401k Plan data: EMPORIA WHOLESALE COFFEE COMPANY EMPLOYEE BENEFIT TRUST plan

EMPORIA WHOLESALE COFFEE COMPANY EMPLOYEE BENEFIT TRUST 401k Plan overview

Plan Name	EMPORIA WHOLESALE COFFEE COMPANY EMPLOYEE BENEFIT TRUST
Plan identification number	503

EMPORIA WHOLESALE COFFEE COMPANY EMPLOYEE BENEFIT TRUST Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Temporary disability (accident and sickness)

401k Sponsoring company profile

EMPORIA WHOLESALE COFFEE COMPANY has sponsored the creation of one or more 401k plans.

Company Name: EMPORIA WHOLESALE COFFEE COMPANY

Employer identification number (EIN): 480209630

NAIC Classification: 424400

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPORIA WHOLESALE COFFEE COMPANY EMPLOYEE BENEFIT TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2023-01-01
503 2022-01-01 DAVID C EVANS 2023-07-31
503 2021-01-01 DAVID C EVANS 2022-07-31
503 2020-01-01 DAVID C EVANS 2021-08-31
503 2019-01-01 DAVID C EVANS 2020-07-25
503 2018-01-01 DAVID C EVANS 2019-07-29
503 2017-01-01 DAVID C EVANS 2018-10-15
503 2016-01-01 DAVID C EVANS 2017-07-25
503 2015-01-01 DAVID C EVANS 2016-07-12
503 2014-01-01 DAVID C. EVANS 2015-08-17
503 2013-01-01 DAVID C. EVANS 2014-09-02
503 2012-01-01 DAVID C. EVANS
503 2011-01-01 DAVID C. EVANS
503 2010-01-01 DAVID C. EVANS
503 2009-01-01 DAVID C. EVANS

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
503	2023-01-01
503	2022-01-01	DAVID C EVANS	2023-07-31
503	2021-01-01	DAVID C EVANS	2022-07-31
503	2020-01-01	DAVID C EVANS	2021-08-31
503	2019-01-01	DAVID C EVANS	2020-07-25
503	2018-01-01	DAVID C EVANS	2019-07-29
503	2017-01-01	DAVID C EVANS	2018-10-15
503	2016-01-01	DAVID C EVANS	2017-07-25
503	2015-01-01	DAVID C EVANS	2016-07-12
503	2014-01-01	DAVID C. EVANS	2015-08-17
503	2013-01-01	DAVID C. EVANS	2014-09-02
503	2012-01-01	DAVID C. EVANS
503	2011-01-01	DAVID C. EVANS
503	2010-01-01	DAVID C. EVANS
503	2009-01-01	DAVID C. EVANS

Plan Statistics for EMPORIA WHOLESALE COFFEE COMPANY EMPLOYEE BENEFIT TRUST

401k plan membership statisitcs for EMPORIA WHOLESALE COFFEE COMPANY EMPLOYEE BENEFIT TRUST

Measure Date Value
2012: EMPORIA WHOLESALE COFFEE COMPANY EMPLOYEE BENEFIT TRUST 2012 401k membership
Total participants, beginning-of-year 2012-01-01 106
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 161
Total of all active and inactive participants 2012-01-01 161
2011: EMPORIA WHOLESALE COFFEE COMPANY EMPLOYEE BENEFIT TRUST 2011 401k membership
Total participants, beginning-of-year 2011-01-01 102
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 106
Total of all active and inactive participants 2011-01-01 106
2010: EMPORIA WHOLESALE COFFEE COMPANY EMPLOYEE BENEFIT TRUST 2010 401k membership
Total participants, beginning-of-year 2010-01-01 114
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 102
Total of all active and inactive participants 2010-01-01 102
2009: EMPORIA WHOLESALE COFFEE COMPANY EMPLOYEE BENEFIT TRUST 2009 401k membership
Total participants, beginning-of-year 2009-01-01 135
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 114
Total of all active and inactive participants 2009-01-01 114

Measure	Date	Value
2012: EMPORIA WHOLESALE COFFEE COMPANY EMPLOYEE BENEFIT TRUST 2012 401k membership
Total participants, beginning-of-year	2012-01-01	106
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	161
Total of all active and inactive participants	2012-01-01	161
2011: EMPORIA WHOLESALE COFFEE COMPANY EMPLOYEE BENEFIT TRUST 2011 401k membership
Total participants, beginning-of-year	2011-01-01	102
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	106
Total of all active and inactive participants	2011-01-01	106
2010: EMPORIA WHOLESALE COFFEE COMPANY EMPLOYEE BENEFIT TRUST 2010 401k membership
Total participants, beginning-of-year	2010-01-01	114
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	102
Total of all active and inactive participants	2010-01-01	102
2009: EMPORIA WHOLESALE COFFEE COMPANY EMPLOYEE BENEFIT TRUST 2009 401k membership
Total participants, beginning-of-year	2009-01-01	135
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	114
Total of all active and inactive participants	2009-01-01	114

