401k Plan data: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. plan

LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 401k Plan overview

Plan Name	LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC.
Plan identification number	502

LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

BOSCOV'S, INC. has sponsored the creation of one or more 401k plans.

Company Name: BOSCOV'S, INC.

Employer identification number (EIN): 231571589

NAIC Classification: 448140
NAIC Description: Family Clothing Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2021-01-01 MICHELLE L. DUPELL 2022-08-18
502 2020-01-01 DIETER F. CZERNY 2021-08-03
502 2019-09-01 DIETER F. CZERNY 2020-04-21
502 2018-09-01 DIETER F. CZERNY 2020-01-23
502 2017-09-01 TONI MILLER
502 2016-09-01 TONI MILLER
502 2015-09-01 TONI MILLER
502 2014-09-01 TONI MILLER
502 2013-09-01 TONI MILLER
502 2012-09-01 TONI M. MILLER
502 2011-09-01 TONI M. MILLER
502 2010-09-01 TONI M. MILLER
502 2009-09-01 TONI M. MILLER, CFO

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
502	2021-01-01	MICHELLE L. DUPELL	2022-08-18
502	2020-01-01	DIETER F. CZERNY	2021-08-03
502	2019-09-01	DIETER F. CZERNY	2020-04-21
502	2018-09-01	DIETER F. CZERNY	2020-01-23
502	2017-09-01	TONI MILLER
502	2016-09-01	TONI MILLER
502	2015-09-01	TONI MILLER
502	2014-09-01	TONI MILLER
502	2013-09-01	TONI MILLER
502	2012-09-01	TONI M. MILLER
502	2011-09-01	TONI M. MILLER
502	2010-09-01	TONI M. MILLER
502	2009-09-01	TONI M. MILLER, CFO

Plan Statistics for LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC.

401k plan membership statisitcs for LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC.

Measure Date Value
2021: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2021 401k membership
Total participants, beginning-of-year 2021-01-01 3,566
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 0
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 0
2020: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2020 401k membership
Total participants, beginning-of-year 2020-01-01 4,788
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 3,498
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 3,498
2019: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2019 401k membership
Total participants, beginning-of-year 2019-09-01 4,489
Total number of active participants reported on line 7a of the Form 5500 2019-09-01 4,728
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 4,728
2018: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2018 401k membership
Total participants, beginning-of-year 2018-09-01 4,702
Total number of active participants reported on line 7a of the Form 5500 2018-09-01 4,789
Number of retired or separated participants receiving benefits 2018-09-01 0
Number of other retired or separated participants entitled to future benefits 2018-09-01 0
Total of all active and inactive participants 2018-09-01 4,789
2017: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2017 401k membership
Total participants, beginning-of-year 2017-09-01 4,650
Total number of active participants reported on line 7a of the Form 5500 2017-09-01 4,776
Total of all active and inactive participants 2017-09-01 4,776
Total participants 2017-09-01 4,776
2016: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2016 401k membership
Total participants, beginning-of-year 2016-09-01 4,532
Total number of active participants reported on line 7a of the Form 5500 2016-09-01 4,650
Total of all active and inactive participants 2016-09-01 4,650
Total participants 2016-09-01 4,650
2015: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2015 401k membership
Total participants, beginning-of-year 2015-09-01 4,694
Total number of active participants reported on line 7a of the Form 5500 2015-09-01 4,532
Total of all active and inactive participants 2015-09-01 4,532
Total participants 2015-09-01 4,532
2014: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2014 401k membership
Total participants, beginning-of-year 2014-09-01 4,539
Total number of active participants reported on line 7a of the Form 5500 2014-09-01 4,694
Total of all active and inactive participants 2014-09-01 4,694
Total participants 2014-09-01 4,694
2013: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2013 401k membership
Total participants, beginning-of-year 2013-09-01 4,539
Total number of active participants reported on line 7a of the Form 5500 2013-09-01 4,539
Total of all active and inactive participants 2013-09-01 4,539
Total participants 2013-09-01 4,539
2012: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2012 401k membership
Total participants, beginning-of-year 2012-09-01 4,518
Total number of active participants reported on line 7a of the Form 5500 2012-09-01 4,539
Total of all active and inactive participants 2012-09-01 4,539
Total participants 2012-09-01 4,539
2011: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2011 401k membership
Total participants, beginning-of-year 2011-09-01 4,414
Total number of active participants reported on line 7a of the Form 5500 2011-09-01 4,518
Total of all active and inactive participants 2011-09-01 4,518
Total participants 2011-09-01 4,518
2010: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2010 401k membership
Total participants, beginning-of-year 2010-09-01 4,465
Total number of active participants reported on line 7a of the Form 5500 2010-09-01 4,414
Total of all active and inactive participants 2010-09-01 4,414
Total participants 2010-09-01 4,414
2009: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2009 401k membership
Total participants, beginning-of-year 2009-09-01 4,343
Total number of active participants reported on line 7a of the Form 5500 2009-09-01 4,465
Total of all active and inactive participants 2009-09-01 4,465
Total participants 2009-09-01 4,465

