401k Plan data: HARRIS BAKING EMPLOYEE BENEFITS STD PLAN plan

HARRIS BAKING EMPLOYEE BENEFITS STD PLAN 401k Plan overview

Plan Name	HARRIS BAKING EMPLOYEE BENEFITS STD PLAN
Plan identification number	503

HARRIS BAKING EMPLOYEE BENEFITS STD PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Temporary disability (accident and sickness)

401k Sponsoring company profile

OZARK EMPIRE DISTRIBUTORS DBA HA has sponsored the creation of one or more 401k plans.

Company Name: OZARK EMPIRE DISTRIBUTORS DBA HA

Employer identification number (EIN): 710335481

NAIC Classification: 311800
NAIC Description: Bakeries and Tortilla Manufacturing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HARRIS BAKING EMPLOYEE BENEFITS STD PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2018-01-01 JIM TWIGGS
503 2018-01-01

Plan Statistics for HARRIS BAKING EMPLOYEE BENEFITS STD PLAN

401k plan membership statisitcs for HARRIS BAKING EMPLOYEE BENEFITS STD PLAN

Measure Date Value
2018: HARRIS BAKING EMPLOYEE BENEFITS STD PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 155
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 0
Total of all active and inactive participants 2018-01-01 0

Measure	Date	Value
2018: HARRIS BAKING EMPLOYEE BENEFITS STD PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	155
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	0
Total of all active and inactive participants	2018-01-01	0

Form 5500 Responses for HARRIS BAKING EMPLOYEE BENEFITS STD PLAN

2018: HARRIS BAKING EMPLOYEE BENEFITS STD PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	Yes
2018-01-01	This submission is the final filing	Yes
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUG 0B97G

Policy instance

Insurance contract or identification number	GUG 0B97G
Number of Individuals Covered	155
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $5,405
Total amount of fees paid to insurance company	USD $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 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	Yes
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 $36,036
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,405
Insurance broker organization code?	3

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Company Name:	OZARK EMPIRE DISTRIBUTORS DBA HA
Employer identification number (EIN):	710335481
NAIC Classification:	311800
NAIC Description:	Bakeries and Tortilla Manufacturing