Financial Data on EMPORIA WHOLESALE COFFEE COMPANY EMPLOYEE BENEFIT TRUST

Measure	Date	Value
2012 : EMPORIA WHOLESALE COFFEE COMPANY EMPLOYEE BENEFIT TRUST 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$580
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$323
Total income from all sources (including contributions)	2012-12-31	$760,821
Total of all expenses incurred	2012-12-31	$867,975
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$825,067
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$754,749
Value of total assets at end of year	2012-12-31	$486,471
Value of total assets at beginning of year	2012-12-31	$593,368
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$42,908
Total interest from all sources	2012-12-31	$1,807
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$325,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$273,015
Participant contributions at end of year	2012-12-31	$20,604
Participant contributions at beginning of year	2012-12-31	$21,290
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$32,014
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-12-31	$17,948
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$1,508
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-12-31	$580
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$323
Other income not declared elsewhere	2012-12-31	$4,265
Total non interest bearing cash at end of year	2012-12-31	$166,073
Total non interest bearing cash at beginning of year	2012-12-31	$365,397
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$-107,154
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$485,891
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$593,045
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$281,846
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$205,173
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$205,173
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$1,807
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$199,658
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$449,720
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$625,409
Contract administrator fees	2012-12-31	$42,908
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2012-12-31	No
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	No
Opinion of an independent qualified public accountant for this plan	2012-12-31	Unqualified
Accountancy firm name	2012-12-31	THOMAS H. SEWELL, CPA, LLC
Accountancy firm EIN	2012-12-31	383805788
2011 : EMPORIA WHOLESALE COFFEE COMPANY EMPLOYEE BENEFIT TRUST 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$323
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$1,496
Total income from all sources (including contributions)	2011-12-31	$994,232
Total of all expenses incurred	2011-12-31	$867,202
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$835,184
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$943,656
Value of total assets at end of year	2011-12-31	$593,368
Value of total assets at beginning of year	2011-12-31	$467,511
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$32,018
Total interest from all sources	2011-12-31	$1,693
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$300,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$294,602
Participant contributions at end of year	2011-12-31	$21,290
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$12,652
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$1,508
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$1,153
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$323
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$1,496
Other income not declared elsewhere	2011-12-31	$48,883
Total non interest bearing cash at end of year	2011-12-31	$365,397
Total non interest bearing cash at beginning of year	2011-12-31	$272,878
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$127,030
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$593,045
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$466,015
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$205,173
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$193,480
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$193,480
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$1,693
Expenses. Payments to insurance carriers foe the provision of benefits	2011-12-31	$219,840
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$636,402
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$615,344
Contract administrator fees	2011-12-31	$32,018
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2011-12-31	No
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	No
Opinion of an independent qualified public accountant for this plan	2011-12-31	Unqualified
Accountancy firm name	2011-12-31	THOMAS H. SEWELL, CPA, LLC
Accountancy firm EIN	2011-12-31	383805788
2010 : EMPORIA WHOLESALE COFFEE COMPANY EMPLOYEE BENEFIT TRUST 2010 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$1,496
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$1,333
Total income from all sources (including contributions)	2010-12-31	$1,236,993
Total of all expenses incurred	2010-12-31	$939,793
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$898,149
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$972,100
Value of total assets at end of year	2010-12-31	$467,511
Value of total assets at beginning of year	2010-12-31	$170,149
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$41,644
Total interest from all sources	2010-12-31	$1,459
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$300,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$299,246
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$1,153
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$4,289
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-12-31	$1,496
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$1,333
Other income not declared elsewhere	2010-12-31	$263,434
Total non interest bearing cash at end of year	2010-12-31	$272,878
Total non interest bearing cash at beginning of year	2010-12-31	$74,017
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$297,200
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$466,015
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$168,816
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$193,480
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$91,843
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$91,843
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$1,459
Expenses. Payments to insurance carriers foe the provision of benefits	2010-12-31	$221,401
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$672,854
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$676,748
Contract administrator fees	2010-12-31	$41,644
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2010-12-31	No
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	No
Opinion of an independent qualified public accountant for this plan	2010-12-31	Unqualified
Accountancy firm name	2010-12-31	THOMAS H. SEWELL, CPA, LLC
Accountancy firm EIN	2010-12-31	383805788

Form 5500 Responses for EMPORIA WHOLESALE COFFEE COMPANY EMPLOYEE BENEFIT TRUST

2012: EMPORIA WHOLESALE COFFEE COMPANY EMPLOYEE BENEFIT TRUST 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: EMPORIA WHOLESALE COFFEE COMPANY EMPLOYEE BENEFIT TRUST 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: EMPORIA WHOLESALE COFFEE COMPANY EMPLOYEE BENEFIT TRUST 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: EMPORIA WHOLESALE COFFEE COMPANY EMPLOYEE BENEFIT TRUST 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

403861

Policy instance

Insurance contract or identification number	403861
Number of Individuals Covered	87
Insurance policy start date	2012-01-01
Insurance policy end date	2012-08-31
Total amount of commissions paid to insurance broker	USD $17,073
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $155,210
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,073
Insurance broker organization code?	3
Insurance broker name	MUTUAL ASSURANCE AGENCY INC

BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 )

Policy contract number

96450

Policy instance

Insurance contract or identification number	96450
Number of Individuals Covered	161
Insurance policy start date	2012-09-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $59,076
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

013847

Policy instance

Insurance contract or identification number	013847
Number of Individuals Covered	103
Insurance policy start date	2011-01-01
Insurance policy end date	2011-08-31
Total amount of commissions paid to insurance broker	USD $15,897
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $144,627
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

403861

Policy instance

Insurance contract or identification number	403861
Number of Individuals Covered	106
Insurance policy start date	2011-09-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $6,179
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $58,234
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

013847

Policy instance

Insurance contract or identification number	013847
Number of Individuals Covered	102
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $29,977
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $221,401
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	EMPORIA WHOLESALE COFFEE COMPANY
Employer identification number (EIN):	480209630
NAIC Classification:	424400