LEPRINO FOODS COMPANY has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan LEPRINO FOODS COMPANY HEALTH & WELFARE PLAN
| Measure | Date | Value |
|---|
| 2019 : LEPRINO FOODS COMPANY HEALTH & WELFARE PLAN 2019 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2019-10-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-10-31 | $5,152,296 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-10-31 | $5,594,631 |
| Total income from all sources (including contributions) | 2019-10-31 | $45,513,624 |
| Total loss/gain on sale of assets | 2019-10-31 | $0 |
| Total of all expenses incurred | 2019-10-31 | $46,013,654 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-10-31 | $43,035,213 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-10-31 | $45,505,875 |
| Value of total assets at end of year | 2019-10-31 | $1,685,727 |
| Value of total assets at beginning of year | 2019-10-31 | $2,628,092 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-10-31 | $2,978,441 |
| Total interest from all sources | 2019-10-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2019-10-31 | $7,749 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-10-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2019-10-31 | $7,749 |
| Administrative expenses professional fees incurred | 2019-10-31 | $344,115 |
| Was this plan covered by a fidelity bond | 2019-10-31 | Yes |
| Value of fidelity bond cover | 2019-10-31 | $10,000,000 |
| If this is an individual account plan, was there a blackout period | 2019-10-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-10-31 | No |
| Contributions received from participants | 2019-10-31 | $12,402,962 |
| Participant contributions at end of year | 2019-10-31 | $850,782 |
| Participant contributions at beginning of year | 2019-10-31 | $1,000,154 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-10-31 | $606,346 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2019-10-31 | $522,524 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2019-10-31 | $87,896 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2019-10-31 | $106,483 |
| Administrative expenses (other) incurred | 2019-10-31 | $283,164 |
| Total non interest bearing cash at end of year | 2019-10-31 | $228,599 |
| Total non interest bearing cash at beginning of year | 2019-10-31 | $158,253 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-10-31 | No |
| Value of net income/loss | 2019-10-31 | $-500,030 |
| Value of net assets at end of year (total assets less liabilities) | 2019-10-31 | $-3,466,569 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-10-31 | $-2,966,539 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-10-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-10-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-10-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2019-10-31 | $0 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2019-10-31 | $947,161 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-10-31 | $6,065,264 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-10-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2019-10-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-10-31 | No |
| Contributions received in cash from employer | 2019-10-31 | $33,102,913 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-10-31 | $36,969,949 |
| Contract administrator fees | 2019-10-31 | $2,351,162 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2019-10-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2019-10-31 | $5,064,400 |
| Liabilities. Value of benefit claims payable at beginning of year | 2019-10-31 | $5,488,148 |
| Did the plan have assets held for investment | 2019-10-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-10-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-10-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-10-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-10-31 | Unqualified |
| Accountancy firm name | 2019-10-31 | BROCK AND CO CPAS P,C. |
| Accountancy firm EIN | 2019-10-31 | 840930288 |
| 2018 : LEPRINO FOODS COMPANY HEALTH & WELFARE PLAN 2018 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2018-10-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-10-31 | $5,594,631 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-10-31 | $5,990,089 |
| Total income from all sources (including contributions) | 2018-10-31 | $38,828,674 |
| Total loss/gain on sale of assets | 2018-10-31 | $0 |
| Total of all expenses incurred | 2018-10-31 | $44,395,292 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-10-31 | $41,217,953 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-10-31 | $38,815,573 |
| Value of total assets at end of year | 2018-10-31 | $2,628,092 |
| Value of total assets at beginning of year | 2018-10-31 | $8,590,168 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-10-31 | $3,177,339 |
| Total interest from all sources | 2018-10-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2018-10-31 | $13,101 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-10-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2018-10-31 | $13,101 |
| Administrative expenses professional fees incurred | 2018-10-31 | $306,729 |
| Was this plan covered by a fidelity bond | 2018-10-31 | Yes |
| Value of fidelity bond cover | 2018-10-31 | $10,000,000 |
| If this is an individual account plan, was there a blackout period | 2018-10-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2018-10-31 | No |
| Contributions received from participants | 2018-10-31 | $11,799,552 |
| Participant contributions at end of year | 2018-10-31 | $1,000,154 |
| Participant contributions at beginning of year | 2018-10-31 | $693,992 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2018-10-31 | $522,524 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2018-10-31 | $828,827 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2018-10-31 | $106,483 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2018-10-31 | $67,340 |
| Administrative expenses (other) incurred | 2018-10-31 | $840,428 |
| Total non interest bearing cash at end of year | 2018-10-31 | $158,253 |
