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| Plan Name | IMPERIAL COFFEE SERVICES, INC. EMPLOYEE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | J.V. MANUFACTURING, INC. |
| Employer identification number (EIN): | 710510476 |
| NAIC Classification: | 333310 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2014-09-01 | ||||
| 501 | 2014-09-01 | ||||
| 501 | 2013-09-01 | ||||
| 501 | 2012-09-01 | PAUL TIMS |
| 2014: IMPERIAL COFFEE SERVICES, INC. EMPLOYEE BENEFIT PLAN 2014 form 5500 responses | ||
|---|---|---|
| 2014-09-01 | Type of plan entity | Single employer plan |
| 2014-09-01 | Plan funding arrangement – Insurance | Yes |
| 2014-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: IMPERIAL COFFEE SERVICES, INC. EMPLOYEE BENEFIT PLAN 2013 form 5500 responses | ||
| 2013-09-01 | Type of plan entity | Single employer plan |
| 2013-09-01 | Plan funding arrangement – Insurance | Yes |
| 2013-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: IMPERIAL COFFEE SERVICES, INC. EMPLOYEE BENEFIT PLAN 2012 form 5500 responses | ||
| 2012-09-01 | Type of plan entity | Single employer plan |
| 2012-09-01 | First time form 5500 has been submitted | Yes |
| 2012-09-01 | Plan funding arrangement – Insurance | Yes |
| 2012-09-01 | Plan benefit arrangement – Insurance | Yes |
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) | |
| Policy contract number | J750 |
| Policy instance | 1 |
| IIS (National Association of Insurance Commissioners NAIC id number: ) | |
| Policy contract number | IIAS 9960-7699- |
| Policy instance | 2 |
| IIS (National Association of Insurance Commissioners NAIC id number: ) | |
| Policy contract number | IIAS 9960-7699- |
| Policy instance | 1 |
| IIS (National Association of Insurance Commissioners NAIC id number: ) | |
| Policy contract number | IIAS 9960-7699- |
| Policy instance | 1 |
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