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ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 401k Plan overview

Plan NameROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D
Plan identification number 501

ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Temporary disability (accident and sickness)

401k Sponsoring company profile

ROTELLAS ITALIAN BAKERY has sponsored the creation of one or more 401k plans.

Company Name:ROTELLAS ITALIAN BAKERY
Employer identification number (EIN):470489748
NAIC Classification:311800
NAIC Description: Bakeries and Tortilla Manufacturing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012024-01-01DEAN JACOBSEN
5012023-01-01
5012023-01-01DEAN JACOBSEN
5012022-01-01
5012022-01-01DEAN JACOBSEN
5012021-01-01
5012021-01-01DEAN JACOBSEN
5012020-01-01
5012019-03-01
5012018-03-01
5012017-03-01DEAN JACOBSEN DEAN JACOBSEN2018-10-08
5012016-03-01DEAN JACOBSEN DEAN JACOBSEN2017-09-13
5012015-03-01DEAN JACOBSEN DEAN JACOBSEN2016-09-12
5012014-03-01DEAN JACOBSEN DEAN JACOBSEN2015-09-21
5012013-03-01DEAN JACOBSEN DEAN JACOBSEN2014-09-25
5012012-03-01DEAN JACOBSEN DEAN JACOBSEN2013-06-24
5012011-03-01DEAN JACOBSEN DEAN JACOBSEN2012-08-07
5012009-03-01DEAN JACOBSEN DEAN JACOBSEN2010-07-30
5012008-03-01

Plan Statistics for ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D

401k plan membership statisitcs for ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D

Measure Date Value
2023: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2023 401k membership
Total participants, beginning-of-year2023-01-01345
Total number of active participants reported on line 7a of the Form 55002023-01-01348
Number of retired or separated participants receiving benefits2023-01-010
Number of other retired or separated participants entitled to future benefits2023-01-010
Total of all active and inactive participants2023-01-01348
2022: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2022 401k membership
Total participants, beginning-of-year2022-01-01406
Total number of active participants reported on line 7a of the Form 55002022-01-01345
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01345
2021: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2021 401k membership
Total participants, beginning-of-year2021-01-01422
Total number of active participants reported on line 7a of the Form 55002021-01-01406
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01406
2020: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2020 401k membership
Total participants, beginning-of-year2020-01-01432
Total number of active participants reported on line 7a of the Form 55002020-01-01422
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01422
2019: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2019 401k membership
Total participants, beginning-of-year2019-03-01438
Total number of active participants reported on line 7a of the Form 55002019-03-01432
Number of retired or separated participants receiving benefits2019-03-010
Number of other retired or separated participants entitled to future benefits2019-03-010
Total of all active and inactive participants2019-03-01432
2018: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2018 401k membership
Total participants, beginning-of-year2018-03-01420
Total number of active participants reported on line 7a of the Form 55002018-03-01438
Number of retired or separated participants receiving benefits2018-03-010
Number of other retired or separated participants entitled to future benefits2018-03-010
Total of all active and inactive participants2018-03-01438
2017: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2017 401k membership
Total participants, beginning-of-year2017-03-01420
Total number of active participants reported on line 7a of the Form 55002017-03-01420
Number of retired or separated participants receiving benefits2017-03-010
Number of other retired or separated participants entitled to future benefits2017-03-010
Total of all active and inactive participants2017-03-01420
2016: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2016 401k membership
Total participants, beginning-of-year2016-03-01368
Total number of active participants reported on line 7a of the Form 55002016-03-01420
Number of retired or separated participants receiving benefits2016-03-010
Number of other retired or separated participants entitled to future benefits2016-03-010
Total of all active and inactive participants2016-03-01420
2015: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2015 401k membership
Total participants, beginning-of-year2015-03-01364
Total number of active participants reported on line 7a of the Form 55002015-03-01368
Number of retired or separated participants receiving benefits2015-03-010
Number of other retired or separated participants entitled to future benefits2015-03-010
Total of all active and inactive participants2015-03-01368
2014: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2014 401k membership
Total participants, beginning-of-year2014-03-01334
Total number of active participants reported on line 7a of the Form 55002014-03-01364
Number of retired or separated participants receiving benefits2014-03-010
Number of other retired or separated participants entitled to future benefits2014-03-010
Total of all active and inactive participants2014-03-01364
2013: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2013 401k membership
Total participants, beginning-of-year2013-03-01302
Total number of active participants reported on line 7a of the Form 55002013-03-01334
Total of all active and inactive participants2013-03-01334
2012: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2012 401k membership
Total participants, beginning-of-year2012-03-01290
Total number of active participants reported on line 7a of the Form 55002012-03-01302
Total of all active and inactive participants2012-03-01302
2011: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2011 401k membership
Total participants, beginning-of-year2011-03-01259
Total number of active participants reported on line 7a of the Form 55002011-03-01290
Total of all active and inactive participants2011-03-01290
2009: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2009 401k membership
Total participants, beginning-of-year2009-03-01221
Total number of active participants reported on line 7a of the Form 55002009-03-01229
Total of all active and inactive participants2009-03-01229