| Total non interest bearing cash at beginning of year | 2018-10-31 | $387,124 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-10-31 | No |
| Value of net income/loss | 2018-10-31 | $-5,566,618 |
| Value of net assets at end of year (total assets less liabilities) | 2018-10-31 | $-2,966,539 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-10-31 | $2,600,079 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-10-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-10-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-10-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2018-10-31 | $947,161 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2018-10-31 | $6,680,225 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-10-31 | $5,198,644 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-10-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2018-10-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-10-31 | No |
| Contributions received in cash from employer | 2018-10-31 | $27,016,021 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-10-31 | $36,019,309 |
| Contract administrator fees | 2018-10-31 | $2,030,182 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2018-10-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2018-10-31 | $5,488,148 |
| Liabilities. Value of benefit claims payable at beginning of year | 2018-10-31 | $5,922,749 |
| Did the plan have assets held for investment | 2018-10-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-10-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-10-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-10-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-10-31 | Unqualified |
| Accountancy firm name | 2018-10-31 | BROCK AND CO CPAS P.C. |
| Accountancy firm EIN | 2018-10-31 | 840930288 |
| 2017 : LEPRINO FOODS COMPANY HEALTH & WELFARE PLAN 2017 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2017-10-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-10-31 | $5,990,089 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-10-31 | $5,442,487 |
| Total income from all sources (including contributions) | 2017-10-31 | $48,299,655 |
| Total loss/gain on sale of assets | 2017-10-31 | $0 |
| Total of all expenses incurred | 2017-10-31 | $41,971,348 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-10-31 | $38,713,628 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-10-31 | $48,298,383 |
| Value of total assets at end of year | 2017-10-31 | $8,590,168 |
| Value of total assets at beginning of year | 2017-10-31 | $1,714,259 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-10-31 | $3,257,720 |
| Total interest from all sources | 2017-10-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2017-10-31 | $1,272 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-10-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2017-10-31 | $1,272 |
| Administrative expenses professional fees incurred | 2017-10-31 | $221,070 |
| Was this plan covered by a fidelity bond | 2017-10-31 | Yes |
| Value of fidelity bond cover | 2017-10-31 | $10,000,000 |
| If this is an individual account plan, was there a blackout period | 2017-10-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-10-31 | Yes |
| Amount of non-exempt transactions with any party-in-interest | 2017-10-31 | $20,027 |
| Contributions received from participants | 2017-10-31 | $9,829,454 |
| Participant contributions at end of year | 2017-10-31 | $693,992 |
| Participant contributions at beginning of year | 2017-10-31 | $668,046 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2017-10-31 | $828,827 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2017-10-31 | $541,309 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2017-10-31 | $67,340 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2017-10-31 | $44,801 |
| Administrative expenses (other) incurred | 2017-10-31 | $941,283 |
| Total non interest bearing cash at end of year | 2017-10-31 | $387,124 |
| Total non interest bearing cash at beginning of year | 2017-10-31 | $482,734 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-10-31 | No |
| Value of net income/loss | 2017-10-31 | $6,328,307 |
| Value of net assets at end of year (total assets less liabilities) | 2017-10-31 | $2,600,079 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-10-31 | $-3,728,228 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-10-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-10-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-10-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2017-10-31 | $6,680,225 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-10-31 | $4,425,019 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-10-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2017-10-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-10-31 | No |
| Contributions received in cash from employer | 2017-10-31 | $38,468,929 |
| Employer contributions (assets) at beginning of year | 2017-10-31 | $22,170 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-10-31 | $34,288,609 |
| Contract administrator fees | 2017-10-31 | $2,095,367 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2017-10-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2017-10-31 | $5,922,749 |
| Liabilities. Value of benefit claims payable at beginning of year | 2017-10-31 | $5,397,686 |
| Did the plan have assets held for investment | 2017-10-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-10-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-10-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-10-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-10-31 | Unqualified |
| Accountancy firm name | 2017-10-31 | BROCK AND CO CPAS P.C. |
| Accountancy firm EIN | 2017-10-31 | 840930288 |
| 2016 : LEPRINO FOODS COMPANY HEALTH & WELFARE PLAN 2016 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2016-10-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-10-31 | $5,442,487 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-10-31 | $4,951,272 |
| Total income from all sources (including contributions) | 2016-10-31 | $38,489,546 |
| Total loss/gain on sale of assets | 2016-10-31 | $0 |
