401k Plan data: BIG ISLAND CANDIES, INC. EMPLOYEE BENEFITS PLAN plan

BIG ISLAND CANDIES, INC. EMPLOYEE BENEFITS PLAN 401k Plan overview

Plan Name	BIG ISLAND CANDIES, INC. EMPLOYEE BENEFITS PLAN
Plan identification number	504

BIG ISLAND CANDIES, INC. EMPLOYEE BENEFITS 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) Other welfare benefit cover

401k Sponsoring company profile

BIG ISLAND CANDIES, INC. has sponsored the creation of one or more 401k plans.

Company Name: BIG ISLAND CANDIES, INC.

Employer identification number (EIN): 990173896

NAIC Classification: 311300
NAIC Description: Sugar and Confectionery Product Manufacturing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BIG ISLAND CANDIES, INC. EMPLOYEE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2021-10-01

Plan Statistics for BIG ISLAND CANDIES, INC. EMPLOYEE BENEFITS PLAN

401k plan membership statisitcs for BIG ISLAND CANDIES, INC. EMPLOYEE BENEFITS PLAN

Measure Date Value
2021: BIG ISLAND CANDIES, INC. EMPLOYEE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year 2021-10-01 119
Total number of active participants reported on line 7a of the Form 5500 2021-10-01 131
Number of retired or separated participants receiving benefits 2021-10-01 0
Number of other retired or separated participants entitled to future benefits 2021-10-01 0
Total of all active and inactive participants 2021-10-01 131

Measure	Date	Value
2021: BIG ISLAND CANDIES, INC. EMPLOYEE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-10-01	119
Total number of active participants reported on line 7a of the Form 5500	2021-10-01	131
Number of retired or separated participants receiving benefits	2021-10-01	0
Number of other retired or separated participants entitled to future benefits	2021-10-01	0
Total of all active and inactive participants	2021-10-01	131

Form 5500 Responses for BIG ISLAND CANDIES, INC. EMPLOYEE BENEFITS PLAN

2021: BIG ISLAND CANDIES, INC. EMPLOYEE BENEFITS PLAN 2021 form 5500 responses
2021-10-01	Type of plan entity	Single employer plan
2021-10-01	First time form 5500 has been submitted	Yes
2021-10-01	Plan funding arrangement – Insurance	Yes
2021-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-10-01	Plan benefit arrangement – Insurance	Yes
2021-10-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50006427

Policy instance

Insurance contract or identification number	50006427
Number of Individuals Covered	131
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $39,996
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

HB0003745

Policy instance

Insurance contract or identification number	HB0003745
Number of Individuals Covered	55
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Other welfare benefits provided	ACCIDENT, CANCER, HIP
Welfare Benefit Premiums Paid to Carrier	USD $19,263
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

7320

Policy instance

Insurance contract or identification number	7320
Number of Individuals Covered	8
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $46,733
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

083367

Policy instance

Insurance contract or identification number	083367
Number of Individuals Covered	176
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $974,779
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	BIG ISLAND CANDIES, INC.
Employer identification number (EIN):	990173896
NAIC Classification:	311300
NAIC Description:	Sugar and Confectionery Product Manufacturing