401k Plan data: MARIANAS ENTERPRISES EMPLOYEE BENEFIT PLAN plan

MARIANAS ENTERPRISES EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	MARIANAS ENTERPRISES EMPLOYEE BENEFIT PLAN
Plan identification number	501

MARIANAS ENTERPRISES EMPLOYEE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover

401k Sponsoring company profile

MARIANAS ENTERPRISES has sponsored the creation of one or more 401k plans.

Company Name: MARIANAS ENTERPRISES

Employer identification number (EIN): 880285288

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MARIANAS ENTERPRISES EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 JOANNA CABRERA 2024-10-08

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	JOANNA CABRERA	2024-10-08

Plan Statistics for MARIANAS ENTERPRISES EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for MARIANAS ENTERPRISES EMPLOYEE BENEFIT PLAN

Measure Date Value
2023: MARIANAS ENTERPRISES EMPLOYEE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 119
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 119
Number of retired or separated participants receiving benefits 2023-01-01 0
Number of other retired or separated participants entitled to future benefits 2023-01-01 0
Total of all active and inactive participants 2023-01-01 119
Number of employers contributing to the scheme 2023-01-01 0

Measure	Date	Value
2023: MARIANAS ENTERPRISES EMPLOYEE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	119
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	119
Number of retired or separated participants receiving benefits	2023-01-01	0
Number of other retired or separated participants entitled to future benefits	2023-01-01	0
Total of all active and inactive participants	2023-01-01	119
Number of employers contributing to the scheme	2023-01-01	0

Form 5500 Responses for MARIANAS ENTERPRISES EMPLOYEE BENEFIT PLAN

2023: MARIANAS ENTERPRISES EMPLOYEE BENEFIT PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 )

Policy contract number

L02119

Policy instance

Insurance contract or identification number	L02119
Number of Individuals Covered	119
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $30,823
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	TELEHEALTH
Welfare Benefit Premiums Paid to Carrier	USD $878,135
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

HBQ34

Policy instance

Insurance contract or identification number	HBQ34
Number of Individuals Covered	119
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
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

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Company Name:	MARIANAS ENTERPRISES
Employer identification number (EIN):	880285288
NAIC Classification:	445110
NAIC Description:	Supermarkets and Other Grocery (except Convenience) Stores