| Total of all expenses incurred | 2016-10-31 | $39,335,162 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-10-31 | $36,376,249 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-10-31 | $38,489,546 |
| Value of total assets at end of year | 2016-10-31 | $1,714,259 |
| Value of total assets at beginning of year | 2016-10-31 | $2,068,660 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-10-31 | $2,958,913 |
| Total interest from all sources | 2016-10-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2016-10-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-10-31 | No |
| Administrative expenses professional fees incurred | 2016-10-31 | $172,738 |
| Was this plan covered by a fidelity bond | 2016-10-31 | Yes |
| Value of fidelity bond cover | 2016-10-31 | $10,000,000 |
| If this is an individual account plan, was there a blackout period | 2016-10-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-10-31 | Yes |
| Amount of non-exempt transactions with any party-in-interest | 2016-10-31 | $20,027 |
| Contributions received from participants | 2016-10-31 | $9,764,637 |
| Participant contributions at end of year | 2016-10-31 | $668,046 |
| Participant contributions at beginning of year | 2016-10-31 | $718,150 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2016-10-31 | $541,309 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2016-10-31 | $788,631 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2016-10-31 | $44,801 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2016-10-31 | $45,361 |
| Administrative expenses (other) incurred | 2016-10-31 | $1,058,894 |
| Total non interest bearing cash at end of year | 2016-10-31 | $482,734 |
| Total non interest bearing cash at beginning of year | 2016-10-31 | $539,709 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-10-31 | No |
| Value of net income/loss | 2016-10-31 | $-845,616 |
| Value of net assets at end of year (total assets less liabilities) | 2016-10-31 | $-3,728,228 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-10-31 | $-2,882,612 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-10-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-10-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-10-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-10-31 | $4,237,617 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-10-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2016-10-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-10-31 | No |
| Contributions received in cash from employer | 2016-10-31 | $28,724,909 |
| Employer contributions (assets) at end of year | 2016-10-31 | $22,170 |
| Employer contributions (assets) at beginning of year | 2016-10-31 | $22,170 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-10-31 | $32,138,632 |
| Contract administrator fees | 2016-10-31 | $1,727,281 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2016-10-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2016-10-31 | $5,397,686 |
| Liabilities. Value of benefit claims payable at beginning of year | 2016-10-31 | $4,905,911 |
| Did the plan have assets held for investment | 2016-10-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-10-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-10-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-10-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-10-31 | Unqualified |
| Accountancy firm name | 2016-10-31 | BROCK AND CO CPAS P.C. |
| Accountancy firm EIN | 2016-10-31 | 840930288 |
| 2015 : LEPRINO FOODS COMPANY HEALTH & WELFARE PLAN 2015 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2015-10-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-10-31 | $3,551,272 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-10-31 | $3,151,448 |
| Total income from all sources (including contributions) | 2015-10-31 | $37,865,083 |
| Total loss/gain on sale of assets | 2015-10-31 | $0 |
| Total of all expenses incurred | 2015-10-31 | $37,686,820 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-10-31 | $34,435,130 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-10-31 | $37,865,083 |
| Value of total assets at end of year | 2015-10-31 | $1,284,365 |
| Value of total assets at beginning of year | 2015-10-31 | $706,278 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-10-31 | $3,251,690 |
| Total interest from all sources | 2015-10-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2015-10-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-10-31 | No |
| Administrative expenses professional fees incurred | 2015-10-31 | $42,830 |
| Was this plan covered by a fidelity bond | 2015-10-31 | Yes |
| Value of fidelity bond cover | 2015-10-31 | $10,000,000 |
| If this is an individual account plan, was there a blackout period | 2015-10-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-10-31 | No |
| Amount of non-exempt transactions with any party-in-interest | 2015-10-31 | $20,027 |
| Contributions received from participants | 2015-10-31 | $9,971,530 |
| Participant contributions at end of year | 2015-10-31 | $718,150 |
| Participant contributions at beginning of year | 2015-10-31 | $706,278 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2015-10-31 | $566,215 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2015-10-31 | $45,361 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2015-10-31 | $82,182 |
| Administrative expenses (other) incurred | 2015-10-31 | $1,148,691 |
| Total non interest bearing cash at end of year | 2015-10-31 | $539,709 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-10-31 | No |
| Value of net income/loss | 2015-10-31 | $178,263 |
| Value of net assets at end of year (total assets less liabilities) | 2015-10-31 | $-2,266,907 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-10-31 | $-2,445,170 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-10-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-10-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-10-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-10-31 | $3,728,610 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-10-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2015-10-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-10-31 | No |
