401k Plan data: SWAGGERTY'S SAUSAGE CO HEALTH AND WELFARE PLAN plan

SWAGGERTY'S SAUSAGE CO HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	SWAGGERTY'S SAUSAGE CO HEALTH AND WELFARE PLAN
Plan identification number	502

SWAGGERTY'S SAUSAGE CO HEALTH AND WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Temporary disability (accident and sickness) Long-term disability cover

401k Sponsoring company profile

SWAGGERTY'S SAUSAGE CO has sponsored the creation of one or more 401k plans.

Company Name: SWAGGERTY'S SAUSAGE CO

Employer identification number (EIN): 620901882

NAIC Classification: 311610
NAIC Description: Animal Slaughtering and Processing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SWAGGERTY'S SAUSAGE CO HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2021-12-01 RANDY TINDELL 2023-05-30
502 2020-12-01 MARK CHILDRESS 2022-04-11
502 2019-12-01 MARK CHILDRESS 2021-04-15
502 2018-12-01 MARK CHILDRESS 2020-05-13
502 2017-12-01 MARK CHILDRESS 2019-05-22
502 2016-12-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
502	2021-12-01	RANDY TINDELL	2023-05-30
502	2020-12-01	MARK CHILDRESS	2022-04-11
502	2019-12-01	MARK CHILDRESS	2021-04-15
502	2018-12-01	MARK CHILDRESS	2020-05-13
502	2017-12-01	MARK CHILDRESS	2019-05-22
502	2016-12-01

Plan Statistics for SWAGGERTY'S SAUSAGE CO HEALTH AND WELFARE PLAN

401k plan membership statisitcs for SWAGGERTY'S SAUSAGE CO HEALTH AND WELFARE PLAN

Measure Date Value
2021: SWAGGERTY'S SAUSAGE CO HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-12-01 188
Total number of active participants reported on line 7a of the Form 5500 2021-12-01 188
Total of all active and inactive participants 2021-12-01 188
2020: SWAGGERTY'S SAUSAGE CO HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-12-01 169
Total number of active participants reported on line 7a of the Form 5500 2020-12-01 188
Total of all active and inactive participants 2020-12-01 188
2019: SWAGGERTY'S SAUSAGE CO HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-12-01 161
Total number of active participants reported on line 7a of the Form 5500 2019-12-01 169
Total of all active and inactive participants 2019-12-01 169
2018: SWAGGERTY'S SAUSAGE CO HEALTH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-12-01 148
Total number of active participants reported on line 7a of the Form 5500 2018-12-01 161
Total of all active and inactive participants 2018-12-01 161
2017: SWAGGERTY'S SAUSAGE CO HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-12-01 133
Total number of active participants reported on line 7a of the Form 5500 2017-12-01 148
Total of all active and inactive participants 2017-12-01 148
Total participants 2017-12-01 148
2016: SWAGGERTY'S SAUSAGE CO HEALTH AND WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-12-01 139
Total number of active participants reported on line 7a of the Form 5500 2016-12-01 133
Total of all active and inactive participants 2016-12-01 133
Total participants 2016-12-01 133

Measure	Date	Value
2021: SWAGGERTY'S SAUSAGE CO HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-12-01	188
Total number of active participants reported on line 7a of the Form 5500	2021-12-01	188
Total of all active and inactive participants	2021-12-01	188
2020: SWAGGERTY'S SAUSAGE CO HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-12-01	169
Total number of active participants reported on line 7a of the Form 5500	2020-12-01	188
Total of all active and inactive participants	2020-12-01	188
2019: SWAGGERTY'S SAUSAGE CO HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-12-01	161
Total number of active participants reported on line 7a of the Form 5500	2019-12-01	169
Total of all active and inactive participants	2019-12-01	169
2018: SWAGGERTY'S SAUSAGE CO HEALTH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-12-01	148
Total number of active participants reported on line 7a of the Form 5500	2018-12-01	161
Total of all active and inactive participants	2018-12-01	161
2017: SWAGGERTY'S SAUSAGE CO HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-12-01	133
Total number of active participants reported on line 7a of the Form 5500	2017-12-01	148
Total of all active and inactive participants	2017-12-01	148
Total participants	2017-12-01	148
2016: SWAGGERTY'S SAUSAGE CO HEALTH AND WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-12-01	139
Total number of active participants reported on line 7a of the Form 5500	2016-12-01	133
Total of all active and inactive participants	2016-12-01	133
Total participants	2016-12-01	133