Measure	Date	Value
2021: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2021 401k membership
Total participants, beginning-of-year	2021-01-01	3,566
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	0
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	0
2020: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2020 401k membership
Total participants, beginning-of-year	2020-01-01	4,788
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	3,498
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	3,498
2019: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2019 401k membership
Total participants, beginning-of-year	2019-09-01	4,489
Total number of active participants reported on line 7a of the Form 5500	2019-09-01	4,728
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	4,728
2018: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2018 401k membership
Total participants, beginning-of-year	2018-09-01	4,702
Total number of active participants reported on line 7a of the Form 5500	2018-09-01	4,789
Number of retired or separated participants receiving benefits	2018-09-01	0
Number of other retired or separated participants entitled to future benefits	2018-09-01	0
Total of all active and inactive participants	2018-09-01	4,789
2017: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2017 401k membership
Total participants, beginning-of-year	2017-09-01	4,650
Total number of active participants reported on line 7a of the Form 5500	2017-09-01	4,776
Total of all active and inactive participants	2017-09-01	4,776
Total participants	2017-09-01	4,776
2016: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2016 401k membership
Total participants, beginning-of-year	2016-09-01	4,532
Total number of active participants reported on line 7a of the Form 5500	2016-09-01	4,650
Total of all active and inactive participants	2016-09-01	4,650
Total participants	2016-09-01	4,650
2015: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2015 401k membership
Total participants, beginning-of-year	2015-09-01	4,694
Total number of active participants reported on line 7a of the Form 5500	2015-09-01	4,532
Total of all active and inactive participants	2015-09-01	4,532
Total participants	2015-09-01	4,532
2014: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2014 401k membership
Total participants, beginning-of-year	2014-09-01	4,539
Total number of active participants reported on line 7a of the Form 5500	2014-09-01	4,694
Total of all active and inactive participants	2014-09-01	4,694
Total participants	2014-09-01	4,694
2013: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2013 401k membership
Total participants, beginning-of-year	2013-09-01	4,539
Total number of active participants reported on line 7a of the Form 5500	2013-09-01	4,539
Total of all active and inactive participants	2013-09-01	4,539
Total participants	2013-09-01	4,539
2012: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2012 401k membership
Total participants, beginning-of-year	2012-09-01	4,518
Total number of active participants reported on line 7a of the Form 5500	2012-09-01	4,539
Total of all active and inactive participants	2012-09-01	4,539
Total participants	2012-09-01	4,539
2011: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2011 401k membership
Total participants, beginning-of-year	2011-09-01	4,414
Total number of active participants reported on line 7a of the Form 5500	2011-09-01	4,518
Total of all active and inactive participants	2011-09-01	4,518
Total participants	2011-09-01	4,518
2010: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2010 401k membership
Total participants, beginning-of-year	2010-09-01	4,465
Total number of active participants reported on line 7a of the Form 5500	2010-09-01	4,414
Total of all active and inactive participants	2010-09-01	4,414
Total participants	2010-09-01	4,414
2009: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2009 401k membership
Total participants, beginning-of-year	2009-09-01	4,343
Total number of active participants reported on line 7a of the Form 5500	2009-09-01	4,465
Total of all active and inactive participants	2009-09-01	4,465
Total participants	2009-09-01	4,465

Form 5500 Responses for LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC.