| Contributions received in cash from employer | 2015-10-31 | $27,893,553 |
| Employer contributions (assets) at end of year | 2015-10-31 | $22,170 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-10-31 | $30,706,520 |
| Contract administrator fees | 2015-10-31 | $2,060,169 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2015-10-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2015-10-31 | $3,505,911 |
| Liabilities. Value of benefit claims payable at beginning of year | 2015-10-31 | $3,069,266 |
| Did the plan have assets held for investment | 2015-10-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-10-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-10-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-10-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-10-31 | Unqualified |
| Accountancy firm name | 2015-10-31 | BROCK AND CO CPAS P.C. |
| Accountancy firm EIN | 2015-10-31 | 840930288 |
| 2014 : LEPRINO FOODS COMPANY HEALTH & WELFARE PLAN 2014 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2014-10-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-10-31 | $3,151,448 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-10-31 | $2,859,262 |
| Total income from all sources (including contributions) | 2014-10-31 | $33,118,865 |
| Total loss/gain on sale of assets | 2014-10-31 | $0 |
| Total of all expenses incurred | 2014-10-31 | $33,348,705 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-10-31 | $30,033,112 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-10-31 | $33,118,865 |
| Value of total assets at end of year | 2014-10-31 | $706,278 |
| Value of total assets at beginning of year | 2014-10-31 | $643,932 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-10-31 | $3,315,593 |
| Total interest from all sources | 2014-10-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2014-10-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-10-31 | No |
| Administrative expenses professional fees incurred | 2014-10-31 | $30,156 |
| Was this plan covered by a fidelity bond | 2014-10-31 | Yes |
| Value of fidelity bond cover | 2014-10-31 | $10,000,000 |
| If this is an individual account plan, was there a blackout period | 2014-10-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-10-31 | No |
| Contributions received from participants | 2014-10-31 | $9,333,901 |
| Participant contributions at end of year | 2014-10-31 | $706,278 |
| Participant contributions at beginning of year | 2014-10-31 | $643,932 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2014-10-31 | $82,182 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2014-10-31 | $26,281 |
| Administrative expenses (other) incurred | 2014-10-31 | $1,034,379 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-10-31 | No |
| Value of net income/loss | 2014-10-31 | $-229,840 |
| Value of net assets at end of year (total assets less liabilities) | 2014-10-31 | $-2,445,170 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-10-31 | $-2,215,330 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-10-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-10-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-10-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-10-31 | $3,254,157 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-10-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2014-10-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-10-31 | No |
| Contributions received in cash from employer | 2014-10-31 | $23,784,964 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-10-31 | $26,778,955 |
| Contract administrator fees | 2014-10-31 | $2,251,058 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2014-10-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2014-10-31 | $3,069,266 |
| Liabilities. Value of benefit claims payable at beginning of year | 2014-10-31 | $2,832,981 |
| Did the plan have assets held for investment | 2014-10-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-10-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-10-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-10-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-10-31 | Unqualified |
| Accountancy firm name | 2014-10-31 | BROCK AND CO CPAS P.C. |
| Accountancy firm EIN | 2014-10-31 | 840930288 |
| 2013 : LEPRINO FOODS COMPANY HEALTH & WELFARE PLAN 2013 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2013-10-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-10-31 | $2,859,262 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-10-31 | $2,820,241 |
| Total income from all sources (including contributions) | 2013-10-31 | $27,414,196 |
| Total loss/gain on sale of assets | 2013-10-31 | $0 |
| Total of all expenses incurred | 2013-10-31 | $29,981,280 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-10-31 | $27,108,250 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-10-31 | $27,414,185 |
| Value of total assets at end of year | 2013-10-31 | $643,932 |
| Value of total assets at beginning of year | 2013-10-31 | $3,171,995 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-10-31 | $2,873,030 |
| Total interest from all sources | 2013-10-31 | $11 |
| Total dividends received (eg from common stock, registered investment company shares) | 2013-10-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-10-31 | No |
| Administrative expenses professional fees incurred | 2013-10-31 | $14,821 |
| Was this plan covered by a fidelity bond | 2013-10-31 | Yes |
| Value of fidelity bond cover | 2013-10-31 | $10,000,000 |
| If this is an individual account plan, was there a blackout period | 2013-10-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-10-31 | No |
| Contributions received from participants | 2013-10-31 | $8,499,034 |
| Participant contributions at end of year | 2013-10-31 | $643,932 |
| Participant contributions at beginning of year | 2013-10-31 | $1,290,994 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2013-10-31 | $26,281 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2013-10-31 | $7,625 |
| Administrative expenses (other) incurred | 2013-10-31 | $751,766 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-10-31 | No |
