401k Plan data: COLE'S QUALITY FOODS, INC. FLEXIBLE BENEFITS PLAN FOR EMPLOYEES OF NORTH LIBERTY, IOWA plan

COLE'S QUALITY FOODS, INC. FLEXIBLE BENEFITS PLAN FOR EMPLOYEES OF NORTH LIBERTY, IOWA 401k Plan overview

Plan Name	COLE'S QUALITY FOODS, INC. FLEXIBLE BENEFITS PLAN FOR EMPLOYEES OF NORTH LIBERTY, IOWA
Plan identification number	502

COLE'S QUALITY FOODS, INC. FLEXIBLE BENEFITS PLAN FOR EMPLOYEES OF NORTH LIBERTY, IOWA Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

COLE'S QUALITY FOODS, INC. has sponsored the creation of one or more 401k plans.

Company Name: COLE'S QUALITY FOODS, INC.

Employer identification number (EIN): 381291439

NAIC Classification: 311800
NAIC Description: Bakeries and Tortilla Manufacturing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COLE'S QUALITY FOODS, INC. FLEXIBLE BENEFITS PLAN FOR EMPLOYEES OF NORTH LIBERTY, IOWA

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2017-01-01
502 2017-01-01 KAREN FRAZIER 2019-05-07
502 2016-01-01

Plan Statistics for COLE'S QUALITY FOODS, INC. FLEXIBLE BENEFITS PLAN FOR EMPLOYEES OF NORTH LIBERTY, IOWA

401k plan membership statisitcs for COLE'S QUALITY FOODS, INC. FLEXIBLE BENEFITS PLAN FOR EMPLOYEES OF NORTH LIBERTY, IOWA

Measure Date Value
2017: COLE'S QUALITY FOODS, INC. FLEXIBLE BENEFITS PLAN FOR EMPLOYEES OF NORTH LIBERTY, IOWA 2017 401k membership
Total participants, beginning-of-year 2017-01-01 129
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 109
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 109
Number of employers contributing to the scheme 2017-01-01 0
2016: COLE'S QUALITY FOODS, INC. FLEXIBLE BENEFITS PLAN FOR EMPLOYEES OF NORTH LIBERTY, IOWA 2016 401k membership
Total participants, beginning-of-year 2016-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 114
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 114

Measure	Date	Value
2017: COLE'S QUALITY FOODS, INC. FLEXIBLE BENEFITS PLAN FOR EMPLOYEES OF NORTH LIBERTY, IOWA 2017 401k membership
Total participants, beginning-of-year	2017-01-01	129
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	109
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	109
Number of employers contributing to the scheme	2017-01-01	0
2016: COLE'S QUALITY FOODS, INC. FLEXIBLE BENEFITS PLAN FOR EMPLOYEES OF NORTH LIBERTY, IOWA 2016 401k membership
Total participants, beginning-of-year	2016-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	114
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	114

Form 5500 Responses for COLE'S QUALITY FOODS, INC. FLEXIBLE BENEFITS PLAN FOR EMPLOYEES OF NORTH LIBERTY, IOWA

2017: COLE'S QUALITY FOODS, INC. FLEXIBLE BENEFITS PLAN FOR EMPLOYEES OF NORTH LIBERTY, IOWA 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	Yes
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: COLE'S QUALITY FOODS, INC. FLEXIBLE BENEFITS PLAN FOR EMPLOYEES OF NORTH LIBERTY, IOWA 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	First time form 5500 has been submitted	Yes
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

K3949

Policy instance

Insurance contract or identification number	K3949
Number of Individuals Covered	55
Insurance policy start date	2016-07-01
Insurance policy end date	2017-06-30
Total amount of commissions paid to insurance broker	USD $3,248
Total amount of fees paid to insurance company	USD $15
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $22,959
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,823
Amount paid for insurance broker fees	11
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	DAVID M. ERICKSON

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

7749

Policy instance

Insurance contract or identification number	7749
Number of Individuals Covered	81
Insurance policy start date	2016-07-01
Insurance policy end date	2017-06-30
Total amount of commissions paid to insurance broker	USD $6,527
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,242
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,781
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	STEPHANIE L. KESSERLRING

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

405692-003 004

Policy instance

Insurance contract or identification number	405692-003 004
Number of Individuals Covered	139
Insurance policy start date	2016-07-01
Insurance policy end date	2017-06-30
Total amount of commissions paid to insurance broker	USD $2,163
Total amount of fees paid to insurance company	USD $175
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	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $17,838
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,474
Amount paid for insurance broker fees	99
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL INS. SVCES., INC.

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Company Name:	COLE'S QUALITY FOODS, INC.
Employer identification number (EIN):	381291439
NAIC Classification:	311800
NAIC Description:	Bakeries and Tortilla Manufacturing

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
502	2017-01-01
502	2017-01-01	KAREN FRAZIER	2019-05-07
502	2016-01-01