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GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE FOR EMPLOYEES OF FOX BROS. PIGGLY WIGGLY, INC. 401k Plan overview

Plan NameGROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE FOR EMPLOYEES OF FOX BROS. PIGGLY WIGGLY, INC.
Plan identification number 505

GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE FOR EMPLOYEES OF FOX BROS. PIGGLY WIGGLY, INC. Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Temporary disability (accident and sickness)
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

FOX BROS. PIGGLY WIGGLY, INC. has sponsored the creation of one or more 401k plans.

Company Name:FOX BROS. PIGGLY WIGGLY, INC.
Employer identification number (EIN):391611134
NAIC Classification:445110
NAIC Description:Supermarkets and Other Grocery (except Convenience) Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE FOR EMPLOYEES OF FOX BROS. PIGGLY WIGGLY, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5052018-06-01MARY LIEBLANG2019-12-13
5052017-06-01
5052016-06-01PATRICK V. FOX
5052015-06-01PATRICK V. FOX
5052014-06-01PATRICK V. FOX
5052013-06-01PATRICK V. FOX
5052012-06-01PATRICK V. FOX
5052011-11-01PATRICK V FOX

Plan Statistics for GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE FOR EMPLOYEES OF FOX BROS. PIGGLY WIGGLY, INC.

401k plan membership statisitcs for GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE FOR EMPLOYEES OF FOX BROS. PIGGLY WIGGLY, INC.

Measure Date Value
2018: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE FOR EMPLOYEES OF FOX BROS. PIGGLY WIGGLY, INC. 2018 401k membership
Total participants, beginning-of-year2018-06-01241
Total number of active participants reported on line 7a of the Form 55002018-06-010
Number of retired or separated participants receiving benefits2018-06-010
Number of other retired or separated participants entitled to future benefits2018-06-010
Total of all active and inactive participants2018-06-010
2017: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE FOR EMPLOYEES OF FOX BROS. PIGGLY WIGGLY, INC. 2017 401k membership
Total participants, beginning-of-year2017-06-01217
Total number of active participants reported on line 7a of the Form 55002017-06-01241
Number of retired or separated participants receiving benefits2017-06-010
Number of other retired or separated participants entitled to future benefits2017-06-010
Total of all active and inactive participants2017-06-01241
2016: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE FOR EMPLOYEES OF FOX BROS. PIGGLY WIGGLY, INC. 2016 401k membership
Total participants, beginning-of-year2016-06-01247
Total number of active participants reported on line 7a of the Form 55002016-06-01217
Total of all active and inactive participants2016-06-01217
Total participants2016-06-01217
2015: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE FOR EMPLOYEES OF FOX BROS. PIGGLY WIGGLY, INC. 2015 401k membership
Total participants, beginning-of-year2015-06-01244
Total number of active participants reported on line 7a of the Form 55002015-06-01247
Total of all active and inactive participants2015-06-01247
Total participants2015-06-010
2014: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE FOR EMPLOYEES OF FOX BROS. PIGGLY WIGGLY, INC. 2014 401k membership
Total participants, beginning-of-year2014-06-01210
Total number of active participants reported on line 7a of the Form 55002014-06-01244
Total of all active and inactive participants2014-06-01244
Total participants2014-06-010
2013: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE FOR EMPLOYEES OF FOX BROS. PIGGLY WIGGLY, INC. 2013 401k membership
Total participants, beginning-of-year2013-06-01186
Total number of active participants reported on line 7a of the Form 55002013-06-01210
Total of all active and inactive participants2013-06-01210
Total participants2013-06-010
2012: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE FOR EMPLOYEES OF FOX BROS. PIGGLY WIGGLY, INC. 2012 401k membership
Total participants, beginning-of-year2012-06-01140
Total number of active participants reported on line 7a of the Form 55002012-06-01186
Total of all active and inactive participants2012-06-01186
Total participants2012-06-010
2011: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE FOR EMPLOYEES OF FOX BROS. PIGGLY WIGGLY, INC. 2011 401k membership
Total participants, beginning-of-year2011-11-01177
Total number of active participants reported on line 7a of the Form 55002011-11-01186
Total of all active and inactive participants2011-11-01186
Total participants2011-11-01186

Form 5500 Responses for GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE FOR EMPLOYEES OF FOX BROS. PIGGLY WIGGLY, INC.

