401k Plan data: FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN plan

FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN 401k Plan overview

Plan Name	FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN
Plan identification number	503

FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

FAIRMONT FOODS, INC. has sponsored the creation of one or more 401k plans.

Company Name: FAIRMONT FOODS, INC.

Employer identification number (EIN): 473280631

NAIC Classification: 311610
NAIC Description: Animal Slaughtering and Processing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2022-01-01 PATRICIA BRANDTS 2023-10-12 PATRICIA BRANDTS 2023-10-12
503 2021-01-01 PATRICIA BRANDTS 2022-07-13 PATRICIA BRANDTS 2022-07-13
503 2020-01-01 PATRICIA BRANDTS 2021-07-23 PATRICIA BRANDTS 2021-07-23
503 2019-01-01 PATRICIA BRANDTS 2020-07-29 PATRICIA BRANDTS 2020-07-29
503 2018-01-01 PATRICIA BRANDTS 2019-09-11 PATRICIA BRANDTS 2019-09-11
503 2017-01-01
503 2016-01-01 PATRICIA BRANDTS PATRICIA BRANDTS 2017-10-16

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2022-01-01	PATRICIA BRANDTS	2023-10-12	PATRICIA BRANDTS	2023-10-12
503	2021-01-01	PATRICIA BRANDTS	2022-07-13	PATRICIA BRANDTS	2022-07-13
503	2020-01-01	PATRICIA BRANDTS	2021-07-23	PATRICIA BRANDTS	2021-07-23
503	2019-01-01	PATRICIA BRANDTS	2020-07-29	PATRICIA BRANDTS	2020-07-29
503	2018-01-01	PATRICIA BRANDTS	2019-09-11	PATRICIA BRANDTS	2019-09-11
503	2017-01-01
503	2016-01-01	PATRICIA BRANDTS		PATRICIA BRANDTS	2017-10-16

Plan Statistics for FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN

401k plan membership statisitcs for FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN

Measure Date Value
2022: FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 292
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 225
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 2022-01-01 225
2021: FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 287
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 296
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 296
2020: FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 310
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 287
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 287
2019: FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 313
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 310
Number of retired or separated participants receiving benefits 2019-01-01 1
Number of other retired or separated participants entitled to future benefits 2019-01-01 1
Total of all active and inactive participants 2019-01-01 312
2018: FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 255
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 313
Total of all active and inactive participants 2018-01-01 313
2017: FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 197
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 243
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 2017-01-01 243
2016: FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 140
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 148
Number of retired or separated participants receiving benefits 2016-01-01 1
Number of other retired or separated participants entitled to future benefits 2016-01-01 19
Total of all active and inactive participants 2016-01-01 168

Measure	Date	Value
2022: FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	292
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	225
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	225
2021: FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	287
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	296
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	296
2020: FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	310
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	287
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	287
2019: FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	313
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	310
Number of retired or separated participants receiving benefits	2019-01-01	1
Number of other retired or separated participants entitled to future benefits	2019-01-01	1
Total of all active and inactive participants	2019-01-01	312
2018: FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	255
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	313
Total of all active and inactive participants	2018-01-01	313
2017: FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	197
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	243
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	243
2016: FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	140
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	148
Number of retired or separated participants receiving benefits	2016-01-01	1
Number of other retired or separated participants entitled to future benefits	2016-01-01	19
Total of all active and inactive participants	2016-01-01	168

Form 5500 Responses for FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN

2022: FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: FAIRMONT FOODS, INC. EMPLOYEE GROUP BENEFIT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
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
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

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

Policy contract number

470817

Policy instance

Insurance contract or identification number	470817
Number of Individuals Covered	45
Insurance policy start date	2022-01-01
Insurance policy end date	2023-01-01
Total amount of commissions paid to insurance broker	USD $4,549
Total amount of fees paid to insurance company	USD $606
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $30,324
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,549
Amount paid for insurance broker fees	606
Insurance broker organization code?	3

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

Policy contract number

471262

Policy instance

Insurance contract or identification number	471262
Number of Individuals Covered	295
Insurance policy start date	2022-01-01
Insurance policy end date	2023-01-01
Total amount of commissions paid to insurance broker	USD $1,669
Total amount of fees paid to insurance company	USD $349
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $17,429
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,669
Amount paid for insurance broker fees	349
Insurance broker organization code?	3

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

Policy contract number

470794

Policy instance

Insurance contract or identification number	470794
Number of Individuals Covered	70
Insurance policy start date	2022-01-01
Insurance policy end date	2023-01-01
Total amount of commissions paid to insurance broker	USD $8,882
Total amount of fees paid to insurance company	USD $1,184
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $60,507
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,882
Amount paid for insurance broker fees	1184
Insurance broker organization code?	3

