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ROTELLA'S ITALIAN BAKERY,INC-SHORT TERM DISABILITY 401k Plan overview

Plan NameROTELLA'S ITALIAN BAKERY,INC-SHORT TERM DISABILITY
Plan identification number 505

ROTELLA'S ITALIAN BAKERY,INC-SHORT TERM DISABILITY Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • 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-SHORT TERM DISABILITY

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5052022-01-01
5052021-01-01
5052020-01-01
5052019-03-01
5052018-03-01
5052017-03-01DEAN JACOBSEN DEAN JACOBSEN2018-10-08
5052016-03-01DEAN JACOBSEN DEAN JACOBSEN2017-09-13
5052015-03-01DEAN JACOBSEN DEAN JACOBSEN2016-09-12
5052014-03-01DEAN JACOBSEN DEAN JACOBSEN2015-09-21
5052013-03-01DEAN JACOBSEN DEAN JACOBSEN2014-09-25
5052012-03-01DEAN JACOBSEN DEAN JACOBSEN2013-06-24
5052011-03-01DEAN JACOBSEN DEAN JACOBSEN2012-08-07
5052010-03-01DEAN JACOBSEN DEAN JACOBSEN2011-09-13
5052009-03-01DEAN JACOBSEN DEAN JACOBSEN2010-07-30

Plan Statistics for ROTELLA'S ITALIAN BAKERY,INC-SHORT TERM DISABILITY

401k plan membership statisitcs for ROTELLA'S ITALIAN BAKERY,INC-SHORT TERM DISABILITY

Measure Date Value
2022: ROTELLA'S ITALIAN BAKERY,INC-SHORT TERM DISABILITY 2022 401k membership
Total participants, beginning-of-year2022-01-01363
Total number of active participants reported on line 7a of the Form 55002022-01-01311
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 participants2022-01-01311
2021: ROTELLA'S ITALIAN BAKERY,INC-SHORT TERM DISABILITY 2021 401k membership
Total participants, beginning-of-year2021-01-01402
Total number of active participants reported on line 7a of the Form 55002021-01-01363
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 participants2021-01-01363
2020: ROTELLA'S ITALIAN BAKERY,INC-SHORT TERM DISABILITY 2020 401k membership
Total participants, beginning-of-year2020-01-01412
Total number of active participants reported on line 7a of the Form 55002020-01-01402
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 participants2020-01-01402
2019: ROTELLA'S ITALIAN BAKERY,INC-SHORT TERM DISABILITY 2019 401k membership
Total participants, beginning-of-year2019-03-01443
Total number of active participants reported on line 7a of the Form 55002019-03-01412
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 participants2019-03-01412
2018: ROTELLA'S ITALIAN BAKERY,INC-SHORT TERM DISABILITY 2018 401k membership
Total participants, beginning-of-year2018-03-01427
Total number of active participants reported on line 7a of the Form 55002018-03-01443
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 participants2018-03-01443
2017: ROTELLA'S ITALIAN BAKERY,INC-SHORT TERM DISABILITY 2017 401k membership
Total participants, beginning-of-year2017-03-01425
Total number of active participants reported on line 7a of the Form 55002017-03-01427
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 participants2017-03-01427
2016: ROTELLA'S ITALIAN BAKERY,INC-SHORT TERM DISABILITY 2016 401k membership
Total participants, beginning-of-year2016-03-01422
Total number of active participants reported on line 7a of the Form 55002016-03-01425
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 participants2016-03-01425
2015: ROTELLA'S ITALIAN BAKERY,INC-SHORT TERM DISABILITY 2015 401k membership
Total participants, beginning-of-year2015-03-01360
Total number of active participants reported on line 7a of the Form 55002015-03-01422
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 participants2015-03-01422
2014: ROTELLA'S ITALIAN BAKERY,INC-SHORT TERM DISABILITY 2014 401k membership
Total participants, beginning-of-year2014-03-01355
Total number of active participants reported on line 7a of the Form 55002014-03-01360
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 participants2014-03-01360
2013: ROTELLA'S ITALIAN BAKERY,INC-SHORT TERM DISABILITY 2013 401k membership
Total participants, beginning-of-year2013-03-01296
Total number of active participants reported on line 7a of the Form 55002013-03-01355
Total of all active and inactive participants2013-03-01355
2012: ROTELLA'S ITALIAN BAKERY,INC-SHORT TERM DISABILITY 2012 401k membership
Total participants, beginning-of-year2012-03-01302
Total number of active participants reported on line 7a of the Form 55002012-03-01296
Total of all active and inactive participants2012-03-01296
2011: ROTELLA'S ITALIAN BAKERY,INC-SHORT TERM DISABILITY 2011 401k membership
Total participants, beginning-of-year2011-03-01286
Total number of active participants reported on line 7a of the Form 55002011-03-01302
Total of all active and inactive participants2011-03-01302
2010: ROTELLA'S ITALIAN BAKERY,INC-SHORT TERM DISABILITY 2010 401k membership
Total participants, beginning-of-year2010-03-01266
Total number of active participants reported on line 7a of the Form 55002010-03-01286
Total of all active and inactive participants2010-03-01286
2009: ROTELLA'S ITALIAN BAKERY,INC-SHORT TERM DISABILITY 2009 401k membership
Total participants, beginning-of-year2009-03-01255
Total number of active participants reported on line 7a of the Form 55002009-03-01266
Total of all active and inactive participants2009-03-01266