2018: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE FOR EMPLOYEES OF FOX BROS. PIGGLY WIGGLY, INC. 2018 form 5500 responses
2018-06-01Type of plan entitySingle employer plan
2018-06-01This submission is the final filingYes
2018-06-01Plan funding arrangement – General assets of the sponsorYes
2018-06-01Plan benefit arrangement – InsuranceYes
2018-06-01Plan benefit arrangement – General assets of the sponsorYes
2017: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE FOR EMPLOYEES OF FOX BROS. PIGGLY WIGGLY, INC. 2017 form 5500 responses
2017-06-01Type of plan entitySingle employer plan
2017-06-01Plan funding arrangement – InsuranceYes
2017-06-01Plan benefit arrangement – InsuranceYes
2016: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE FOR EMPLOYEES OF FOX BROS. PIGGLY WIGGLY, INC. 2016 form 5500 responses
2016-06-01Type of plan entitySingle employer plan
2016-06-01Plan funding arrangement – InsuranceYes
2016-06-01Plan benefit arrangement – InsuranceYes
2015: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE FOR EMPLOYEES OF FOX BROS. PIGGLY WIGGLY, INC. 2015 form 5500 responses
2015-06-01Type of plan entitySingle employer plan
2015-06-01Plan funding arrangement – InsuranceYes
2015-06-01Plan benefit arrangement – InsuranceYes
2014: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE FOR EMPLOYEES OF FOX BROS. PIGGLY WIGGLY, INC. 2014 form 5500 responses
2014-06-01Type of plan entitySingle employer plan
2014-06-01Plan funding arrangement – InsuranceYes
2014-06-01Plan benefit arrangement – InsuranceYes
2013: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE FOR EMPLOYEES OF FOX BROS. PIGGLY WIGGLY, INC. 2013 form 5500 responses
2013-06-01Type of plan entitySingle employer plan
2013-06-01Plan funding arrangement – InsuranceYes
2013-06-01Plan benefit arrangement – InsuranceYes
2012: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE FOR EMPLOYEES OF FOX BROS. PIGGLY WIGGLY, INC. 2012 form 5500 responses
2012-06-01Type of plan entitySingle employer plan
2012-06-01Plan funding arrangement – InsuranceYes
2012-06-01Plan benefit arrangement – InsuranceYes
2011: GROUP LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE FOR EMPLOYEES OF FOX BROS. PIGGLY WIGGLY, INC. 2011 form 5500 responses
2011-11-01Type of plan entitySingle employer plan
2011-11-01First time form 5500 has been submittedYes
2011-11-01Submission has been amendedYes
2011-11-01This return/report is a short plan year return/report (less than 12 months)Yes
2011-11-01Plan funding arrangement – InsuranceYes
2011-11-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE5038856
Policy instance 1
Insurance contract or identification numberE5038856
Number of Individuals Covered277
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $5,579
Total amount of fees paid to insurance companyUSD $840
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $22,179
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,133
Amount paid for insurance broker fees79
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number248500
Policy instance 1
Insurance contract or identification number248500
Number of Individuals Covered241
Insurance policy start date2017-06-01
Insurance policy end date2018-05-31
Total amount of commissions paid to insurance brokerUSD $3,349
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $26,198
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,349
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010191660
Policy instance 1
Insurance contract or identification number000010191660
Number of Individuals Covered247
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $1,336
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,571
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $718
Insurance broker organization code?3
Insurance broker nameBURKWALD & ASSOCIATES INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010191660
Policy instance 1
Insurance contract or identification number000010191660
Number of Individuals Covered244
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $1,251
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,518
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,251
Insurance broker organization code?3
Insurance broker nameBURKWALD & ASSOCIATES INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number303299
Policy instance 1
Insurance contract or identification number303299
Number of Individuals Covered210
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $700
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,686
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $700
Insurance broker organization code?3
Insurance broker nameBURKWALD & ASSOCIATES INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number303299
Policy instance 1
Insurance contract or identification number303299
Number of Individuals Covered186
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $732
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,322
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $732
Insurance broker organization code?3
Insurance broker nameBURKWALD & ASSOCIATES INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010152276 00
Policy instance 1
Insurance contract or identification number000010152276 00
Number of Individuals Covered186
Insurance policy start date2012-02-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $309
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,062
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1014286
Policy instance 2
Insurance contract or identification number1014286
Number of Individuals Covered99
Insurance policy start date2011-11-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $557
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,718
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1014286
Policy instance 3
Insurance contract or identification number1014286
Number of Individuals Covered165
Insurance policy start date2011-11-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $97
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $972
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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