401k Plan data: RIVER VALLEY MARKET WELFARE BENEFIT PLAN plan

RIVER VALLEY MARKET WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	RIVER VALLEY MARKET WELFARE BENEFIT PLAN
Plan identification number	503

RIVER VALLEY MARKET WELFARE 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

RIVER VALLEY MARKET LLC has sponsored the creation of one or more 401k plans.

Company Name: RIVER VALLEY MARKET LLC

Employer identification number (EIN): 208519734

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RIVER VALLEY MARKET WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2022-07-01 NICOLE COWLIN 2024-01-02
503 2021-07-01 NICOLE COWLIN 2023-01-27
503 2020-07-01 NICOLE COWLIN 2022-01-24
503 2019-07-01 2021-03-15 NICOLE COWLIN 2021-03-15
503 2018-07-01 NICOLE COWLIN 2020-02-26

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2022-07-01	NICOLE COWLIN	2024-01-02
503	2021-07-01	NICOLE COWLIN	2023-01-27
503	2020-07-01	NICOLE COWLIN	2022-01-24
503	2019-07-01		2021-03-15	NICOLE COWLIN	2021-03-15
503	2018-07-01	NICOLE COWLIN	2020-02-26

Plan Statistics for RIVER VALLEY MARKET WELFARE BENEFIT PLAN

401k plan membership statisitcs for RIVER VALLEY MARKET WELFARE BENEFIT PLAN

Measure Date Value
2022: RIVER VALLEY MARKET WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-07-01 196
Total number of active participants reported on line 7a of the Form 5500 2022-07-01 206
Number of retired or separated participants receiving benefits 2022-07-01 1
Total of all active and inactive participants 2022-07-01 207
2021: RIVER VALLEY MARKET WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-07-01 148
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 195
Number of retired or separated participants receiving benefits 2021-07-01 2
Total of all active and inactive participants 2021-07-01 197
2020: RIVER VALLEY MARKET WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-07-01 142
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 147
Total of all active and inactive participants 2020-07-01 147
2019: RIVER VALLEY MARKET WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-07-01 139
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 145
Total of all active and inactive participants 2019-07-01 145
2018: RIVER VALLEY MARKET WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-07-01 132
Total number of active participants reported on line 7a of the Form 5500 2018-07-01 130
Total of all active and inactive participants 2018-07-01 130

Measure	Date	Value
2022: RIVER VALLEY MARKET WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-07-01	196
Total number of active participants reported on line 7a of the Form 5500	2022-07-01	206
Number of retired or separated participants receiving benefits	2022-07-01	1
Total of all active and inactive participants	2022-07-01	207
2021: RIVER VALLEY MARKET WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-07-01	148
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	195
Number of retired or separated participants receiving benefits	2021-07-01	2
Total of all active and inactive participants	2021-07-01	197
2020: RIVER VALLEY MARKET WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-07-01	142
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	147
Total of all active and inactive participants	2020-07-01	147
2019: RIVER VALLEY MARKET WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-07-01	139
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	145
Total of all active and inactive participants	2019-07-01	145
2018: RIVER VALLEY MARKET WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-07-01	132
Total number of active participants reported on line 7a of the Form 5500	2018-07-01	130
Total of all active and inactive participants	2018-07-01	130

Form 5500 Responses for RIVER VALLEY MARKET WELFARE BENEFIT PLAN

2022: RIVER VALLEY MARKET WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-07-01	Type of plan entity	Single employer plan
2022-07-01	Plan funding arrangement – Insurance	Yes
2022-07-01	Plan benefit arrangement – Insurance	Yes
2021: RIVER VALLEY MARKET WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2020: RIVER VALLEY MARKET WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2019: RIVER VALLEY MARKET WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2018: RIVER VALLEY MARKET WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-07-01	Type of plan entity	Single employer plan
2018-07-01	First time form 5500 has been submitted	Yes
2018-07-01	Plan funding arrangement – Insurance	Yes
2018-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00021447

Policy instance

Insurance contract or identification number	00021447
Number of Individuals Covered	279
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $11,795
Total amount of fees paid to insurance company	USD $4,375
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD & D, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $127,745
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,795
Amount paid for insurance broker fees	4375
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )

Policy contract number

115858

Policy instance

Insurance contract or identification number	115858
Number of Individuals Covered	193
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $40,789
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $982,981
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,789
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00021447

Policy instance

Insurance contract or identification number	00021447
Number of Individuals Covered	265
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $11,059
Total amount of fees paid to insurance company	USD $1,166
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD & D, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $120,639
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,059
Amount paid for insurance broker fees	1166
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )

Policy contract number

115858

Policy instance

Insurance contract or identification number	115858
Number of Individuals Covered	190
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $38,245
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $948,648
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $38,245
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5952404

Policy instance

Insurance contract or identification number	5952404
Number of Individuals Covered	210
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $6,462
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $100,023
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,462
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0215634

Policy instance

Insurance contract or identification number	0215634
Number of Individuals Covered	68
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $1,232
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $5,181
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,232
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0215630

Policy instance

Insurance contract or identification number	0215630
Number of Individuals Covered	105
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $1,760
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $7,988
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,760
Insurance broker organization code?	3

HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )

Policy contract number

115858

Policy instance

Insurance contract or identification number	115858
Number of Individuals Covered	176
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $27,889
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $771,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,889
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0215632

Policy instance

Insurance contract or identification number	0215632
Number of Individuals Covered	49
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $2,672
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	HOSPITAL GAP
Welfare Benefit Premiums Paid to Carrier	USD $11,628
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,672
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0215632

Policy instance

Insurance contract or identification number	0215632
Number of Individuals Covered	44
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $2,543
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	HOSPITAL GAP
Welfare Benefit Premiums Paid to Carrier	USD $9,665
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,543
Insurance broker organization code?	3

HEALTH NEW ENGLAND, INC. (National Association of Insurance Commissioners NAIC id number: 95673 )

Policy contract number

115858

Policy instance

Insurance contract or identification number	115858
Number of Individuals Covered	167
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $31,936
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $717,861
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,936
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0215630

Policy instance

Insurance contract or identification number	0215630
Number of Individuals Covered	94
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $1,592
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $7,208
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
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0215634

Policy instance

Insurance contract or identification number	0215634
Number of Individuals Covered	66
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $1,137
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $4,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,137
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5952404

Policy instance

Insurance contract or identification number	5952404
Number of Individuals Covered	204
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $6,221
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $113,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,221
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5952404

Policy instance

Insurance contract or identification number	5952404
Number of Individuals Covered	107
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $1,696
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $8,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,696
Additional information about fees paid to insurance broker	BASE COMPENSATION
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5952404

Policy instance

Insurance contract or identification number	5952404
Number of Individuals Covered	110
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $1,759
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $8,795
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,759
Additional information about fees paid to insurance broker	BASE COMPENSATION
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5952404

Policy instance

Insurance contract or identification number	5952404
Number of Individuals Covered	99
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $4,302
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $21,509
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,302
Additional information about fees paid to insurance broker	BASE COMPENSATION
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5952404

Policy instance

Insurance contract or identification number	5952404
Number of Individuals Covered	42
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $787
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	VOLUNTARY LIFE
Welfare Benefit Premiums Paid to Carrier	USD $5,245
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $787
Additional information about fees paid to insurance broker	BASE COMPENSATION
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5952404

Policy instance

Insurance contract or identification number	5952404
Number of Individuals Covered	97
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $3,038
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $42,340
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,038
Additional information about fees paid to insurance broker	BASE COMPENSATION
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5952404

Policy instance

Insurance contract or identification number	5952404
Number of Individuals Covered	65
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $812
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,124
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $812
Additional information about fees paid to insurance broker	BASE COMPENSATION
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5952404

Policy instance

Insurance contract or identification number	5952404
Number of Individuals Covered	130
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $6,339
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $50,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,339
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BASE COMPENSATION
Insurance broker organization code?	3

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Company Name:	RIVER VALLEY MARKET LLC
Employer identification number (EIN):	208519734
NAIC Classification:	445110
NAIC Description:	Supermarkets and Other Grocery (except Convenience) Stores