401k Plan data: DFA DAIRY BRANDS UNION WELFARE PLAN plan

DFA DAIRY BRANDS UNION WELFARE PLAN 401k Plan overview

Plan Name	DFA DAIRY BRANDS UNION WELFARE PLAN
Plan identification number	502

DFA DAIRY BRANDS UNION WELFARE 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) Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

DFA DAIRY BRANDS CORPORATE LLC has sponsored the creation of one or more 401k plans.

Company Name: DFA DAIRY BRANDS CORPORATE LLC

Employer identification number (EIN): 850489626

NAIC Classification: 311500
NAIC Description: Dairy Product Manufacturing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DFA DAIRY BRANDS UNION WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2020-05-01

Plan Statistics for DFA DAIRY BRANDS UNION WELFARE PLAN

401k plan membership statisitcs for DFA DAIRY BRANDS UNION WELFARE PLAN

Measure Date Value
2020: DFA DAIRY BRANDS UNION WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-05-01 3,863
Total number of active participants reported on line 7a of the Form 5500 2020-05-01 0
Number of retired or separated participants receiving benefits 2020-05-01 0
Number of other retired or separated participants entitled to future benefits 2020-05-01 0
Total of all active and inactive participants 2020-05-01 0

Measure	Date	Value
2020: DFA DAIRY BRANDS UNION WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-05-01	3,863
Total number of active participants reported on line 7a of the Form 5500	2020-05-01	0
Number of retired or separated participants receiving benefits	2020-05-01	0
Number of other retired or separated participants entitled to future benefits	2020-05-01	0
Total of all active and inactive participants	2020-05-01	0

Form 5500 Responses for DFA DAIRY BRANDS UNION WELFARE PLAN

2020: DFA DAIRY BRANDS UNION WELFARE PLAN 2020 form 5500 responses
2020-05-01	Type of plan entity	Single employer plan
2020-05-01	First time form 5500 has been submitted	Yes
2020-05-01	This submission is the final filing	Yes
2020-05-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2020-05-01	Plan funding arrangement – Insurance	Yes
2020-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-05-01	Plan benefit arrangement – Insurance	Yes
2020-05-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

20746

Policy instance

Insurance contract or identification number	20746
Number of Individuals Covered	446
Insurance policy start date	2020-05-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $6,220
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $24,432
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,145
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLK980179

Policy instance

Insurance contract or identification number	FLK980179
Number of Individuals Covered	802
Insurance policy start date	2020-05-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $876
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $88,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $876
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX980343

Policy instance

Insurance contract or identification number	FLX980343
Number of Individuals Covered	1598
Insurance policy start date	2020-05-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $15,692
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $291,428
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,692
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 980365

Policy instance

Insurance contract or identification number	OK 980365
Number of Individuals Covered	1279
Insurance policy start date	2020-05-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,655
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $33,988
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,655
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12191674

Policy instance

Insurance contract or identification number	12191674
Number of Individuals Covered	489
Insurance policy start date	2020-05-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,974
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $56,359
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,974
Insurance broker organization code?	3

VALUEOPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 62199 )

Policy contract number

Policy instance

Number of Individuals Covered	3772
Insurance policy start date	2020-05-01
Insurance policy end date	2020-12-31
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $14,894
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	DFA DAIRY BRANDS CORPORATE LLC
Employer identification number (EIN):	850489626
NAIC Classification:	311500
NAIC Description:	Dairy Product Manufacturing