401k Plan data: WHEAT HOLDINGS, LLC HEATH AND WELFARE BENEFITS PLAN plan

WHEAT HOLDINGS, LLC HEATH AND WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	WHEAT HOLDINGS, LLC HEATH AND WELFARE BENEFITS PLAN
Plan identification number	501

WHEAT HOLDINGS, LLC HEATH AND WELFARE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

WHEAT MONTANA BAKERY, INC. has sponsored the creation of one or more 401k plans.

Company Name: WHEAT MONTANA BAKERY, INC.

Employer identification number (EIN): 810440427

NAIC Classification: 445291
NAIC Description: Baked Goods Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WHEAT HOLDINGS, LLC HEATH AND WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 NANCY TODD 2024-08-16

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	NANCY TODD	2024-08-16

Form 5500 Responses for WHEAT HOLDINGS, LLC HEATH AND WELFARE BENEFITS PLAN

2023: WHEAT HOLDINGS, LLC HEATH AND WELFARE BENEFITS PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

157445

Policy instance

Insurance contract or identification number	157445
Number of Individuals Covered	154
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $31,200
Total amount of fees paid to insurance company	USD $2
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $781,973
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

8721

Policy instance

Insurance contract or identification number	8721
Number of Individuals Covered	172
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $5,053
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,531
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

922351

Policy instance

Insurance contract or identification number	922351
Number of Individuals Covered	69
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,117
Total amount of fees paid to insurance company	USD $149
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,598
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

GLUG0BTXZ

Policy instance

Insurance contract or identification number	GLUG0BTXZ
Number of Individuals Covered	326
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $6,192
Total amount of fees paid to insurance company	USD $0
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	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $61,913
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

WHEAT HOLDINGS, LLC 401(K) PLAN [EIN = 822888405]

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Company Name:	WHEAT MONTANA BAKERY, INC.
Employer identification number (EIN):	810440427
NAIC Classification:	445291
NAIC Description:	Baked Goods Stores