| Value of net income/loss | 2013-10-31 | $-2,567,084 |
| Value of net assets at end of year (total assets less liabilities) | 2013-10-31 | $-2,215,330 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-10-31 | $351,754 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-10-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-10-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-10-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2013-10-31 | $0 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-10-31 | $1,881,001 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-10-31 | $1,881,001 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2013-10-31 | $11 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-10-31 | $2,942,502 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-10-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2013-10-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-10-31 | No |
| Contributions received in cash from employer | 2013-10-31 | $18,915,151 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-10-31 | $24,165,748 |
| Contract administrator fees | 2013-10-31 | $2,106,443 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2013-10-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2013-10-31 | $2,832,981 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-10-31 | $2,812,616 |
| Did the plan have assets held for investment | 2013-10-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-10-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-10-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-10-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-10-31 | Unqualified |
| Accountancy firm name | 2013-10-31 | BROCK AND CO CPAS P.C. |
| Accountancy firm EIN | 2013-10-31 | 840930288 |
| 2012 : LEPRINO FOODS COMPANY HEALTH & WELFARE PLAN 2012 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-10-31 | $2,820,241 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-10-31 | $2,312,348 |
| Total income from all sources (including contributions) | 2012-10-31 | $27,720,785 |
| Total of all expenses incurred | 2012-10-31 | $28,904,603 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-10-31 | $26,516,920 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-10-31 | $27,720,761 |
| Value of total assets at end of year | 2012-10-31 | $3,171,995 |
| Value of total assets at beginning of year | 2012-10-31 | $3,847,920 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-10-31 | $2,387,683 |
| Total interest from all sources | 2012-10-31 | $24 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-10-31 | No |
| Administrative expenses professional fees incurred | 2012-10-31 | $164,779 |
| Was this plan covered by a fidelity bond | 2012-10-31 | Yes |
| Value of fidelity bond cover | 2012-10-31 | $10,000,000 |
| If this is an individual account plan, was there a blackout period | 2012-10-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-10-31 | No |
| Contributions received from participants | 2012-10-31 | $7,348,209 |
| Participant contributions at end of year | 2012-10-31 | $1,290,994 |
| Participant contributions at beginning of year | 2012-10-31 | $503,916 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2012-10-31 | $7,625 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2012-10-31 | $23,404 |
| Administrative expenses (other) incurred | 2012-10-31 | $277,516 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-10-31 | No |
| Value of net income/loss | 2012-10-31 | $-1,183,818 |
| Value of net assets at end of year (total assets less liabilities) | 2012-10-31 | $351,754 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-10-31 | $1,535,572 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-10-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-10-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-10-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-10-31 | $1,881,001 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-10-31 | $3,344,004 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-10-31 | $3,344,004 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2012-10-31 | $24 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-10-31 | $2,709,580 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-10-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2012-10-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-10-31 | No |
| Contributions received in cash from employer | 2012-10-31 | $20,372,552 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-10-31 | $23,807,340 |
| Contract administrator fees | 2012-10-31 | $1,945,388 |
| Liabilities. Value of benefit claims payable at end of year | 2012-10-31 | $2,812,616 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-10-31 | $2,288,944 |
| Did the plan have assets held for investment | 2012-10-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-10-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-10-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-10-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-10-31 | Unqualified |
| Accountancy firm name | 2012-10-31 | BROCK AND COMPANY CPAS P.C. |
| Accountancy firm EIN | 2012-10-31 | 840930288 |
| 2011 : LEPRINO FOODS COMPANY HEALTH & WELFARE PLAN 2011 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-10-31 | $2,312,348 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-10-31 | $2,256,016 |
| Total income from all sources (including contributions) | 2011-10-31 | $25,165,423 |
| Total of all expenses incurred | 2011-10-31 | $23,594,565 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-10-31 | $21,712,202 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-10-31 | $25,165,397 |
| Value of total assets at end of year | 2011-10-31 | $3,847,920 |
| Value of total assets at beginning of year | 2011-10-31 | $2,220,730 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-10-31 | $1,882,363 |
| Total interest from all sources | 2011-10-31 | $26 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-10-31 | No |
| Administrative expenses professional fees incurred | 2011-10-31 | $12,640 |
| Was this plan covered by a fidelity bond | 2011-10-31 | Yes |
| Value of fidelity bond cover | 2011-10-31 | $10,000,000 |
