401k Plan data: ASSOCIATED GROCERS OF THE SOUTH, INC. VISION PLAN plan

ASSOCIATED GROCERS OF THE SOUTH, INC. VISION PLAN 401k Plan overview

Plan Name	ASSOCIATED GROCERS OF THE SOUTH, INC. VISION PLAN
Plan identification number	504

ASSOCIATED GROCERS OF THE SOUTH, INC. VISION PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Vision

401k Sponsoring company profile

ASSOCIATED GROCERS OF THE SOUTH, INC. has sponsored the creation of one or more 401k plans.

Company Name: ASSOCIATED GROCERS OF THE SOUTH, INC.

Employer identification number (EIN): 630011690

NAIC Classification: 424400

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ASSOCIATED GROCERS OF THE SOUTH, INC. VISION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2022-10-01
504 2021-10-01

Plan Statistics for ASSOCIATED GROCERS OF THE SOUTH, INC. VISION PLAN

401k plan membership statisitcs for ASSOCIATED GROCERS OF THE SOUTH, INC. VISION PLAN

Measure Date Value
2022: ASSOCIATED GROCERS OF THE SOUTH, INC. VISION PLAN 2022 401k membership
Total participants, beginning-of-year 2022-10-01 117
Total number of active participants reported on line 7a of the Form 5500 2022-10-01 101
Number of retired or separated participants receiving benefits 2022-10-01 0
Number of other retired or separated participants entitled to future benefits 2022-10-01 0
Total of all active and inactive participants 2022-10-01 101
2021: ASSOCIATED GROCERS OF THE SOUTH, INC. VISION PLAN 2021 401k membership
Total participants, beginning-of-year 2021-10-01 106
Total number of active participants reported on line 7a of the Form 5500 2021-10-01 93
Number of retired or separated participants receiving benefits 2021-10-01 0
Number of other retired or separated participants entitled to future benefits 2021-10-01 0
Total of all active and inactive participants 2021-10-01 93

Measure	Date	Value
2022: ASSOCIATED GROCERS OF THE SOUTH, INC. VISION PLAN 2022 401k membership
Total participants, beginning-of-year	2022-10-01	117
Total number of active participants reported on line 7a of the Form 5500	2022-10-01	101
Number of retired or separated participants receiving benefits	2022-10-01	0
Number of other retired or separated participants entitled to future benefits	2022-10-01	0
Total of all active and inactive participants	2022-10-01	101
2021: ASSOCIATED GROCERS OF THE SOUTH, INC. VISION PLAN 2021 401k membership
Total participants, beginning-of-year	2021-10-01	106
Total number of active participants reported on line 7a of the Form 5500	2021-10-01	93
Number of retired or separated participants receiving benefits	2021-10-01	0
Number of other retired or separated participants entitled to future benefits	2021-10-01	0
Total of all active and inactive participants	2021-10-01	93

Form 5500 Responses for ASSOCIATED GROCERS OF THE SOUTH, INC. VISION PLAN

2022: ASSOCIATED GROCERS OF THE SOUTH, INC. VISION PLAN 2022 form 5500 responses
2022-10-01	Type of plan entity	Single employer plan
2022-10-01	Submission has been amended	No
2022-10-01	This submission is the final filing	No
2022-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-10-01	Plan is a collectively bargained plan	No
2022-10-01	Plan funding arrangement – Insurance	Yes
2022-10-01	Plan benefit arrangement – Insurance	Yes
2021: ASSOCIATED GROCERS OF THE SOUTH, INC. VISION PLAN 2021 form 5500 responses
2021-10-01	Type of plan entity	Single employer plan
2021-10-01	First time form 5500 has been submitted	Yes
2021-10-01	Submission has been amended	No
2021-10-01	This submission is the final filing	No
2021-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-10-01	Plan is a collectively bargained plan	No
2021-10-01	Plan funding arrangement – Insurance	Yes
2021-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

30021781

Policy instance

Insurance contract or identification number	30021781
Number of Individuals Covered	101
Insurance policy start date	2022-10-01
Insurance policy end date	2023-09-30
Total amount of commissions paid to insurance broker	USD $2,023
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 $17,595
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,602
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

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

Policy contract number

30021781

Policy instance

Insurance contract or identification number	30021781
Number of Individuals Covered	97
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $1,418
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 $16,816
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,418
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

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Company Name:	ASSOCIATED GROCERS OF THE SOUTH, INC.
Employer identification number (EIN):	630011690
NAIC Classification:	424400