| Plan Name | THE GOOD FOOD STORE LIFE & ACCIDENTAL DEATH AND DISABILITY |
| Plan identification number | 506 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | GOOD FOOD STORE INC. |
| Employer identification number (EIN): | 810468070 |
| NAIC Classification: | 445110 |
| NAIC Description: | Supermarkets and Other Grocery (except Convenience) Stores |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 506 | 2024-04-01 | ANNE HESER | |||
| 506 | 2023-04-01 | ||||
| 506 | 2023-04-01 | ANNE HESER |
| 2023: THE GOOD FOOD STORE LIFE & ACCIDENTAL DEATH AND DISABILITY 2023 form 5500 responses | ||
|---|---|---|
| 2023-04-01 | Type of plan entity | Single employer plan |
| 2023-04-01 | First time form 5500 has been submitted | Yes |
| 2023-04-01 | Plan funding arrangement – Insurance | Yes |
| 2023-04-01 | Plan benefit arrangement – Insurance | Yes |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |||||||||||||||||||
| Policy contract number | GVTL0C749 | ||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |||||||||||||||||||
| Policy contract number | GVTL0C749 | ||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |||||||||||||||||||
| Policy contract number | GLUG0C749 | ||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |||||||||||||||||||
| Policy contract number | GLUG0C749 | ||||||||||||||||||
| Policy instance | 4 | ||||||||||||||||||
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