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

Policy contract number

470817

Policy instance

Insurance contract or identification number	470817
Number of Individuals Covered	48
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $5,211
Total amount of fees paid to insurance company	USD $695
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $34,741
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,211
Amount paid for insurance broker fees	695
Insurance broker organization code?	3

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

Policy contract number

471262

Policy instance

Insurance contract or identification number	471262
Number of Individuals Covered	296
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $1,663
Total amount of fees paid to insurance company	USD $346
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $17,295
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,663
Amount paid for insurance broker fees	346
Insurance broker organization code?	3

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

Policy contract number

470794

Policy instance

Insurance contract or identification number	470794
Number of Individuals Covered	80
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $10,432
Total amount of fees paid to insurance company	USD $1,391
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $68,251
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,432
Amount paid for insurance broker fees	1391
Insurance broker organization code?	3

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

Policy contract number

470817

Policy instance

Insurance contract or identification number	470817
Number of Individuals Covered	54
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $5,408
Total amount of fees paid to insurance company	USD $721
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $33,228
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,408
Amount paid for insurance broker fees	721
Insurance broker organization code?	3

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

Policy contract number

471262

Policy instance

Insurance contract or identification number	471262
Number of Individuals Covered	284
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $1,756
Total amount of fees paid to insurance company	USD $361
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $16,607
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,756
Amount paid for insurance broker fees	361
Insurance broker organization code?	3

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

Policy contract number

470794

Policy instance

Insurance contract or identification number	470794
Number of Individuals Covered	86
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $11,478
Total amount of fees paid to insurance company	USD $1,530
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $70,609
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,478
Amount paid for insurance broker fees	1530
Insurance broker organization code?	3

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

Policy contract number

470817

Policy instance

Insurance contract or identification number	470817
Number of Individuals Covered	60
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $5,347
Total amount of fees paid to insurance company	USD $713
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $35,211
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,347
Amount paid for insurance broker fees	713
Insurance broker organization code?	3

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

Policy contract number

471262

Policy instance

Insurance contract or identification number	471262
Number of Individuals Covered	310
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $1,637
Total amount of fees paid to insurance company	USD $339
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $18,413
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,637
Amount paid for insurance broker fees	339
Insurance broker organization code?	3

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

Policy contract number

470794

Policy instance

Insurance contract or identification number	470794
Number of Individuals Covered	89
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $10,476
Total amount of fees paid to insurance company	USD $1,397
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $69,955
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,476
Amount paid for insurance broker fees	1397
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05922733

Policy instance

Insurance contract or identification number	KM05922733
Number of Individuals Covered	197
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $5,070
Total amount of fees paid to insurance company	USD $1,480
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,867
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,070
Amount paid for insurance broker fees	1480
Insurance broker organization code?	3

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

Policy contract number

470817

Policy instance

Insurance contract or identification number	470817
Number of Individuals Covered	73
Insurance policy start date	2018-01-01
Insurance policy end date	2019-01-01
Total amount of commissions paid to insurance broker	USD $5,720
Total amount of fees paid to insurance company	USD $763
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $41,391
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,720
Amount paid for insurance broker fees	763

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

Policy contract number

471262

Policy instance

Insurance contract or identification number	471262
Number of Individuals Covered	286
Insurance policy start date	2018-01-01
Insurance policy end date	2019-01-01
Total amount of commissions paid to insurance broker	USD $1,547
Total amount of fees paid to insurance company	USD $313
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $15,672
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,547
Insurance broker organization code?	3
Amount paid for insurance broker fees	313

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

Policy contract number

470794

Policy instance

Insurance contract or identification number	470794
Number of Individuals Covered	94
Insurance policy start date	2018-01-01
Insurance policy end date	2019-01-01
Total amount of commissions paid to insurance broker	USD $10,517
Total amount of fees paid to insurance company	USD $1,402
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $75,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,517
Insurance broker organization code?	3
Amount paid for insurance broker fees	1402

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

Policy contract number

471262

Policy instance

Insurance contract or identification number	471262
Number of Individuals Covered	287
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,570
Total amount of fees paid to insurance company	USD $685
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $13,699
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,570
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker name	HAYS BENEFITS GROUP LLC

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

Policy contract number

470794

Policy instance

Insurance contract or identification number	470794
Number of Individuals Covered	101
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $11,323
Total amount of fees paid to insurance company	USD $3,641
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $73,229
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,323
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker name	HAYS BENEFITS GROUP LLC

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Company Name:	FAIRMONT FOODS, INC.
Employer identification number (EIN):	473280631
NAIC Classification:	311610
NAIC Description:	Animal Slaughtering and Processing