401k Plan data: HERB PHARM, LLC LIFE INSURANCE PLAN plan

HERB PHARM, LLC LIFE INSURANCE PLAN 401k Plan overview

Plan Name	HERB PHARM, LLC LIFE INSURANCE PLAN
Plan identification number	502

HERB PHARM, LLC LIFE INSURANCE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance

401k Sponsoring company profile

HERB PHARM, LLC has sponsored the creation of one or more 401k plans.

Company Name: HERB PHARM, LLC

Employer identification number (EIN): 473470089

NAIC Classification: 325410

Additional information about HERB PHARM, LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 4964835

More information about HERB PHARM, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HERB PHARM, LLC LIFE INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2018-04-01 MARGARET CLARK-COVARRUBIAS
502 2017-04-01 MARGARET CLARK-COVARRUBIAS

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2018-04-01	MARGARET CLARK-COVARRUBIAS
502	2017-04-01	MARGARET CLARK-COVARRUBIAS

Plan Statistics for HERB PHARM, LLC LIFE INSURANCE PLAN

401k plan membership statisitcs for HERB PHARM, LLC LIFE INSURANCE PLAN

Measure Date Value
2018: HERB PHARM, LLC LIFE INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-04-01 122
Total number of active participants reported on line 7a of the Form 5500 2018-04-01 0
Number of retired or separated participants receiving benefits 2018-04-01 0
Number of other retired or separated participants entitled to future benefits 2018-04-01 0
Total of all active and inactive participants 2018-04-01 0
2017: HERB PHARM, LLC LIFE INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-04-01 122
Total number of active participants reported on line 7a of the Form 5500 2017-04-01 122
Number of retired or separated participants receiving benefits 2017-04-01 0
Number of other retired or separated participants entitled to future benefits 2017-04-01 0
Total of all active and inactive participants 2017-04-01 122

Measure	Date	Value
2018: HERB PHARM, LLC LIFE INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-04-01	122
Total number of active participants reported on line 7a of the Form 5500	2018-04-01	0
Number of retired or separated participants receiving benefits	2018-04-01	0
Number of other retired or separated participants entitled to future benefits	2018-04-01	0
Total of all active and inactive participants	2018-04-01	0
2017: HERB PHARM, LLC LIFE INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-04-01	122
Total number of active participants reported on line 7a of the Form 5500	2017-04-01	122
Number of retired or separated participants receiving benefits	2017-04-01	0
Number of other retired or separated participants entitled to future benefits	2017-04-01	0
Total of all active and inactive participants	2017-04-01	122

Form 5500 Responses for HERB PHARM, LLC LIFE INSURANCE PLAN

2018: HERB PHARM, LLC LIFE INSURANCE PLAN 2018 form 5500 responses
2018-04-01	Type of plan entity	Single employer plan
2018-04-01	Submission has been amended	No
2018-04-01	This submission is the final filing	Yes
2018-04-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2018-04-01	Plan is a collectively bargained plan	No
2018-04-01	Plan funding arrangement – Insurance	Yes
2018-04-01	Plan benefit arrangement – Insurance	Yes
2017: HERB PHARM, LLC LIFE INSURANCE PLAN 2017 form 5500 responses
2017-04-01	Type of plan entity	Single employer plan
2017-04-01	First time form 5500 has been submitted	Yes
2017-04-01	Submission has been amended	No
2017-04-01	This submission is the final filing	No
2017-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-04-01	Plan is a collectively bargained plan	No
2017-04-01	Plan funding arrangement – Insurance	Yes
2017-04-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0625B

Policy instance

Insurance contract or identification number	GLUG0625B
Number of Individuals Covered	125
Insurance policy start date	2018-04-01
Insurance policy end date	2018-07-31
Total amount of commissions paid to insurance broker	USD $1,205
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
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	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $12,053
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,205
Insurance broker organization code?	3
Insurance broker name	PROPEL INSURANCE AGENCY, LLC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0625B

Policy instance

Insurance contract or identification number	GLUG0625B
Number of Individuals Covered	122
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $3,029
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
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	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $30,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,029
Insurance broker organization code?	3
Insurance broker name	BRATRUD MIDDLETON INS. BROKERS INC.

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Company Name:	HERB PHARM, LLC
Employer identification number (EIN):	473470089
NAIC Classification:	325410

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	4964835