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| Plan Name | BASIC LIFE AND BASIC AD&D POLICY |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | HUNGER MOUNTAIN COOPERATIVE, INC. |
| Employer identification number (EIN): | 030229475 |
| 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 |
|---|---|---|---|---|---|
| 501 | 2015-07-01 | ||||
| 501 | 2014-07-01 | ||||
| 501 | 2013-07-01 | TIMOTHY WINGATE |
| Measure | Date | Value |
|---|---|---|
| 2015: BASIC LIFE AND BASIC AD&D POLICY 2015 401k membership | ||
| Total participants, beginning-of-year | 2015-07-01 | 127 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-07-01 | 137 |
| Total of all active and inactive participants | 2015-07-01 | 137 |
| 2014: BASIC LIFE AND BASIC AD&D POLICY 2014 401k membership | ||
| Total participants, beginning-of-year | 2014-07-01 | 110 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-07-01 | 127 |
| Total of all active and inactive participants | 2014-07-01 | 127 |
| 2013: BASIC LIFE AND BASIC AD&D POLICY 2013 401k membership | ||
| Total participants, beginning-of-year | 2013-07-01 | 113 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-07-01 | 110 |
| Total of all active and inactive participants | 2013-07-01 | 110 |
| Total participants | 2013-07-01 | 110 |
| 2015: BASIC LIFE AND BASIC AD&D POLICY 2015 form 5500 responses | ||
|---|---|---|
| 2015-07-01 | Type of plan entity | Single employer plan |
| 2015-07-01 | This submission is the final filing | Yes |
| 2015-07-01 | Plan funding arrangement – Insurance | Yes |
| 2015-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: BASIC LIFE AND BASIC AD&D POLICY 2014 form 5500 responses | ||
| 2014-07-01 | Type of plan entity | Single employer plan |
| 2014-07-01 | Plan funding arrangement – Insurance | Yes |
| 2014-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: BASIC LIFE AND BASIC AD&D POLICY 2013 form 5500 responses | ||
| 2013-07-01 | Type of plan entity | Single employer plan |
| 2013-07-01 | First time form 5500 has been submitted | Yes |
| 2013-07-01 | Submission has been amended | No |
| 2013-07-01 | This submission is the final filing | No |
| 2013-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-07-01 | Plan is a collectively bargained plan | No |
| 2013-07-01 | Plan funding arrangement – Insurance | Yes |
| 2013-07-01 | Plan benefit arrangement – Insurance | Yes |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) | |
| Policy contract number | SGM604298 |
| Policy instance | 1 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) | |
| Policy contract number | SGM604298 |
| Policy instance | 1 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) | |
| Policy contract number | SGM604298 |
| Policy instance | 1 |
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