401k Plan data: GENERATIVE GROWTH II, LLC MEDICAL BENEFITS PLAN plan

GENERATIVE GROWTH II, LLC MEDICAL BENEFITS PLAN 401k Plan overview

Plan Name	GENERATIVE GROWTH II, LLC MEDICAL BENEFITS PLAN
Plan identification number	501

GENERATIVE GROWTH II, LLC MEDICAL BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

GENERATIVE GROWTH II, LLC has sponsored the creation of one or more 401k plans.

Company Name: GENERATIVE GROWTH II, LLC

Employer identification number (EIN): 821768217

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GENERATIVE GROWTH II, LLC MEDICAL BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-09-01 TIFFANY RIKER 2023-03-01
501 2021-09-01 TIFFANY RIKER 2023-04-28
501 2020-09-01 TIFFANY RIKER 2021-12-08
501 2019-09-01 TIFFANY RIKER 2020-12-18
501 2019-08-01 TIFFANY RIKER 2020-01-22

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2021-09-01	TIFFANY RIKER	2023-03-01
501	2021-09-01	TIFFANY RIKER	2023-04-28
501	2020-09-01	TIFFANY RIKER	2021-12-08
501	2019-09-01	TIFFANY RIKER	2020-12-18
501	2019-08-01	TIFFANY RIKER	2020-01-22

Plan Statistics for GENERATIVE GROWTH II, LLC MEDICAL BENEFITS PLAN

401k plan membership statisitcs for GENERATIVE GROWTH II, LLC MEDICAL BENEFITS PLAN

Measure Date Value
2021: GENERATIVE GROWTH II, LLC MEDICAL BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year 2021-09-01 166
Total number of active participants reported on line 7a of the Form 5500 2021-09-01 156
Number of retired or separated participants receiving benefits 2021-09-01 0
Number of other retired or separated participants entitled to future benefits 2021-09-01 0
Total of all active and inactive participants 2021-09-01 156
Number of employers contributing to the scheme 2021-09-01 0
2020: GENERATIVE GROWTH II, LLC MEDICAL BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year 2020-09-01 185
Total number of active participants reported on line 7a of the Form 5500 2020-09-01 166
Number of retired or separated participants receiving benefits 2020-09-01 0
Number of other retired or separated participants entitled to future benefits 2020-09-01 0
Total of all active and inactive participants 2020-09-01 166
Number of employers contributing to the scheme 2020-09-01 0
2019: GENERATIVE GROWTH II, LLC MEDICAL BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year 2019-09-01 185
Total number of active participants reported on line 7a of the Form 5500 2019-09-01 185
Number of retired or separated participants receiving benefits 2019-09-01 0
Number of other retired or separated participants entitled to future benefits 2019-09-01 0
Total of all active and inactive participants 2019-09-01 185
Number of employers contributing to the scheme 2019-09-01 0
Total participants, beginning-of-year 2019-08-01 287
Total number of active participants reported on line 7a of the Form 5500 2019-08-01 185
Number of retired or separated participants receiving benefits 2019-08-01 0
Number of other retired or separated participants entitled to future benefits 2019-08-01 0
Total of all active and inactive participants 2019-08-01 185
Number of employers contributing to the scheme 2019-08-01 0

Measure	Date	Value
2021: GENERATIVE GROWTH II, LLC MEDICAL BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-09-01	166
Total number of active participants reported on line 7a of the Form 5500	2021-09-01	156
Number of retired or separated participants receiving benefits	2021-09-01	0
Number of other retired or separated participants entitled to future benefits	2021-09-01	0
Total of all active and inactive participants	2021-09-01	156
Number of employers contributing to the scheme	2021-09-01	0
2020: GENERATIVE GROWTH II, LLC MEDICAL BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year	2020-09-01	185
Total number of active participants reported on line 7a of the Form 5500	2020-09-01	166
Number of retired or separated participants receiving benefits	2020-09-01	0
Number of other retired or separated participants entitled to future benefits	2020-09-01	0
Total of all active and inactive participants	2020-09-01	166
Number of employers contributing to the scheme	2020-09-01	0
2019: GENERATIVE GROWTH II, LLC MEDICAL BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-09-01	185
Total number of active participants reported on line 7a of the Form 5500	2019-09-01	185
Number of retired or separated participants receiving benefits	2019-09-01	0
Number of other retired or separated participants entitled to future benefits	2019-09-01	0
Total of all active and inactive participants	2019-09-01	185
Number of employers contributing to the scheme	2019-09-01	0
Total participants, beginning-of-year	2019-08-01	287
Total number of active participants reported on line 7a of the Form 5500	2019-08-01	185
Number of retired or separated participants receiving benefits	2019-08-01	0
Number of other retired or separated participants entitled to future benefits	2019-08-01	0
Total of all active and inactive participants	2019-08-01	185
Number of employers contributing to the scheme	2019-08-01	0

Form 5500 Responses for GENERATIVE GROWTH II, LLC MEDICAL BENEFITS PLAN

2021: GENERATIVE GROWTH II, LLC MEDICAL BENEFITS PLAN 2021 form 5500 responses
2021-09-01	Type of plan entity	Single employer plan
2021-09-01	Submission has been amended	Yes
2021-09-01	This submission is the final filing	Yes
2021-09-01	Plan funding arrangement – Insurance	Yes
2021-09-01	Plan benefit arrangement – Insurance	Yes
2020: GENERATIVE GROWTH II, LLC MEDICAL BENEFITS PLAN 2020 form 5500 responses
2020-09-01	Type of plan entity	Single employer plan
2020-09-01	Plan funding arrangement – Insurance	Yes
2020-09-01	Plan benefit arrangement – Insurance	Yes
2019: GENERATIVE GROWTH II, LLC MEDICAL BENEFITS PLAN 2019 form 5500 responses
2019-09-01	Type of plan entity	Single employer plan
2019-09-01	Plan funding arrangement – Insurance	Yes
2019-09-01	Plan benefit arrangement – Insurance	Yes
2019-08-01	Type of plan entity	Single employer plan
2019-08-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2019-08-01	Plan funding arrangement – Insurance	Yes
2019-08-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract number	W42591
Policy instance	1
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract number	W42591
Policy instance	1

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Company Name:	GENERATIVE GROWTH II, LLC
Employer identification number (EIN):	821768217
NAIC Classification:	445110
NAIC Description:	Supermarkets and Other Grocery (except Convenience) Stores