401k Plan data: ALABAMA GROCERS ASSOCIATION plan

ALABAMA GROCERS ASSOCIATION 401k Plan overview

Plan Name	ALABAMA GROCERS ASSOCIATION
Plan identification number	501

ALABAMA GROCERS ASSOCIATION Benefits

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

401k Sponsoring company profile

ALABAMA GROCERS ASSOCIATION HEALTH AND WELFARE TRUST has sponsored the creation of one or more 401k plans.

Company Name: ALABAMA GROCERS ASSOCIATION HEALTH AND WELFARE TRUST

Employer identification number (EIN): 866435184

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ALABAMA GROCERS ASSOCIATION

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2024-04-01 ELLIE TAYLOR
501 2023-01-01 ELLIE TAYLOR 2024-09-17
501 2022-01-01 ELLIE TAYLOR 2023-08-22
501 2021-01-01 ELLIE TAYLOR 2022-07-13
501 2021-01-01 ELLIE TAYLOR 2023-04-19

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2024-04-01	ELLIE TAYLOR
501	2023-01-01	ELLIE TAYLOR	2024-09-17
501	2022-01-01	ELLIE TAYLOR	2023-08-22
501	2021-01-01	ELLIE TAYLOR	2022-07-13
501	2021-01-01	ELLIE TAYLOR	2023-04-19

Form 5500 Responses for ALABAMA GROCERS ASSOCIATION

2023: ALABAMA GROCERS ASSOCIATION 2023 form 5500 responses
2023-01-01	Type of plan entity	Mulitple employer plan
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2022: ALABAMA GROCERS ASSOCIATION 2022 form 5500 responses
2022-01-01	Type of plan entity	Mulitple employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: ALABAMA GROCERS ASSOCIATION 2021 form 5500 responses
2021-01-01	Type of plan entity	Mulitple employer plan
2021-01-01	First time form 5500 has been submitted	Yes
2021-01-01	Submission has been amended	Yes
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30100064

Policy instance

Insurance contract or identification number	30100064
Number of Individuals Covered	145
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,474
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

21119

Policy instance

Insurance contract or identification number	21119
Number of Individuals Covered	237
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $709
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $70,889
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 )

Policy contract number

MZ0938992H0000A

Policy instance

Insurance contract or identification number	MZ0938992H0000A
Number of Individuals Covered	233
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $37,919
Total amount of fees paid to insurance company	USD $19,821
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $114,617
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

59623

Policy instance

Insurance contract or identification number	59623
Number of Individuals Covered	390
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30100064

Policy instance

Insurance contract or identification number	30100064
Number of Individuals Covered	82
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,762
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

21119

Policy instance

Insurance contract or identification number	21119
Number of Individuals Covered	129
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $343
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,345
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 )

Policy contract number

MZ0938992H0000A

Policy instance

Insurance contract or identification number	MZ0938992H0000A
Number of Individuals Covered	99
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $26,107
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $51,824
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

59623

Policy instance

Insurance contract or identification number	59623
Number of Individuals Covered	169
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30100064

Policy instance

DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )

Policy contract number

21119

Policy instance

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

G1054-2

Policy instance

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

59623

Policy instance

Potentially related plans

ALABAMA GROCERS ASSOCIATION 401(K) PLAN [EIN = 631025911]

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Company Name:	ALABAMA GROCERS ASSOCIATION HEALTH AND WELFARE TRUST
Employer identification number (EIN):	866435184
NAIC Classification:	445110
NAIC Description:	Supermarkets and Other Grocery (except Convenience) Stores