401k Plan data: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN plan

ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 401k Plan overview

Plan Name	ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN
Plan identification number	504

ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance

401k Sponsoring company profile

ROBERTS COMPANY, INC. has sponsored the creation of one or more 401k plans.

Company Name: ROBERTS COMPANY, INC.

Employer identification number (EIN): 720719149

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2022-08-01
504 2021-08-01
504 2020-08-01
504 2019-08-01
504 2018-08-01
504 2017-08-01 FORREST ROBERTS
504 2016-08-01 FORREST ROBERTS
504 2015-08-01 FORREST ROBERTS
504 2014-08-01 FORREST ROBERTS
504 2013-08-01 FORREST ROBERTS
504 2012-08-01 FORREST ROBERTS
504 2011-01-01 FORREST ROBERTS
504 2009-08-01 FORREST ROBERTS 2010-09-28
504 2009-08-01 FORREST ROBERTS
504 2009-08-01 FORREST ROBERTS 2010-10-15

Plan Statistics for ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN

401k plan membership statisitcs for ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN

Measure Date Value
2022: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-08-01 340
Total number of active participants reported on line 7a of the Form 5500 2022-08-01 348
Total of all active and inactive participants 2022-08-01 348
2021: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-08-01 321
Total number of active participants reported on line 7a of the Form 5500 2021-08-01 340
Total of all active and inactive participants 2021-08-01 340
2020: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-08-01 273
Total number of active participants reported on line 7a of the Form 5500 2020-08-01 321
Total of all active and inactive participants 2020-08-01 321
2019: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-08-01 285
Total number of active participants reported on line 7a of the Form 5500 2019-08-01 273
Total of all active and inactive participants 2019-08-01 273
2018: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-08-01 284
Total number of active participants reported on line 7a of the Form 5500 2018-08-01 285
Total of all active and inactive participants 2018-08-01 285
2017: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-08-01 279
Total number of active participants reported on line 7a of the Form 5500 2017-08-01 284
Total of all active and inactive participants 2017-08-01 284
2016: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-08-01 280
Total number of active participants reported on line 7a of the Form 5500 2016-08-01 279
Total of all active and inactive participants 2016-08-01 279
2015: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-08-01 319
Total number of active participants reported on line 7a of the Form 5500 2015-08-01 280
Total of all active and inactive participants 2015-08-01 280
2014: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-08-01 307
Total number of active participants reported on line 7a of the Form 5500 2014-08-01 319
Total of all active and inactive participants 2014-08-01 319
2013: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-08-01 313
Total number of active participants reported on line 7a of the Form 5500 2013-08-01 307
Total of all active and inactive participants 2013-08-01 307
2012: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-08-01 315
Total number of active participants reported on line 7a of the Form 5500 2012-08-01 313
Total of all active and inactive participants 2012-08-01 313
Total participants 2012-08-01 0
2011: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 236
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 315
Total of all active and inactive participants 2011-01-01 315
Total participants 2011-01-01 315
2009: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-08-01 289
Total number of active participants reported on line 7a of the Form 5500 2009-08-01 262
Number of retired or separated participants receiving benefits 2009-08-01 0
Number of other retired or separated participants entitled to future benefits 2009-08-01 0
Total of all active and inactive participants 2009-08-01 262
Total participants 2009-08-01 262

Measure	Date	Value
2022: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-08-01	340
Total number of active participants reported on line 7a of the Form 5500	2022-08-01	348
Total of all active and inactive participants	2022-08-01	348
2021: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-08-01	321
Total number of active participants reported on line 7a of the Form 5500	2021-08-01	340
Total of all active and inactive participants	2021-08-01	340
2020: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-08-01	273
Total number of active participants reported on line 7a of the Form 5500	2020-08-01	321
Total of all active and inactive participants	2020-08-01	321
2019: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-08-01	285
Total number of active participants reported on line 7a of the Form 5500	2019-08-01	273
Total of all active and inactive participants	2019-08-01	273
2018: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-08-01	284
Total number of active participants reported on line 7a of the Form 5500	2018-08-01	285
Total of all active and inactive participants	2018-08-01	285
2017: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-08-01	279
Total number of active participants reported on line 7a of the Form 5500	2017-08-01	284
Total of all active and inactive participants	2017-08-01	284
2016: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-08-01	280
Total number of active participants reported on line 7a of the Form 5500	2016-08-01	279
Total of all active and inactive participants	2016-08-01	279
2015: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-08-01	319
Total number of active participants reported on line 7a of the Form 5500	2015-08-01	280
Total of all active and inactive participants	2015-08-01	280
2014: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-08-01	307
Total number of active participants reported on line 7a of the Form 5500	2014-08-01	319
Total of all active and inactive participants	2014-08-01	319
2013: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-08-01	313
Total number of active participants reported on line 7a of the Form 5500	2013-08-01	307
Total of all active and inactive participants	2013-08-01	307
2012: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-08-01	315
Total number of active participants reported on line 7a of the Form 5500	2012-08-01	313
Total of all active and inactive participants	2012-08-01	313
Total participants	2012-08-01	0
2011: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	236
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	315
Total of all active and inactive participants	2011-01-01	315
Total participants	2011-01-01	315
2009: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-08-01	289
Total number of active participants reported on line 7a of the Form 5500	2009-08-01	262
Number of retired or separated participants receiving benefits	2009-08-01	0
Number of other retired or separated participants entitled to future benefits	2009-08-01	0
Total of all active and inactive participants	2009-08-01	262
Total participants	2009-08-01	262