| If this is an individual account plan, was there a blackout period | 2011-10-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-10-31 | No |
| Contributions received from participants | 2011-10-31 | $6,322,880 |
| Participant contributions at end of year | 2011-10-31 | $503,916 |
| Participant contributions at beginning of year | 2011-10-31 | $420,730 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2011-10-31 | $23,404 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2011-10-31 | $11,653 |
| Administrative expenses (other) incurred | 2011-10-31 | $70,399 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-10-31 | No |
| Value of net income/loss | 2011-10-31 | $1,570,858 |
| Value of net assets at end of year (total assets less liabilities) | 2011-10-31 | $1,535,572 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-10-31 | $-35,286 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-10-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-10-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-10-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-10-31 | $3,344,004 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-10-31 | $1,800,000 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-10-31 | $1,800,000 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-10-31 | $26 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-10-31 | $2,528,801 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-10-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2011-10-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-10-31 | No |
| Contributions received in cash from employer | 2011-10-31 | $18,842,517 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-10-31 | $19,183,401 |
| Contract administrator fees | 2011-10-31 | $1,799,324 |
| Liabilities. Value of benefit claims payable at end of year | 2011-10-31 | $2,288,944 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-10-31 | $2,244,363 |
| Did the plan have assets held for investment | 2011-10-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-10-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-10-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-10-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-10-31 | Unqualified |
| Accountancy firm name | 2011-10-31 | BROCK AND COMPANY CPAS P.C. |
| Accountancy firm EIN | 2011-10-31 | 840930288 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 94218 |
| Policy instance | 3 |
| Insurance contract or identification number | 94218 | | Number of Individuals Covered | 603 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $16,066 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | VOLUNTARY HOSPITAL INDEMNITY | | 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 $150,761 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 803712G |
| Policy instance | 2 |
| Insurance contract or identification number | 803712G | | Number of Individuals Covered | 4175 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | 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 | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | 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 $2,154,987 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | G1434 |
| Policy instance | 1 |
| Insurance contract or identification number | G1434 | | Number of Individuals Covered | 1025 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $30,497 | | Total amount of fees paid to insurance company | USD $1,975 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | VOLUNTARY CRITICAL ILLNESS, VOLUNTARY ACCIDENT | | 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 $283,740 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 803712G |
| Policy instance | 1 |
| Insurance contract or identification number | 803712G | | Number of Individuals Covered | 4052 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of fees paid to insurance company | USD $19,156 | | 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 | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | 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 $2,746,272 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | G1434 |
| Policy instance | 2 |
| Insurance contract or identification number | G1434 | | Number of Individuals Covered | 598 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | VOLUNTARY CRITICAL ILLNESS, VOLUNTARY HOSPITAL INDEMNITY, VOLUNTARY ACCIDENT | | 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 $516,763 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 70932-8 |
| Policy instance | 3 |
| Insurance contract or identification number | 70932-8 | | Number of Individuals Covered | 3076 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | 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 | No | | 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 $2,321,144 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 4EL-7227-18 |
| Policy instance | 4 |
| Insurance contract or identification number | 4EL-7227-18 | | Number of Individuals Covered | 38 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2019-12-31 | | 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 | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | 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 $28,443 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | G1434 |
| Policy instance | 3 |
| Insurance contract or identification number | G1434 | | Number of Individuals Covered | 598 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | VOLUNTARY CRITICAL ILLNESS, VOLUNTARY HOSPITAL INDEMNITY, VOLUNTARY ACCIDENT | | 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 $502,849 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 713533D 803712G |
| Policy instance | 2 |
| Insurance contract or identification number | 713533D 803712G | | Number of Individuals Covered | 3922 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | 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 | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | 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 $2,244,284 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 70932-8 |
