401k Plan data: TRILLIANT EMPLOYEE BENEFIT PLAN plan

TRILLIANT EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	TRILLIANT EMPLOYEE BENEFIT PLAN
Plan identification number	503

TRILLIANT 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) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

TRILLIANT HOLDINGS L.P. has sponsored the creation of one or more 401k plans.

Company Name: TRILLIANT HOLDINGS L.P.

Employer identification number (EIN): 900924820

NAIC Classification: 311900
NAIC Description: Other Food Manufacturing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TRILLIANT EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2019-04-01

Plan Statistics for TRILLIANT EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for TRILLIANT EMPLOYEE BENEFIT PLAN

Measure Date Value
2019: TRILLIANT EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-04-01 887
Total number of active participants reported on line 7a of the Form 5500 2019-04-01 597
Number of retired or separated participants receiving benefits 2019-04-01 0
Total of all active and inactive participants 2019-04-01 597
Total participants 2019-04-01 597

Measure	Date	Value
2019: TRILLIANT EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-04-01	887
Total number of active participants reported on line 7a of the Form 5500	2019-04-01	597
Number of retired or separated participants receiving benefits	2019-04-01	0
Total of all active and inactive participants	2019-04-01	597
Total participants	2019-04-01	597

Form 5500 Responses for TRILLIANT EMPLOYEE BENEFIT PLAN

2019: TRILLIANT EMPLOYEE BENEFIT PLAN 2019 form 5500 responses
2019-04-01	Type of plan entity	Single employer plan
2019-04-01	Submission has been amended	No
2019-04-01	This submission is the final filing	No
2019-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-04-01	Plan is a collectively bargained plan	No
2019-04-01	Plan funding arrangement – Insurance	Yes
2019-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-04-01	Plan benefit arrangement – Insurance	Yes
2019-04-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

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

Policy contract number

0909274

Policy instance

Insurance contract or identification number	0909274
Number of Individuals Covered	507
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $7,983
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $79,872
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,983
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3

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

Policy contract number

G000BJ92

Policy instance

Insurance contract or identification number	G000BJ92
Number of Individuals Covered	489
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $20,995
Total amount of fees paid to insurance company	USD $15,567
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	VOLUNTARY AD&D
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $323,906
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	10405
Additional information about fees paid to insurance broker	ADMINISTRATION
Insurance broker organization code?	5

Potentially related plans

TRILLIANT EMPLOYEE BENEFIT PLAN [EIN = 680496194]

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Company Name:	TRILLIANT HOLDINGS L.P.
Employer identification number (EIN):	900924820
NAIC Classification:	311900
NAIC Description:	Other Food Manufacturing