Form 5500 Responses for ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN

2022: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2022 form 5500 responses
2022-08-01	Type of plan entity	Single employer plan
2022-08-01	Plan funding arrangement – Insurance	Yes
2022-08-01	Plan benefit arrangement – Insurance	Yes
2021: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2021 form 5500 responses
2021-08-01	Type of plan entity	Single employer plan
2021-08-01	Plan funding arrangement – Insurance	Yes
2021-08-01	Plan benefit arrangement – Insurance	Yes
2020: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2020 form 5500 responses
2020-08-01	Type of plan entity	Single employer plan
2020-08-01	Plan funding arrangement – Insurance	Yes
2020-08-01	Plan benefit arrangement – Insurance	Yes
2019: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2019 form 5500 responses
2019-08-01	Type of plan entity	Single employer plan
2019-08-01	Plan funding arrangement – Insurance	Yes
2019-08-01	Plan benefit arrangement – Insurance	Yes
2018: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2018 form 5500 responses
2018-08-01	Type of plan entity	Single employer plan
2018-08-01	Plan funding arrangement – Insurance	Yes
2018-08-01	Plan benefit arrangement – Insurance	Yes
2017: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2017 form 5500 responses
2017-08-01	Type of plan entity	Single employer plan
2017-08-01	Plan funding arrangement – Insurance	Yes
2017-08-01	Plan benefit arrangement – Insurance	Yes
2016: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2016 form 5500 responses
2016-08-01	Type of plan entity	Single employer plan
2016-08-01	Plan funding arrangement – Insurance	Yes
2016-08-01	Plan benefit arrangement – Insurance	Yes
2015: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2015 form 5500 responses
2015-08-01	Type of plan entity	Single employer plan
2015-08-01	Plan funding arrangement – Insurance	Yes
2015-08-01	Plan benefit arrangement – Insurance	Yes
2014: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2014 form 5500 responses
2014-08-01	Type of plan entity	Single employer plan
2014-08-01	Plan funding arrangement – Insurance	Yes
2014-08-01	Plan benefit arrangement – Insurance	Yes
2013: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2013 form 5500 responses
2013-08-01	Type of plan entity	Single employer plan
2013-08-01	Plan funding arrangement – Insurance	Yes
2013-08-01	Plan benefit arrangement – Insurance	Yes
2012: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2012 form 5500 responses
2012-08-01	Type of plan entity	Single employer plan
2012-08-01	Plan funding arrangement – Insurance	Yes
2012-08-01	Plan benefit arrangement – Insurance	Yes
2011: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: ROBERTS COMPANY, INC. TERM LIFE INSURANCE PLAN 2009 form 5500 responses
2009-08-01	Type of plan entity	Single employer plan
2009-08-01	Submission has been amended	No
2009-08-01	This submission is the final filing	No
2009-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-08-01	Plan is a collectively bargained plan	No
2009-08-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-08-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000BR48

Policy instance

Insurance contract or identification number	G000BR48
Number of Individuals Covered	348
Insurance policy start date	2022-08-01
Insurance policy end date	2023-08-01
Total amount of commissions paid to insurance broker	USD $5,547
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,980
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,547
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000BR48

Policy instance

Insurance contract or identification number	G000BR48
Number of Individuals Covered	340
Insurance policy start date	2021-08-01
Insurance policy end date	2022-08-01
Total amount of commissions paid to insurance broker	USD $5,224
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,828
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,224
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000BR48

Policy instance

Insurance contract or identification number	G000BR48
Number of Individuals Covered	321
Insurance policy start date	2020-08-01
Insurance policy end date	2021-08-01
Total amount of commissions paid to insurance broker	USD $4,812
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,082
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,812
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10193459

Policy instance

Insurance contract or identification number	10193459
Number of Individuals Covered	273
Insurance policy start date	2019-08-01
Insurance policy end date	2020-07-31
Total amount of commissions paid to insurance broker	USD $5,357
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,716
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,357
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10193459

Policy instance

Insurance contract or identification number	10193459
Number of Individuals Covered	285
Insurance policy start date	2018-08-01
Insurance policy end date	2019-07-31
Total amount of commissions paid to insurance broker	USD $5,269
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,124
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,269
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10193459

Policy instance

Insurance contract or identification number	10193459
Number of Individuals Covered	284
Insurance policy start date	2017-08-01
Insurance policy end date	2018-07-31
Total amount of commissions paid to insurance broker	USD $5,203
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,686
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	ROBERTS COMPANY, INC.
Employer identification number (EIN):	720719149
NAIC Classification:	445110
NAIC Description:	Supermarkets and Other Grocery (except Convenience) Stores