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THE GOOD FOOD STORE LIFE & ACCIDENTAL DEATH AND DISABILITY 401k Plan overview

Plan NameTHE GOOD FOOD STORE LIFE & ACCIDENTAL DEATH AND DISABILITY
Plan identification number 506

THE GOOD FOOD STORE LIFE & ACCIDENTAL DEATH AND DISABILITY Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Temporary disability (accident and sickness)

401k Sponsoring company profile

GOOD FOOD STORE INC. has sponsored the creation of one or more 401k plans.

Company Name:GOOD FOOD STORE INC.
Employer identification number (EIN):810468070
NAIC Classification:445110
NAIC Description:Supermarkets and Other Grocery (except Convenience) Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE GOOD FOOD STORE LIFE & ACCIDENTAL DEATH AND DISABILITY

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5062024-04-01ANNE HESER
5062023-04-01
5062023-04-01ANNE HESER

Form 5500 Responses for THE GOOD FOOD STORE LIFE & ACCIDENTAL DEATH AND DISABILITY

2023: THE GOOD FOOD STORE LIFE & ACCIDENTAL DEATH AND DISABILITY 2023 form 5500 responses
2023-04-01Type of plan entitySingle employer plan
2023-04-01First time form 5500 has been submittedYes
2023-04-01Plan funding arrangement – InsuranceYes
2023-04-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0C749
Policy instance 1
Insurance contract or identification numberGVTL0C749
Number of Individuals Covered53
Insurance policy start date2023-01-01
Insurance policy end date2023-04-01
Total amount of commissions paid to insurance brokerUSD $339
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
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 numberGVTL0C749
Policy instance 2
Insurance contract or identification numberGVTL0C749
Number of Individuals Covered61
Insurance policy start date2023-04-01
Insurance policy end date2024-04-01
Total amount of commissions paid to insurance brokerUSD $1,476
Total amount of fees paid to insurance companyUSD $642
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
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 numberGLUG0C749
Policy instance 3
Insurance contract or identification numberGLUG0C749
Number of Individuals Covered132
Insurance policy start date2023-01-01
Insurance policy end date2023-04-01
Total amount of commissions paid to insurance brokerUSD $101
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
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 numberGLUG0C749
Policy instance 4
Insurance contract or identification numberGLUG0C749
Number of Individuals Covered134
Insurance policy start date2023-04-01
Insurance policy end date2024-04-01
Total amount of commissions paid to insurance brokerUSD $391
Total amount of fees paid to insurance companyUSD $283
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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