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MELITTA PROFESSIONAL COFFEE SOLUTIONS USA, INC. HEALTH PLAN BENEFITS 401k Plan overview

Plan NameMELITTA PROFESSIONAL COFFEE SOLUTIONS USA, INC. HEALTH PLAN BENEFITS
Plan identification number 502

MELITTA PROFESSIONAL COFFEE SOLUTIONS USA, INC. HEALTH PLAN BENEFITS Benefits

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

401k Sponsoring company profile

MELITTA PROFESSIONAL COFFEE SOLUTIONS USA, INC. has sponsored the creation of one or more 401k plans.

Company Name:MELITTA PROFESSIONAL COFFEE SOLUTIONS USA, INC.
Employer identification number (EIN):830503584
NAIC Classification:311900
NAIC Description: Other Food Manufacturing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MELITTA PROFESSIONAL COFFEE SOLUTIONS USA, INC. HEALTH PLAN BENEFITS

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-02-01SUSAN MCNAMARA2023-04-03
5022021-02-01SUSAN MCNAMARA2022-05-12
5022020-02-01SUSAN MCNAMARA2021-06-10
5022019-02-01SUSAN MCNAMARA2020-07-14
5022018-02-01SUSAN MCNAMARA2019-09-05

Plan Statistics for MELITTA PROFESSIONAL COFFEE SOLUTIONS USA, INC. HEALTH PLAN BENEFITS

401k plan membership statisitcs for MELITTA PROFESSIONAL COFFEE SOLUTIONS USA, INC. HEALTH PLAN BENEFITS

Measure Date Value
2022: MELITTA PROFESSIONAL COFFEE SOLUTIONS USA, INC. HEALTH PLAN BENEFITS 2022 401k membership
Total participants, beginning-of-year2022-02-01121
Total number of active participants reported on line 7a of the Form 55002022-02-01113
Number of retired or separated participants receiving benefits2022-02-010
Number of other retired or separated participants entitled to future benefits2022-02-010
Total of all active and inactive participants2022-02-01113
Number of employers contributing to the scheme2022-02-010
2021: MELITTA PROFESSIONAL COFFEE SOLUTIONS USA, INC. HEALTH PLAN BENEFITS 2021 401k membership
Total participants, beginning-of-year2021-02-01139
Total number of active participants reported on line 7a of the Form 55002021-02-01121
Number of retired or separated participants receiving benefits2021-02-010
Number of other retired or separated participants entitled to future benefits2021-02-010
Total of all active and inactive participants2021-02-01121
Number of employers contributing to the scheme2021-02-010
2020: MELITTA PROFESSIONAL COFFEE SOLUTIONS USA, INC. HEALTH PLAN BENEFITS 2020 401k membership
Total participants, beginning-of-year2020-02-01131
Total number of active participants reported on line 7a of the Form 55002020-02-01139
Number of retired or separated participants receiving benefits2020-02-010
Number of other retired or separated participants entitled to future benefits2020-02-010
Total of all active and inactive participants2020-02-01139
Number of employers contributing to the scheme2020-02-010
2019: MELITTA PROFESSIONAL COFFEE SOLUTIONS USA, INC. HEALTH PLAN BENEFITS 2019 401k membership
Total participants, beginning-of-year2019-02-01129
Total number of active participants reported on line 7a of the Form 55002019-02-01131
Number of retired or separated participants receiving benefits2019-02-010
Number of other retired or separated participants entitled to future benefits2019-02-010
Total of all active and inactive participants2019-02-01131
Number of employers contributing to the scheme2019-02-010
2018: MELITTA PROFESSIONAL COFFEE SOLUTIONS USA, INC. HEALTH PLAN BENEFITS 2018 401k membership
Total participants, beginning-of-year2018-02-01117
Total number of active participants reported on line 7a of the Form 55002018-02-01128
Number of retired or separated participants receiving benefits2018-02-011
Number of other retired or separated participants entitled to future benefits2018-02-010
Total of all active and inactive participants2018-02-01129
Number of employers contributing to the scheme2018-02-010