2021: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	Yes
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2019 form 5500 responses
2019-09-01	Type of plan entity	Single employer plan
2019-09-01	Submission has been amended	No
2019-09-01	This submission is the final filing	No
2019-09-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2019-09-01	Plan is a collectively bargained plan	No
2019-09-01	Plan funding arrangement – Insurance	Yes
2019-09-01	Plan benefit arrangement – Insurance	Yes
2018: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2018 form 5500 responses
2018-09-01	Type of plan entity	Single employer plan
2018-09-01	Submission has been amended	No
2018-09-01	This submission is the final filing	No
2018-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-09-01	Plan is a collectively bargained plan	No
2018-09-01	Plan funding arrangement – Insurance	Yes
2018-09-01	Plan benefit arrangement – Insurance	Yes
2017: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2017 form 5500 responses
2017-09-01	Type of plan entity	Single employer plan
2017-09-01	Plan funding arrangement – Insurance	Yes
2017-09-01	Plan benefit arrangement – Insurance	Yes
2016: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2016 form 5500 responses
2016-09-01	Type of plan entity	Single employer plan
2016-09-01	Plan funding arrangement – Insurance	Yes
2016-09-01	Plan benefit arrangement – Insurance	Yes
2015: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2015 form 5500 responses
2015-09-01	Type of plan entity	Single employer plan
2015-09-01	Plan funding arrangement – Insurance	Yes
2015-09-01	Plan benefit arrangement – Insurance	Yes
2014: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2014 form 5500 responses
2014-09-01	Type of plan entity	Single employer plan
2014-09-01	Plan funding arrangement – Insurance	Yes
2014-09-01	Plan benefit arrangement – Insurance	Yes
2013: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2013 form 5500 responses
2013-09-01	Type of plan entity	Single employer plan
2013-09-01	Plan funding arrangement – Insurance	Yes
2013-09-01	Plan benefit arrangement – Insurance	Yes
2012: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2012 form 5500 responses
2012-09-01	Type of plan entity	Single employer plan
2012-09-01	Plan funding arrangement – Insurance	Yes
2012-09-01	Plan benefit arrangement – Insurance	Yes
2011: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2011 form 5500 responses
2011-09-01	Type of plan entity	Single employer plan
2011-09-01	Plan funding arrangement – Insurance	Yes
2011-09-01	Plan benefit arrangement – Insurance	Yes
2010: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2010 form 5500 responses
2010-09-01	Type of plan entity	Single employer plan
2010-09-01	Plan funding arrangement – Insurance	Yes
2010-09-01	Plan benefit arrangement – Insurance	Yes
2009: LIFE INSURANCE PLAN FOR THE EMPLOYEES OF BOSCOV'S, INC. 2009 form 5500 responses
2009-09-01	Type of plan entity	Single employer plan
2009-09-01	Plan funding arrangement – Insurance	Yes
2009-09-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	SA3-890LF046101
Policy instance	1
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	VAR 204570
Policy instance	2
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	GL 145250
Policy instance	1
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	VAR 204570
Policy instance	2
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	GL 145250
Policy instance	1
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	VAR 204570
Policy instance	2
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	GL 145250
Policy instance	1
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	VAR 204570
Policy instance	2
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	GL 145250
Policy instance	1
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	GL 145250
Policy instance	1
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	VAR 204570
Policy instance	2
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	VAR204570
Policy instance	2
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	GL145250
Policy instance	1
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	VAR 204570
Policy instance	2
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	GL145250
Policy instance	1
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	GL 145250
Policy instance	1
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	VAR 204570
Policy instance	2
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	VAR 204570
Policy instance	2
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	GL 145250
Policy instance	1
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	VAR 204570
Policy instance	2
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	GL 145250
Policy instance	1

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Company Name:	BOSCOV'S, INC.
Employer identification number (EIN):	231571589
NAIC Classification:	448140
NAIC Description:	Family Clothing Stores