401k Plan data: SORBARA & SON, LP LIFE, AD&D AND STD PLAN plan

SORBARA & SON, LP LIFE, AD&D AND STD PLAN 401k Plan overview

Plan Name	SORBARA & SON, LP LIFE, AD&D AND STD PLAN
Plan identification number	501

SORBARA & SON, LP LIFE, AD&D AND STD PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Temporary disability (accident and sickness) Death benefits (include travel accident but not life insurance) Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

SORBARA AND SON, LP has sponsored the creation of one or more 401k plans.

Company Name: SORBARA AND SON, LP

Employer identification number (EIN): 204245192

NAIC Classification: 445110
NAIC Description: Supermarkets and Other Grocery (except Convenience) Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SORBARA & SON, LP LIFE, AD&D AND STD PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-09-01
501 2014-09-01
501 2013-09-01

Plan Statistics for SORBARA & SON, LP LIFE, AD&D AND STD PLAN

401k plan membership statisitcs for SORBARA & SON, LP LIFE, AD&D AND STD PLAN

Measure Date Value
2015: SORBARA & SON, LP LIFE, AD&D AND STD PLAN 2015 401k membership
Total participants, beginning-of-year 2015-09-01 100
Total number of active participants reported on line 7a of the Form 5500 2015-09-01 64
Number of retired or separated participants receiving benefits 2015-09-01 0
Number of other retired or separated participants entitled to future benefits 2015-09-01 0
Total of all active and inactive participants 2015-09-01 64
2014: SORBARA & SON, LP LIFE, AD&D AND STD PLAN 2014 401k membership
Total participants, beginning-of-year 2014-09-01 108
Total number of active participants reported on line 7a of the Form 5500 2014-09-01 99
Number of retired or separated participants receiving benefits 2014-09-01 0
Number of other retired or separated participants entitled to future benefits 2014-09-01 0
Total of all active and inactive participants 2014-09-01 99
2013: SORBARA & SON, LP LIFE, AD&D AND STD PLAN 2013 401k membership
Total participants, beginning-of-year 2013-09-01 280
Total number of active participants reported on line 7a of the Form 5500 2013-09-01 197
Number of retired or separated participants receiving benefits 2013-09-01 0
Number of other retired or separated participants entitled to future benefits 2013-09-01 0
Total of all active and inactive participants 2013-09-01 197

Measure	Date	Value
2015: SORBARA & SON, LP LIFE, AD&D AND STD PLAN 2015 401k membership
Total participants, beginning-of-year	2015-09-01	100
Total number of active participants reported on line 7a of the Form 5500	2015-09-01	64
Number of retired or separated participants receiving benefits	2015-09-01	0
Number of other retired or separated participants entitled to future benefits	2015-09-01	0
Total of all active and inactive participants	2015-09-01	64
2014: SORBARA & SON, LP LIFE, AD&D AND STD PLAN 2014 401k membership
Total participants, beginning-of-year	2014-09-01	108
Total number of active participants reported on line 7a of the Form 5500	2014-09-01	99
Number of retired or separated participants receiving benefits	2014-09-01	0
Number of other retired or separated participants entitled to future benefits	2014-09-01	0
Total of all active and inactive participants	2014-09-01	99
2013: SORBARA & SON, LP LIFE, AD&D AND STD PLAN 2013 401k membership
Total participants, beginning-of-year	2013-09-01	280
Total number of active participants reported on line 7a of the Form 5500	2013-09-01	197
Number of retired or separated participants receiving benefits	2013-09-01	0
Number of other retired or separated participants entitled to future benefits	2013-09-01	0
Total of all active and inactive participants	2013-09-01	197

Form 5500 Responses for SORBARA & SON, LP LIFE, AD&D AND STD PLAN

2015: SORBARA & SON, LP LIFE, AD&D AND STD PLAN 2015 form 5500 responses
2015-09-01	Type of plan entity	Single employer plan
2015-09-01	Plan funding arrangement – Insurance	Yes
2015-09-01	Plan benefit arrangement – Insurance	Yes
2014: SORBARA & SON, LP LIFE, AD&D AND STD PLAN 2014 form 5500 responses
2014-09-01	Type of plan entity	Single employer plan
2014-09-01	Plan funding arrangement – Insurance	Yes
2014-09-01	Plan benefit arrangement – Insurance	Yes
2013: SORBARA & SON, LP LIFE, AD&D AND STD PLAN 2013 form 5500 responses
2013-09-01	Type of plan entity	Single employer plan
2013-09-01	Plan funding arrangement – Insurance	Yes
2013-09-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MADISON NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65781 )

Policy contract number

7672-MNL

Policy instance

Insurance contract or identification number	7672-MNL
Number of Individuals Covered	101
Insurance policy start date	2015-09-01
Insurance policy end date	2016-08-31
Total amount of commissions paid to insurance broker	USD $476
Total amount of fees paid to insurance company	USD $737
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $4,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $476
Insurance broker organization code?	3
Amount paid for insurance broker fees	404
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker name	STUART D. FOX

MADISON NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65781 )

Policy contract number

7672-MNL

Policy instance

Insurance contract or identification number	7672-MNL
Number of Individuals Covered	99
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $959
Total amount of fees paid to insurance company	USD $644
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $7,579
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	644
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker organization code?	5
Commission paid to Insurance Broker	USD $564
Insurance broker name	STUART D. FOX

FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )

Policy contract number

7672-4EL

Policy instance

Insurance contract or identification number	7672-4EL
Number of Individuals Covered	197
Insurance policy start date	2013-09-01
Insurance policy end date	2014-08-31
Total amount of commissions paid to insurance broker	USD $1,039
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $10,385
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,039
Insurance broker organization code?	3
Insurance broker name	COURY HEALTH SERVICES, INC.

Potentially related plans

SORBARA & SON, LP HEALTH PLAN [EIN = 251859682]

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Company Name:	SORBARA AND SON, LP
Employer identification number (EIN):	204245192
NAIC Classification:	445110
NAIC Description:	Supermarkets and Other Grocery (except Convenience) Stores