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MONADNOCK COMMUNITY COOPERATIVE LIFE & DISABILITY PLAN 401k Plan overview

Plan NameMONADNOCK COMMUNITY COOPERATIVE LIFE & DISABILITY PLAN
Plan identification number 501

MONADNOCK COMMUNITY COOPERATIVE LIFE & DISABILITY PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

MONADNOCK COMMUNITY MARKET COOPERATIVE has sponsored the creation of one or more 401k plans.

Company Name:MONADNOCK COMMUNITY MARKET COOPERATIVE
Employer identification number (EIN):272395771
NAIC Classification:445110
NAIC Description:Supermarkets and Other Grocery (except Convenience) Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MONADNOCK COMMUNITY COOPERATIVE LIFE & DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-05-01SUSAN ELLS2024-03-18
5012021-05-01SUSAN ELLS2022-09-23
5012020-05-01SUSAN ELLS2021-11-02

Plan Statistics for MONADNOCK COMMUNITY COOPERATIVE LIFE & DISABILITY PLAN

401k plan membership statisitcs for MONADNOCK COMMUNITY COOPERATIVE LIFE & DISABILITY PLAN

Measure Date Value
2022: MONADNOCK COMMUNITY COOPERATIVE LIFE & DISABILITY PLAN 2022 401k membership
Total participants, beginning-of-year2022-05-01100
Total number of active participants reported on line 7a of the Form 55002022-05-01100
Number of retired or separated participants receiving benefits2022-05-010
Number of other retired or separated participants entitled to future benefits2022-05-010
Total of all active and inactive participants2022-05-01100
Number of employers contributing to the scheme2022-05-010
2021: MONADNOCK COMMUNITY COOPERATIVE LIFE & DISABILITY PLAN 2021 401k membership
Total participants, beginning-of-year2021-05-01109
Total number of active participants reported on line 7a of the Form 55002021-05-0196
Number of retired or separated participants receiving benefits2021-05-010
Number of other retired or separated participants entitled to future benefits2021-05-010
Total of all active and inactive participants2021-05-0196
Number of employers contributing to the scheme2021-05-010
2020: MONADNOCK COMMUNITY COOPERATIVE LIFE & DISABILITY PLAN 2020 401k membership
Total participants, beginning-of-year2020-05-01100
Total number of active participants reported on line 7a of the Form 55002020-05-01109
Number of retired or separated participants receiving benefits2020-05-010
Number of other retired or separated participants entitled to future benefits2020-05-010
Total of all active and inactive participants2020-05-01109
Number of employers contributing to the scheme2020-05-010

Form 5500 Responses for MONADNOCK COMMUNITY COOPERATIVE LIFE & DISABILITY PLAN

2022: MONADNOCK COMMUNITY COOPERATIVE LIFE & DISABILITY PLAN 2022 form 5500 responses
2022-05-01Type of plan entitySingle employer plan
2022-05-01Submission has been amendedYes
2022-05-01Plan funding arrangement – InsuranceYes
2022-05-01Plan benefit arrangement – InsuranceYes
2021: MONADNOCK COMMUNITY COOPERATIVE LIFE & DISABILITY PLAN 2021 form 5500 responses
2021-05-01Type of plan entitySingle employer plan
2021-05-01Plan funding arrangement – InsuranceYes
2021-05-01Plan benefit arrangement – InsuranceYes
2020: MONADNOCK COMMUNITY COOPERATIVE LIFE & DISABILITY PLAN 2020 form 5500 responses
2020-05-01Type of plan entitySingle employer plan
2020-05-01First time form 5500 has been submittedYes
2020-05-01Plan funding arrangement – InsuranceYes
2020-05-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberAL00006493
Policy instance 1
Insurance contract or identification numberAL00006493
Number of Individuals Covered100
Insurance policy start date2022-05-01
Insurance policy end date2023-04-30
Total amount of commissions paid to insurance brokerUSD $2,824
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $21,750
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,824
Amount paid for insurance broker fees0
Insurance broker organization code?3
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberAL00006493
Policy instance 1
Insurance contract or identification numberAL00006493
Number of Individuals Covered96
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
Total amount of commissions paid to insurance brokerUSD $3,038
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $21,228
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,038
Amount paid for insurance broker fees0
Insurance broker organization code?3
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberAL00006493
Policy instance 1
Insurance contract or identification numberAL00006493
Number of Individuals Covered109
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Total amount of commissions paid to insurance brokerUSD $2,600
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $22,290
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,398
Amount paid for insurance broker fees0
Insurance broker organization code?3

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