Form 5500 Responses for SWAGGERTY'S SAUSAGE CO HEALTH AND WELFARE PLAN

2021: SWAGGERTY'S SAUSAGE CO HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-12-01	Type of plan entity	Single employer plan
2021-12-01	Plan funding arrangement – Insurance	Yes
2021-12-01	Plan benefit arrangement – Insurance	Yes
2020: SWAGGERTY'S SAUSAGE CO HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-12-01	Type of plan entity	Single employer plan
2020-12-01	Plan funding arrangement – Insurance	Yes
2020-12-01	Plan benefit arrangement – Insurance	Yes
2019: SWAGGERTY'S SAUSAGE CO HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-12-01	Type of plan entity	Single employer plan
2019-12-01	Plan funding arrangement – Insurance	Yes
2019-12-01	Plan benefit arrangement – Insurance	Yes
2018: SWAGGERTY'S SAUSAGE CO HEALTH AND WELFARE PLAN 2018 form 5500 responses
2018-12-01	Type of plan entity	Single employer plan
2018-12-01	Plan funding arrangement – Insurance	Yes
2018-12-01	Plan benefit arrangement – Insurance	Yes
2017: SWAGGERTY'S SAUSAGE CO HEALTH AND WELFARE PLAN 2017 form 5500 responses
2017-12-01	Type of plan entity	Single employer plan
2017-12-01	Plan funding arrangement – Insurance	Yes
2017-12-01	Plan benefit arrangement – Insurance	Yes
2016: SWAGGERTY'S SAUSAGE CO HEALTH AND WELFARE PLAN 2016 form 5500 responses
2016-12-01	Type of plan entity	Single employer plan
2016-12-01	First time form 5500 has been submitted	Yes
2016-12-01	Plan funding arrangement – Insurance	Yes
2016-12-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1119222

Policy instance

Insurance contract or identification number	1119222
Number of Individuals Covered	195
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $1,614
Total amount of fees paid to insurance company	USD $248
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,561
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,467
Amount paid for insurance broker fees	248
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

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

Policy contract number

GUPR0AYGQ

Policy instance

Insurance contract or identification number	GUPR0AYGQ
Number of Individuals Covered	54
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $3,576
Other welfare benefits provided	VOLUNTARY LONG-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $23,843
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,576
Insurance broker organization code?	3

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

Policy contract number

GUC 0AYGQ

Policy instance

Insurance contract or identification number	GUC 0AYGQ
Number of Individuals Covered	72
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $4,186
Other welfare benefits provided	VOLUNTARY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $27,906
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,186
Insurance broker organization code?	3

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

Policy contract number

GVTL0AYGQ

Policy instance

Insurance contract or identification number	GVTL0AYGQ
Number of Individuals Covered	80
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $6,238
Other welfare benefits provided	VOLUNTARY LIFE, VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $41,587
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,238
Insurance broker organization code?	3

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

Policy contract number

GLUG0AYGQ

Policy instance

Insurance contract or identification number	GLUG0AYGQ
Number of Individuals Covered	188
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $838
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $5,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $838
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )

Policy contract number

132600

Policy instance

Insurance contract or identification number	132600
Number of Individuals Covered	233
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $50,369
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,249,668
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $50,369
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )

Policy contract number

132600

Policy instance

Insurance contract or identification number	132600
Number of Individuals Covered	233
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $65,663
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,209,672
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $65,663
Insurance broker organization code?	3

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

Policy contract number

GLUG0AYGQ

Policy instance

Insurance contract or identification number	GLUG0AYGQ
Number of Individuals Covered	188
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $841
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $5,608
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $841
Insurance broker organization code?	3

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

Policy contract number

GVTL0AYGQ

Policy instance

Insurance contract or identification number	GVTL0AYGQ
Number of Individuals Covered	84
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $5,980
Other welfare benefits provided	VOLUNTARY LIFE, VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $39,867
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,980
Insurance broker organization code?	3

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

Policy contract number

GUC 0AYGQ

Policy instance

Insurance contract or identification number	GUC 0AYGQ
Number of Individuals Covered	67
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $3,490
Other welfare benefits provided	VOLUNTARY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $23,265
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,490
Insurance broker organization code?	3

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

Policy contract number

GUPR0AYGQ

Policy instance

Insurance contract or identification number	GUPR0AYGQ
Number of Individuals Covered	56
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $3,346
Other welfare benefits provided	VOLUNTARY LONG-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $22,304
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,346
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1119222

Policy instance

Insurance contract or identification number	1119222
Number of Individuals Covered	212
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $1,633
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,568
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,633
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1119222

Policy instance

Insurance contract or identification number	1119222
Number of Individuals Covered	189
Insurance policy start date	2019-12-01
Insurance policy end date	2020-11-30
Total amount of commissions paid to insurance broker	USD $1,592
Total amount of fees paid to insurance company	USD $653
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,256
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,592
Amount paid for insurance broker fees	653
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

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

Policy contract number

GUPR0AYGQ

Policy instance

Insurance contract or identification number	GUPR0AYGQ
Number of Individuals Covered	47
Insurance policy start date	2019-12-01
Insurance policy end date	2020-11-30
Total amount of commissions paid to insurance broker	USD $3,314
Other welfare benefits provided	VOLUNTARY LONG-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $22,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,314
Insurance broker organization code?	3

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

Policy contract number

GUC 0AYGQ

Policy instance

Insurance contract or identification number	GUC 0AYGQ
Number of Individuals Covered	56
Insurance policy start date	2019-12-01
Insurance policy end date	2020-11-30
Total amount of commissions paid to insurance broker	USD $3,065
Other welfare benefits provided	VOLUNTARY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $20,431
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,065
Insurance broker organization code?	3

