401k Plan data: FOOD LIFELINE GROUP HEALTH & WELFARE PLAN plan

FOOD LIFELINE GROUP HEALTH & WELFARE PLAN 401k Plan overview

Plan Name	FOOD LIFELINE GROUP HEALTH & WELFARE PLAN
Plan identification number	505

FOOD LIFELINE GROUP HEALTH & WELFARE PLAN Benefits

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

401k Sponsoring company profile

FOOD LIFELINE has sponsored the creation of one or more 401k plans.

Company Name: FOOD LIFELINE

Employer identification number (EIN): 911090450

NAIC Classification: 813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Additional information about FOOD LIFELINE

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division

Incorporation Date: 1979-12-24

Company Identification Number: 601141497

Legal Registered Office Address: 815 S 96TH ST

SEATTLE
United States of America (USA)
981084934

More information about FOOD LIFELINE

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FOOD LIFELINE GROUP HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2023-07-01 NIKOLE KRAUSE-THOMPSON 2024-12-09

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
505	2023-07-01	NIKOLE KRAUSE-THOMPSON	2024-12-09

Form 5500 Responses for FOOD LIFELINE GROUP HEALTH & WELFARE PLAN

2023: FOOD LIFELINE GROUP HEALTH & WELFARE PLAN 2023 form 5500 responses
2023-07-01	Type of plan entity	Single employer plan
2023-07-01	First time form 5500 has been submitted	Yes
2023-07-01	Plan funding arrangement – Insurance	Yes
2023-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-07-01	Plan benefit arrangement – Insurance	Yes
2023-07-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )

Policy contract number

4025544

Policy instance

Insurance contract or identification number	4025544
Number of Individuals Covered	167
Insurance policy start date	2023-07-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $66,463
Total amount of fees paid to insurance company	USD $9,298
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,330,034
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )

Policy contract number

30026694

Policy instance

Insurance contract or identification number	30026694
Number of Individuals Covered	110
Insurance policy start date	2023-07-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $701
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,004
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

533579

Policy instance

Insurance contract or identification number	533579
Number of Individuals Covered	108
Insurance policy start date	2023-07-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $3,988
Total amount of fees paid to insurance company	USD $2,489
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $80,913
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	FOOD LIFELINE
Employer identification number (EIN):	911090450
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations

Jurisdiction of Incorporation:	Washington Secretary of State Corporations Division
Incorporation Date:	1979-12-24
Company Identification Number:	601141497
Legal Registered Office Address:	815 S 96TH ST SEATTLE United States of America (USA) 981084934