401k Plan data: CP FOODS CAFETERIA & WRAP PLAN plan

CP FOODS CAFETERIA & WRAP PLAN 401k Plan overview

Plan Name	CP FOODS CAFETERIA & WRAP PLAN
Plan identification number	501

CP FOODS CAFETERIA & WRAP 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)

401k Sponsoring company profile

CP FOODS has sponsored the creation of one or more 401k plans.

Company Name: CP FOODS

Employer identification number (EIN): 863165454

NAIC Classification: 311900
NAIC Description: Other Food Manufacturing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CP FOODS CAFETERIA & WRAP PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-05-01

Plan Statistics for CP FOODS CAFETERIA & WRAP PLAN

401k plan membership statisitcs for CP FOODS CAFETERIA & WRAP PLAN

Measure Date Value
2021: CP FOODS CAFETERIA & WRAP PLAN 2021 401k membership
Total participants, beginning-of-year 2021-05-01 128
Total number of active participants reported on line 7a of the Form 5500 2021-05-01 0
Number of retired or separated participants receiving benefits 2021-05-01 0
Number of other retired or separated participants entitled to future benefits 2021-05-01 0
Total of all active and inactive participants 2021-05-01 0

Measure	Date	Value
2021: CP FOODS CAFETERIA & WRAP PLAN 2021 401k membership
Total participants, beginning-of-year	2021-05-01	128
Total number of active participants reported on line 7a of the Form 5500	2021-05-01	0
Number of retired or separated participants receiving benefits	2021-05-01	0
Number of other retired or separated participants entitled to future benefits	2021-05-01	0
Total of all active and inactive participants	2021-05-01	0

Form 5500 Responses for CP FOODS CAFETERIA & WRAP PLAN

2021: CP FOODS CAFETERIA & WRAP PLAN 2021 form 5500 responses
2021-05-01	Type of plan entity	Single employer plan
2021-05-01	First time form 5500 has been submitted	Yes
2021-05-01	Submission has been amended	No
2021-05-01	This submission is the final filing	Yes
2021-05-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2021-05-01	Plan is a collectively bargained plan	No
2021-05-01	Plan funding arrangement – Insurance	Yes
2021-05-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0922959

Policy instance

Insurance contract or identification number	0922959
Number of Individuals Covered	145
Insurance policy start date	2021-05-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $28,910
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $652,956
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,089
Insurance broker organization code?	3

ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )

Policy contract number

AL00006236

Policy instance

Insurance contract or identification number	AL00006236
Number of Individuals Covered	81
Insurance policy start date	2021-05-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $4,963
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $38,911
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,644
Insurance broker organization code?	3

ANTHEM HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 60217 )

Policy contract number

800692

Policy instance

Insurance contract or identification number	800692
Number of Individuals Covered	130
Insurance policy start date	2021-05-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,345
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,309
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $369
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0922959

Policy instance

Insurance contract or identification number	0922959
Number of Individuals Covered	75
Insurance policy start date	2021-05-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,873
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $42,772
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $358
Insurance broker organization code?	3

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Company Name:	CP FOODS
Employer identification number (EIN):	863165454
NAIC Classification:	311900
NAIC Description:	Other Food Manufacturing