401k Plan data: CENTRAL REGION COOPERATIVE HEALTH AND WELFARE PLAN plan

CENTRAL REGION COOPERATIVE HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	CENTRAL REGION COOPERATIVE HEALTH AND WELFARE PLAN
Plan identification number	501

CENTRAL REGION COOPERATIVE HEALTH AND WELFARE PLAN Benefits

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

401k Sponsoring company profile

CENTRAL REGION COOPERATIVE has sponsored the creation of one or more 401k plans.

Company Name: CENTRAL REGION COOPERATIVE

Employer identification number (EIN): 410247880

NAIC Classification: 115110

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CENTRAL REGION COOPERATIVE 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 CHARLES A. BRAUN 2023-04-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	CHARLES A. BRAUN	2023-04-14

Plan Statistics for CENTRAL REGION COOPERATIVE HEALTH AND WELFARE PLAN

401k plan membership statisitcs for CENTRAL REGION COOPERATIVE HEALTH AND WELFARE PLAN

Measure Date Value
2022: CENTRAL REGION COOPERATIVE HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 152
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 2022-01-01 152
Number of employers contributing to the scheme 2022-01-01 0

Measure	Date	Value
2022: CENTRAL REGION COOPERATIVE HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	152
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	152
Number of employers contributing to the scheme	2022-01-01	0

Form 5500 Responses for CENTRAL REGION COOPERATIVE HEALTH AND WELFARE PLAN

2022: CENTRAL REGION COOPERATIVE 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 funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

MEDICA (National Association of Insurance Commissioners NAIC id number: 12459 )

Policy contract number

310754

Policy instance

Insurance contract or identification number	310754
Number of Individuals Covered	285
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $53,381
Total amount of fees paid to insurance company	USD $707
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,779,380
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $53,381
Amount paid for insurance broker fees	707
Additional information about fees paid to insurance broker	BROKER INCENTIVE PROGRAM
Insurance broker organization code?	3

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

Policy contract number

28334

Policy instance

Insurance contract or identification number	28334
Number of Individuals Covered	152
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $24,163
Total amount of fees paid to insurance company	USD $2,148
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM, ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $150,030
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,087
Amount paid for insurance broker fees	2148
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

EBMS RE-BENCHMARK INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 41394 )

Policy contract number

Policy instance

Insurance contract or identification number	00
Number of Individuals Covered	125
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $26,553
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

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Company Name:	CENTRAL REGION COOPERATIVE
Employer identification number (EIN):	410247880
NAIC Classification:	115110