Form 5500 Responses for ROTELLA'S ITALIAN BAKERY,INC-SHORT TERM DISABILITY

2022: ROTELLA'S ITALIAN BAKERY,INC-SHORT TERM DISABILITY 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-SHORT TERM DISABILITY 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-SHORT TERM DISABILITY 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-SHORT TERM DISABILITY 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-SHORT TERM DISABILITY 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-SHORT TERM DISABILITY 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-SHORT TERM DISABILITY 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-SHORT TERM DISABILITY 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-SHORT TERM DISABILITY 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-SHORT TERM DISABILITY 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-SHORT TERM DISABILITY 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-SHORT TERM DISABILITY 2011 form 5500 responses
2011-03-01Type of plan entitySingle employer plan
2011-03-01Plan funding arrangement – InsuranceYes
2011-03-01Plan benefit arrangement – InsuranceYes
2010: ROTELLA'S ITALIAN BAKERY,INC-SHORT TERM DISABILITY 2010 form 5500 responses
2010-03-01Type of plan entitySingle employer plan
2010-03-01Plan funding arrangement – InsuranceYes
2010-03-01Plan benefit arrangement – InsuranceYes
2009: ROTELLA'S ITALIAN BAKERY,INC-SHORT TERM DISABILITY 2009 form 5500 responses
2009-03-01Type of plan entitySingle employer plan
2009-03-01Plan funding arrangement – InsuranceYes
2009-03-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

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 Covered311
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $4,969
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $90,573
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,969
Insurance broker organization code?3
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 Covered363
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $5,270
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $108,529
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,270
Insurance broker organization code?3
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 Covered402
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $5,330
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $112,798
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,330
Insurance broker organization code?3
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 Covered412
Insurance policy start date2019-03-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $5,168
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $96,705
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,168
Insurance broker organization code?3
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 Covered443
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $5,311
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $106,074
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,311
Insurance broker organization code?3
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 Covered427
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $5,155
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $96,185
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,155
Insurance broker organization code?3
Insurance broker nameDIVERSIFIED BENEFITS GROUP LLC
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 Covered422
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $4,949
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $87,957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,949
Insurance broker organization code?3
Insurance broker nameDIVERSIFIED BENEFITS GROUP LLC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberG 162232
Policy instance 1
Insurance contract or identification numberG 162232
Number of Individuals Covered360
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $4,029
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $82,881
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,029
Insurance broker organization code?3
Insurance broker nameDIVERSIFIED BENEFITS GROUP LLC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberG 162232
Policy instance 1
Insurance contract or identification numberG 162232
Number of Individuals Covered355
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $3,720
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $52,001
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,720
Insurance broker organization code?3
Insurance broker nameDIVERSIFIED BENEFITS GROUP LLC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberG 162232
Policy instance 1
Insurance contract or identification numberG 162232
Number of Individuals Covered296
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $3,662
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $49,245
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,662
Insurance broker organization code?3
Insurance broker nameDIVERSIFIED BENEFITS GROUP LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010113446
Policy instance 1
Insurance contract or identification number000010113446
Number of Individuals Covered302
Insurance policy start date2011-03-01
Insurance policy end date2012-02-29
Total amount of commissions paid to insurance brokerUSD $1,657
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $53,945
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010113446
Policy instance 1
Insurance contract or identification number000010113446
Number of Individuals Covered286
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $1,601
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $47,356
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,601
Insurance broker organization code?3
Insurance broker nameDIVERSIFIED BENEFITS GROUP INC

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