97
Number of retired or separated participants receiving benefits	2018-06-01	0
Number of other retired or separated participants entitled to future benefits	2018-06-01	0
Total of all active and inactive participants	2018-06-01	97
Number of employers contributing to the scheme	2018-06-01	0

Form 5500 Responses for WINDSET FARMS (CALIFORNIA), INC HEALTH & WELFARE

2019: WINDSET FARMS (CALIFORNIA), INC HEALTH & WELFARE 2019 form 5500 responses
2019-06-01	Type of plan entity	Single employer plan
2019-06-01	Plan funding arrangement – Insurance	Yes
2019-06-01	Plan benefit arrangement – Insurance	Yes
2018: WINDSET FARMS (CALIFORNIA), INC HEALTH & WELFARE 2018 form 5500 responses
2018-06-01	Type of plan entity	Single employer plan
2018-06-01	First time form 5500 has been submitted	Yes
2018-06-01	Plan funding arrangement – Insurance	Yes
2018-06-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1019148

Policy instance

Insurance contract or identification number	1019148
Number of Individuals Covered	210
Insurance policy start date	2019-06-01
Insurance policy end date	2020-05-31
Total amount of commissions paid to insurance broker	USD $10,169
Total amount of fees paid to insurance company	USD $7,282
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $139,285
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,169
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	BONUS

HOLMAN FAMILY COUNSELING, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

Policy instance

Insurance contract or identification number	00
Number of Individuals Covered	111
Insurance policy start date	2018-11-01
Insurance policy end date	2019-10-31
Total amount of commissions paid to insurance broker	USD $75
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $1,505
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $75
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1019148

Policy instance

Insurance contract or identification number	1019148
Number of Individuals Covered	261
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $10,071
Total amount of fees paid to insurance company	USD $3,141
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $139,070
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,071
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	BONUS

HOLMAN FAMILY COUNSELING, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

Policy instance

Insurance contract or identification number	00
Number of Individuals Covered	111
Insurance policy start date	2017-11-01
Insurance policy end date	2018-10-31
Total amount of commissions paid to insurance broker	USD $75
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $1,505
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $75
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

Potentially related plans

WINDSET FARMS INC. 401(K) PLAN [EIN = 421771013]

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Company Name:	WINDSET FARMS (CALIFORNIA), INC.
Employer identification number (EIN):	680678683
NAIC Classification:	111400
NAIC Description:	Greenhouse, Nursery, and Floriculture Production