AMERICAN DAIRY QUEEN CORPORATION has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan AMERICAN DAIRY QUEEN GROUP HEALTH PLAN
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 903926 |
| Policy instance | 5 |
| Insurance contract or identification number | 903926 | | Number of Individuals Covered | 384 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $40,775 | | Total amount of fees paid to insurance company | USD $7,901 | | 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 | ACCIDENT, CRITICAL ILLNESS, HOSPITAL,ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $386,864 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
| Policy contract number | GTU0553378 |
| Policy instance | 4 |
| Insurance contract or identification number | GTU0553378 | | Number of Individuals Covered | 376 | | Insurance policy start date | 2022-02-23 | | Insurance policy end date | 2023-02-22 | | Total amount of commissions paid to insurance broker | USD $1,178 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $5,890 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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| COUNSELING GLOBAL DOMESTIC (National Association of Insurance Commissioners NAIC id number: 54161 ) |
| Policy contract number | 00 |
| Policy instance | 3 |
| Insurance contract or identification number | 00 | | Number of Individuals Covered | 504 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $9,603 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 203733 |
| Policy instance | 2 |
| Insurance contract or identification number | 203733 | | Number of Individuals Covered | 81 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $2,470 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | LEGAL | | Welfare Benefit Premiums Paid to Carrier | USD $16,117 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10141941001 |
| Policy instance | 1 |
| Insurance contract or identification number | 10141941001 | | Number of Individuals Covered | 547 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $24,251 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
| Policy contract number | GTU0553378 |
| Policy instance | 8 |
| Insurance contract or identification number | GTU0553378 | | Number of Individuals Covered | 520 | | Insurance policy start date | 2021-02-23 | | Insurance policy end date | 2022-02-22 | | Total amount of commissions paid to insurance broker | USD $1,178 | | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $5,890 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 203733 |
| Policy instance | 7 |
| Insurance contract or identification number | 203733 | | Number of Individuals Covered | 93 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $2,976 | | Other welfare benefits provided | LEGAL SERVICES PLAN MEMBERSHIPS | | Welfare Benefit Premiums Paid to Carrier | USD $17,509 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 951633 |
| Policy instance | 6 |
| Insurance contract or identification number | 951633 | | Number of Individuals Covered | 294 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $30,220 | | Total amount of fees paid to insurance company | USD $16,993 | | Welfare Benefit Premiums Paid to Carrier | USD $604,405 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 903933 |
| Policy instance | 5 |
| Insurance contract or identification number | 903933 | | Number of Individuals Covered | 370 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $8,080 | | Total amount of fees paid to insurance company | USD $2,020 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $107,455 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0565432 |
| Policy instance | 4 |
| Insurance contract or identification number | R0565432 | | Number of Individuals Covered | 352 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $13,119 | | Total amount of fees paid to insurance company | USD $4,108 | | Other welfare benefits provided | GCIEE, GRPACCVO, GRPHSPVOEN | | Welfare Benefit Premiums Paid to Carrier | USD $72,612 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 903927 |
| Policy instance | 3 |
| Insurance contract or identification number | 903927 | | Number of Individuals Covered | 193 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $14,548 | | Total amount of fees paid to insurance company | USD $2,645 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $142,607 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 903926 |
| Policy instance | 2 |
| Insurance contract or identification number | 903926 | | Number of Individuals Covered | 376 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $8,452 | | Total amount of fees paid to insurance company | USD $1,537 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $81,102 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10141941001 |
| Policy instance | 1 |
| Insurance contract or identification number | 10141941001 | | Number of Individuals Covered | 511 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,333 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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