401k Plan data: AG PARTNERS EMPLOYEE BENEFIT PLAN plan

AG PARTNERS EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	AG PARTNERS EMPLOYEE BENEFIT PLAN
Plan identification number	501

AG PARTNERS EMPLOYEE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Other welfare benefit cover

401k Sponsoring company profile

AG PARTNERS COOPERATIVE, INC. has sponsored the creation of one or more 401k plans.

Company Name: AG PARTNERS COOPERATIVE, INC.

Employer identification number (EIN): 480612412

NAIC Classification: 115110

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AG PARTNERS EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-07-01

Plan Statistics for AG PARTNERS EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for AG PARTNERS EMPLOYEE BENEFIT PLAN

Measure Date Value
2022: AG PARTNERS EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-07-01 169
Total number of active participants reported on line 7a of the Form 5500 2022-07-01 164
Number of retired or separated participants receiving benefits 2022-07-01 2
Number of other retired or separated participants entitled to future benefits 2022-07-01 0
Total of all active and inactive participants 2022-07-01 166

Measure	Date	Value
2022: AG PARTNERS EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-07-01	169
Total number of active participants reported on line 7a of the Form 5500	2022-07-01	164
Number of retired or separated participants receiving benefits	2022-07-01	2
Number of other retired or separated participants entitled to future benefits	2022-07-01	0
Total of all active and inactive participants	2022-07-01	166

Form 5500 Responses for AG PARTNERS EMPLOYEE BENEFIT PLAN

2022: AG PARTNERS EMPLOYEE BENEFIT PLAN 2022 form 5500 responses
2022-07-01	Type of plan entity	Single employer plan
2022-07-01	First time form 5500 has been submitted	Yes
2022-07-01	Plan funding arrangement – Insurance	Yes
2022-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

9627104

Policy instance

Insurance contract or identification number	9627104
Number of Individuals Covered	359
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )

Policy contract number

52514-000-00001

Policy instance

Insurance contract or identification number	52514-000-00001
Number of Individuals Covered	108
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $3,454
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $69,085
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,454
Insurance broker organization code?	3

ASSURITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71439 )

Policy contract number

1100000668

Policy instance

Insurance contract or identification number	1100000668
Number of Individuals Covered	74
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $6,469
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $21,435
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,469
Insurance broker organization code?	3

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-418449

Policy instance

Insurance contract or identification number	010-418449
Number of Individuals Covered	77
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $887
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,191
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $887
Insurance broker organization code?	3

VISION CARE DIRECT OF KANSAS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

8987

Policy instance

Insurance contract or identification number	8987
Number of Individuals Covered	75
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $869
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,816
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $869
Insurance broker organization code?	3

KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 )

Policy contract number

25317

Policy instance

Insurance contract or identification number	25317
Number of Individuals Covered	164
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $3,468
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D, VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $39,107
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,468
Insurance broker organization code?	3

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Company Name:	AG PARTNERS COOPERATIVE, INC.
Employer identification number (EIN):	480612412
NAIC Classification:	115110