Form 5500 Responses for ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D

2023: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – InsuranceYes
2022: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2019 form 5500 responses
2019-03-01Type of plan entitySingle employer plan
2019-03-01This return/report is a short plan year return/report (less than 12 months)Yes
2019-03-01Plan funding arrangement – InsuranceYes
2019-03-01Plan benefit arrangement – InsuranceYes
2018: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2018 form 5500 responses
2018-03-01Type of plan entitySingle employer plan
2018-03-01Plan funding arrangement – InsuranceYes
2018-03-01Plan benefit arrangement – InsuranceYes
2017: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2017 form 5500 responses
2017-03-01Type of plan entitySingle employer plan
2017-03-01Plan funding arrangement – InsuranceYes
2017-03-01Plan benefit arrangement – InsuranceYes
2016: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2016 form 5500 responses
2016-03-01Type of plan entitySingle employer plan
2016-03-01Plan funding arrangement – InsuranceYes
2016-03-01Plan benefit arrangement – InsuranceYes
2015: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2015 form 5500 responses
2015-03-01Type of plan entitySingle employer plan
2015-03-01Plan funding arrangement – InsuranceYes
2015-03-01Plan benefit arrangement – InsuranceYes
2014: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2014 form 5500 responses
2014-03-01Type of plan entitySingle employer plan
2014-03-01Plan funding arrangement – InsuranceYes
2014-03-01Plan benefit arrangement – InsuranceYes
2013: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2013 form 5500 responses
2013-03-01Type of plan entitySingle employer plan
2013-03-01Plan funding arrangement – InsuranceYes
2013-03-01Plan benefit arrangement – InsuranceYes
2012: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2012 form 5500 responses
2012-03-01Type of plan entitySingle employer plan
2012-03-01Plan funding arrangement – InsuranceYes
2012-03-01Plan benefit arrangement – InsuranceYes
2011: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2011 form 5500 responses
2011-03-01Type of plan entitySingle employer plan
2011-03-01Plan funding arrangement – InsuranceYes
2011-03-01Plan benefit arrangement – InsuranceYes
2009: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2009 form 5500 responses
2009-03-01Type of plan entitySingle employer plan
2009-03-01Plan funding arrangement – InsuranceYes
2009-03-01Plan benefit arrangement – InsuranceYes
2008: ROTELLA'S ITALIAN BAKERY, INC.-HEALTH, LIFE,& AD&D 2008 form 5500 responses
2008-03-01Type of plan entitySingle employer plan
2008-03-01Submission has been amendedYes
2008-03-01This submission is the final filingNo
2008-03-01This return/report is a short plan year return/report (less than 12 months)No
2008-03-01Plan is a collectively bargained planNo

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number957320
Policy instance 2
Insurance contract or identification number957320
Number of Individuals Covered348
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $4,097
Welfare Benefit Premiums Paid to CarrierUSD $705,523
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AVZM
Policy instance 1
Insurance contract or identification numberG000AVZM
Number of Individuals Covered336
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $1,691
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $16,914
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )
Policy contract numberEMC L2210022000
Policy instance 2
Insurance contract or identification numberEMC L2210022000
Number of Individuals Covered345
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of fees paid to insurance companyUSD $61,785
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $574,664
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AVZM
Policy instance 1
Insurance contract or identification numberG000AVZM
Number of Individuals Covered329
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,478
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $14,779
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )
Policy contract numberEMC L2010022000
Policy instance 2
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AVZM
Policy instance 1
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AVZM
Policy instance 1
BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )
Policy contract numberEMC L2010022000
Policy instance 2
BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )
Policy contract numberEMC L1810022000
Policy instance 2
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AVZM
Policy instance 1
BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )
Policy contract numberEMC L1810022000
Policy instance 2
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AVZM
Policy instance 1
BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )
Policy contract numberEMC L1610022000
Policy instance 2
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AVZM
Policy instance 1
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AVZM
Policy instance 1
BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )
Policy contract numberERL L12100660
Policy instance 2
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 149730
Policy instance 1
BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )
Policy contract numberERL L12100660
Policy instance 2
BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )
Policy contract numberERL L12100660
Policy instance 2
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 149730
Policy instance 1
BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )
Policy contract numberERL L12100660
Policy instance 2
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 149730
Policy instance 1
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL17649
Policy instance 2
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10113445
Policy instance 1
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10113445
Policy instance 1
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL17649
Policy instance 2

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