| Policy instance | 1 |
| Insurance contract or identification number | 70932-8 | | Number of Individuals Covered | 3076 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $200,307 | | 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 | No | | 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 $2,003,076 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $200,307 | | Additional information about fees paid to insurance broker | WRITING AGENT | | Insurance broker organization code? | 3 |
|
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) |
| Policy contract number | 70932-8 |
| Policy instance | 2 |
| Insurance contract or identification number | 70932-8 | | Number of Individuals Covered | 3061 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-10-31 | | 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 | No | | 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 $1,673,298 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 713533D 803712G |
| Policy instance | 9 |
| Insurance contract or identification number | 713533D 803712G | | Number of Individuals Covered | 3922 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2019-10-31 | | 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 | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | 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 $829,402 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 4EL-7227-18 |
| Policy instance | 8 |
| Insurance contract or identification number | 4EL-7227-18 | | Number of Individuals Covered | 38 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of fees paid to insurance company | USD $27,965 | | 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 | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | 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 $349,567 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 27965 |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 16-012876-000 |
| Policy instance | 1 |
| Insurance contract or identification number | 16-012876-000 | | Number of Individuals Covered | 3061 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2018-12-31 | | 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 | No | | 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 $444,311 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0737474 |
| Policy instance | 3 |
| Insurance contract or identification number | 0737474 | | Number of Individuals Covered | 7472 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | 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 | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | 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 $2,873,704 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTH AND HUMAN RESOURCES CENTER, INC. (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 603083 |
| Policy instance | 4 |
| Insurance contract or identification number | 603083 | | Number of Individuals Covered | 1626 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | CALIFORNIA EES | | 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 $20,878 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | G1434 |
| Policy instance | 5 |
| Insurance contract or identification number | G1434 | | Number of Individuals Covered | 598 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $786,857 | | Total amount of fees paid to insurance company | USD $155,727 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENT | | 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 $66,123 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Amount paid for insurance broker fees | 825 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | G1434 |
| Policy instance | 6 |
| Insurance contract or identification number | G1434 | | Number of Individuals Covered | 382 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $24,982 | | Total amount of fees paid to insurance company | USD $2,115 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | CRITICAL ILLNESS | | 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 $91,799 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Amount paid for insurance broker fees | 1110 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 94218 |
| Policy instance | 7 |
| Insurance contract or identification number | 94218 | | Number of Individuals Covered | 274 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $5,724 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | HOSPITAL INDEMNITY | | 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 $93,936 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 5724 |
|
| WORLDWIDE INSURANCE SERVICES, LLC (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | LEPRI |
| Policy instance | 4 |
| Insurance contract or identification number | LEPRI | | Number of Individuals Covered | 41 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | INTERNATIONAL INSURANCE | | 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 $271,041 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | 94218 G1434 |
| Policy instance | 3 |
| Insurance contract or identification number | 94218 G1434 | | Number of Individuals Covered | 611 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-10-31 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENT - VOLUNTARY | | 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 $149,746 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 16-012876-000 |
| Policy instance | 2 |
| Insurance contract or identification number | 16-012876-000 | | Number of Individuals Covered | 3063 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | 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 | No | | 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 $1,673,721 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0737474 |
| Policy instance | 1 |
| Insurance contract or identification number | 0737474 | | Number of Individuals Covered | 8541 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | 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 | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | 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 $3,224,431 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
