401k Plan data: COMMUNITY FOOD BANK WELFARE BENEFIT PLAN plan

COMMUNITY FOOD BANK WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	COMMUNITY FOOD BANK WELFARE BENEFIT PLAN
Plan identification number	502

COMMUNITY FOOD BANK WELFARE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

COMMUNITY FOOD BANK, INC. has sponsored the creation of one or more 401k plans.

Company Name: COMMUNITY FOOD BANK, INC.

Employer identification number (EIN): 510192519

NAIC Classification: 624200

Additional information about COMMUNITY FOOD BANK, INC.

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 1982-03-04

Company Identification Number: 0059899401

Legal Registered Office Address: 3000 GALVEZ AVE

FORT WORTH
United States of America (USA)
76111

More information about COMMUNITY FOOD BANK, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COMMUNITY FOOD BANK WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2014-07-01 MICHAEL MCDONALD MICHAEL MCDONALD 2016-01-11
502 2013-07-01 MICHAEL MCDONALD MICHAEL MCDONALD 2016-01-11

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2014-07-01	MICHAEL MCDONALD		MICHAEL MCDONALD	2016-01-11
502	2013-07-01	MICHAEL MCDONALD		MICHAEL MCDONALD	2016-01-11

Plan Statistics for COMMUNITY FOOD BANK WELFARE BENEFIT PLAN

401k plan membership statisitcs for COMMUNITY FOOD BANK WELFARE BENEFIT PLAN

Measure Date Value
2014: COMMUNITY FOOD BANK WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-07-01 286
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 0
Number of retired or separated participants receiving benefits 2014-07-01 0
Number of other retired or separated participants entitled to future benefits 2014-07-01 0
Total of all active and inactive participants 2014-07-01 0
2013: COMMUNITY FOOD BANK WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-07-01 0
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 286
Number of retired or separated participants receiving benefits 2013-07-01 0
Number of other retired or separated participants entitled to future benefits 2013-07-01 0
Total of all active and inactive participants 2013-07-01 286

Measure	Date	Value
2014: COMMUNITY FOOD BANK WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-07-01	286
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	0
Number of retired or separated participants receiving benefits	2014-07-01	0
Number of other retired or separated participants entitled to future benefits	2014-07-01	0
Total of all active and inactive participants	2014-07-01	0
2013: COMMUNITY FOOD BANK WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-07-01	0
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	286
Number of retired or separated participants receiving benefits	2013-07-01	0
Number of other retired or separated participants entitled to future benefits	2013-07-01	0
Total of all active and inactive participants	2013-07-01	286

Form 5500 Responses for COMMUNITY FOOD BANK WELFARE BENEFIT PLAN

2014: COMMUNITY FOOD BANK WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	This submission is the final filing	Yes
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2013: COMMUNITY FOOD BANK WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	First time form 5500 has been submitted	Yes
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

TS05343300

Policy instance

Insurance contract or identification number	TS05343300
Number of Individuals Covered	297
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $11,431
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $102,214
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,836
Additional information about fees paid to insurance broker	COMMISSIONS PAID
Insurance broker organization code?	3
Insurance broker name	JIM BLACK INS SERVICES LLC

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

Policy contract number

TS05343300

Policy instance

Insurance contract or identification number	TS05343300
Number of Individuals Covered	286
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $10,779
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $99,106
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,412
Additional information about fees paid to insurance broker	COMMISSIONS PAID
Insurance broker organization code?	3
Insurance broker name	JIM BLACK INS SERVICES LLC

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Company Name:	COMMUNITY FOOD BANK, INC.
Employer identification number (EIN):	510192519
NAIC Classification:	624200

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	1982-03-04
Company Identification Number:	0059899401
Legal Registered Office Address:	3000 GALVEZ AVE FORT WORTH United States of America (USA) 76111