401k Plan data: PACIFIC AGRI-PRODUCTS, INC. HEALTH AND WELFARE PLAN plan

PACIFIC AGRI-PRODUCTS, INC. HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	PACIFIC AGRI-PRODUCTS, INC. HEALTH AND WELFARE PLAN
Plan identification number	501

PACIFIC AGRI-PRODUCTS, INC. HEALTH AND WELFARE PLAN Benefits

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

401k Sponsoring company profile

PACIFIC AGRI-PRODUCTS INC has sponsored the creation of one or more 401k plans.

Company Name: PACIFIC AGRI-PRODUCTS INC

Employer identification number (EIN): 942248471

NAIC Classification: 424400

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PACIFIC AGRI-PRODUCTS, INC. HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 BRIAN RIPARBELLI 2023-07-18

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	BRIAN RIPARBELLI	2023-07-18

Plan Statistics for PACIFIC AGRI-PRODUCTS, INC. HEALTH AND WELFARE PLAN

401k plan membership statisitcs for PACIFIC AGRI-PRODUCTS, INC. HEALTH AND WELFARE PLAN

Measure Date Value
2022: PACIFIC AGRI-PRODUCTS, INC. HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 108
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 103
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 103
Number of employers contributing to the scheme 2022-01-01 0

Measure	Date	Value
2022: PACIFIC AGRI-PRODUCTS, INC. HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	108
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	103
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	103
Number of employers contributing to the scheme	2022-01-01	0

Form 5500 Responses for PACIFIC AGRI-PRODUCTS, INC. HEALTH AND WELFARE PLAN

2022: PACIFIC AGRI-PRODUCTS, INC. HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	First time form 5500 has been submitted	Yes
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

660914

Policy instance

Insurance contract or identification number	660914
Number of Individuals Covered	137
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $48,375
Total amount of fees paid to insurance company	USD $1,127
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $697,368
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $48,375
Amount paid for insurance broker fees	1127
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )

Policy contract number

W0009603

Policy instance

Insurance contract or identification number	W0009603
Number of Individuals Covered	15
Insurance policy start date	2021-02-01
Insurance policy end date	2022-01-31
Total amount of commissions paid to insurance broker	USD $8,262
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $119,685
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,262
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1087157

Policy instance

Insurance contract or identification number	1087157
Number of Individuals Covered	156
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $7,269
Total amount of fees paid to insurance company	USD $1,313
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $72,826
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,269
Amount paid for insurance broker fees	1313
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

97374121001

Policy instance

Insurance contract or identification number	97374121001
Number of Individuals Covered	150
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $957
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,573
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $902
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	PACIFIC AGRI-PRODUCTS INC
Employer identification number (EIN):	942248471
NAIC Classification:	424400