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

Policy contract number

GVTL0AYGQ

Policy instance

Insurance contract or identification number	GVTL0AYGQ
Number of Individuals Covered	82
Insurance policy start date	2019-12-01
Insurance policy end date	2020-11-30
Total amount of commissions paid to insurance broker	USD $5,304
Other welfare benefits provided	VOL LIFE, VOL AD&D
Welfare Benefit Premiums Paid to Carrier	USD $35,359
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,304
Insurance broker organization code?	3

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

Policy contract number

GLUG0AYGQ

Policy instance

Insurance contract or identification number	GLUG0AYGQ
Number of Individuals Covered	169
Insurance policy start date	2019-12-01
Insurance policy end date	2020-11-30
Total amount of commissions paid to insurance broker	USD $778
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $5,189
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $778
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )

Policy contract number

132600

Policy instance

Insurance contract or identification number	132600
Number of Individuals Covered	207
Insurance policy start date	2019-12-01
Insurance policy end date	2020-11-30
Total amount of commissions paid to insurance broker	USD $56,981
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $993,887
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $53,103
Insurance broker organization code?	3

BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )

Policy contract number

132600

Policy instance

Insurance contract or identification number	132600
Number of Individuals Covered	204
Insurance policy start date	2018-12-01
Insurance policy end date	2019-11-30
Total amount of commissions paid to insurance broker	USD $50,112
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $943,143
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $50,112
Insurance broker organization code?	3

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

Policy contract number

GLUG0AYGQ

Policy instance

Insurance contract or identification number	GLUG0AYGQ
Number of Individuals Covered	161
Insurance policy start date	2018-12-01
Insurance policy end date	2019-11-30
Total amount of commissions paid to insurance broker	USD $736
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $4,906
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $736
Insurance broker organization code?	3

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

Policy contract number

GVTL0AYGQ

Policy instance

Insurance contract or identification number	GVTL0AYGQ
Number of Individuals Covered	73
Insurance policy start date	2018-12-01
Insurance policy end date	2019-11-30
Total amount of commissions paid to insurance broker	USD $4,912
Other welfare benefits provided	VOLUNTARY LIFE, VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $32,745
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,912
Insurance broker organization code?	3

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

Policy contract number

GUC 0AYGQ

Policy instance

Insurance contract or identification number	GUC 0AYGQ
Number of Individuals Covered	54
Insurance policy start date	2018-12-01
Insurance policy end date	2019-11-30
Total amount of commissions paid to insurance broker	USD $3,095
Other welfare benefits provided	VOLUNTARY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $20,635
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,095
Insurance broker organization code?	3

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

Policy contract number

GUPR0AYGQ

Policy instance

Insurance contract or identification number	GUPR0AYGQ
Number of Individuals Covered	45
Insurance policy start date	2018-12-01
Insurance policy end date	2019-11-30
Total amount of commissions paid to insurance broker	USD $2,989
Other welfare benefits provided	VOLUNTARY LONG-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $19,929
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,989
Insurance broker organization code?	3

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

Policy contract number

GUPR0AYGQ

Policy instance

Insurance contract or identification number	GUPR0AYGQ
Number of Individuals Covered	42
Insurance policy start date	2017-12-01
Insurance policy end date	2018-11-30
Total amount of commissions paid to insurance broker	USD $2,302
Other welfare benefits provided	VOLUNTARY LONG-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $15,376
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

GUC 0AYGQ

Policy instance

Insurance contract or identification number	GUC 0AYGQ
Number of Individuals Covered	58
Insurance policy start date	2017-12-01
Insurance policy end date	2018-11-30
Total amount of commissions paid to insurance broker	USD $2,864
Other welfare benefits provided	VOLUNTARY SHORT-TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $19,126
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

GVTL0AYGQ

Policy instance

Insurance contract or identification number	GVTL0AYGQ
Number of Individuals Covered	73
Insurance policy start date	2017-12-01
Insurance policy end date	2018-11-30
Total amount of commissions paid to insurance broker	USD $4,685
Other welfare benefits provided	VOLUNTARY LIFE, VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $31,286
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

GLUG0AYGQ

Policy instance

Insurance contract or identification number	GLUG0AYGQ
Number of Individuals Covered	148
Insurance policy start date	2017-12-01
Insurance policy end date	2018-11-30
Total amount of commissions paid to insurance broker	USD $645
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $4,307
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )

Policy contract number

132600

Policy instance

Insurance contract or identification number	132600
Number of Individuals Covered	194
Insurance policy start date	2017-12-01
Insurance policy end date	2018-11-30
Total amount of commissions paid to insurance broker	USD $51,147
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $810,377
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	SWAGGERTY'S SAUSAGE CO
Employer identification number (EIN):	620901882
NAIC Classification:	311610
NAIC Description:	Animal Slaughtering and Processing