Form 5500 Responses for MELITTA PROFESSIONAL COFFEE SOLUTIONS USA, INC. HEALTH PLAN BENEFITS

2022: MELITTA PROFESSIONAL COFFEE SOLUTIONS USA, INC. HEALTH PLAN BENEFITS 2022 form 5500 responses
2022-02-01Type of plan entitySingle employer plan
2022-02-01Plan funding arrangement – InsuranceYes
2022-02-01Plan benefit arrangement – InsuranceYes
2021: MELITTA PROFESSIONAL COFFEE SOLUTIONS USA, INC. HEALTH PLAN BENEFITS 2021 form 5500 responses
2021-02-01Type of plan entitySingle employer plan
2021-02-01Plan funding arrangement – InsuranceYes
2021-02-01Plan benefit arrangement – InsuranceYes
2020: MELITTA PROFESSIONAL COFFEE SOLUTIONS USA, INC. HEALTH PLAN BENEFITS 2020 form 5500 responses
2020-02-01Type of plan entitySingle employer plan
2020-02-01Plan funding arrangement – InsuranceYes
2020-02-01Plan benefit arrangement – InsuranceYes
2019: MELITTA PROFESSIONAL COFFEE SOLUTIONS USA, INC. HEALTH PLAN BENEFITS 2019 form 5500 responses
2019-02-01Type of plan entitySingle employer plan
2019-02-01Plan funding arrangement – InsuranceYes
2019-02-01Plan benefit arrangement – InsuranceYes
2018: MELITTA PROFESSIONAL COFFEE SOLUTIONS USA, INC. HEALTH PLAN BENEFITS 2018 form 5500 responses
2018-02-01Type of plan entitySingle employer plan
2018-02-01First time form 5500 has been submittedYes
2018-02-01Plan funding arrangement – InsuranceYes
2018-02-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberVF026370
Policy instance 3
Insurance contract or identification numberVF026370
Number of Individuals Covered128
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $19,208
Total amount of fees paid to insurance companyUSD $15,979
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $127,991
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,208
Amount paid for insurance broker fees6839
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number463198
Policy instance 2
Insurance contract or identification number463198
Number of Individuals Covered113
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $7,990
Total amount of fees paid to insurance companyUSD $6,045
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $127,507
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,990
Amount paid for insurance broker fees6045
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number0MC527
Policy instance 1
Insurance contract or identification number0MC527
Number of Individuals Covered226
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $79,511
Total amount of fees paid to insurance companyUSD $2,900
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,047,874
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $79,511
Amount paid for insurance broker fees2900
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberVF026370
Policy instance 3
Insurance contract or identification numberVF026370
Number of Individuals Covered134
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $26,100
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $130,477
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,574
Amount paid for insurance broker fees0
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number463198
Policy instance 2
Insurance contract or identification number463198
Number of Individuals Covered121
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $4,073
Total amount of fees paid to insurance companyUSD $4,251
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $111,496
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,073
Amount paid for insurance broker fees4251
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number0MC527
Policy instance 1
Insurance contract or identification number0MC527
Number of Individuals Covered253
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $75,236
Total amount of fees paid to insurance companyUSD $2,851
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,937,074
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $75,236
Amount paid for insurance broker fees2851
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS, NON-MONETARY COMPENSATION
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number463198
Policy instance 2
Insurance contract or identification number463198
Number of Individuals Covered139
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $18,128
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $266,903
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,128
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number0MC527
Policy instance 1
Insurance contract or identification number0MC527
Number of Individuals Covered264
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $71,712
Total amount of fees paid to insurance companyUSD $2,800
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,885,423
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $71,712
Amount paid for insurance broker fees2800
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS NON-MONETARY COMPENSATION
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number463198
Policy instance 2
Insurance contract or identification number463198
Number of Individuals Covered131
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $17,715
Total amount of fees paid to insurance companyUSD $7,121
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $254,578
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,715
Amount paid for insurance broker fees7121
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number0MC527
Policy instance 1
Insurance contract or identification number0MC527
Number of Individuals Covered232
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $66,863
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,657,283
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $66,863
Amount paid for insurance broker fees0
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00463198
Policy instance 2
Insurance contract or identification number00463198
Number of Individuals Covered131
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $17,512
Total amount of fees paid to insurance companyUSD $4,590
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $238,068
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,512
Amount paid for insurance broker fees4590
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number0MC527
Policy instance 1
Insurance contract or identification number0MC527
Number of Individuals Covered208
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $21,102
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,489,398
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,033
Amount paid for insurance broker fees0
Insurance broker organization code?3

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