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MEDICAL/DENTAL BENEFIT PLAN OF Z, INC. DBA PAUL'S MARKET 401k Plan overview

Plan NameMEDICAL/DENTAL BENEFIT PLAN OF Z, INC. DBA PAUL'S MARKET
Plan identification number 501

MEDICAL/DENTAL BENEFIT PLAN OF Z, INC. DBA PAUL'S MARKET Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision

401k Sponsoring company profile

Z CORPORATION, INC. has sponsored the creation of one or more 401k plans.

Company Name:Z CORPORATION, INC.
Employer identification number (EIN):820277272
NAIC Classification:445110
NAIC Description:Supermarkets and Other Grocery (except Convenience) Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDICAL/DENTAL BENEFIT PLAN OF Z, INC. DBA PAUL'S MARKET

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012016-04-01STAN ZATICA
5012015-04-01STAN ZATICA
5012014-04-01STAN ZATICA
5012013-04-01STAN ZATICA
5012012-04-01STAN ZATICA
5012012-01-01STAN ZATICA STAN ZATICA2012-10-19
5012011-01-01STAN ZATICA STAN ZATICA2012-09-26
5012010-01-01STAN ZATICA STAN ZATICA2011-09-20
5012009-01-01STAN ZATICA STAN ZATICA2010-10-12

Plan Statistics for MEDICAL/DENTAL BENEFIT PLAN OF Z, INC. DBA PAUL'S MARKET

401k plan membership statisitcs for MEDICAL/DENTAL BENEFIT PLAN OF Z, INC. DBA PAUL'S MARKET

Measure Date Value
2016: MEDICAL/DENTAL BENEFIT PLAN OF Z, INC. DBA PAUL'S MARKET 2016 401k membership
Total participants, beginning-of-year2016-04-01196
Total number of active participants reported on line 7a of the Form 55002016-04-010
Number of retired or separated participants receiving benefits2016-04-010
Number of other retired or separated participants entitled to future benefits2016-04-010
Total of all active and inactive participants2016-04-010
2015: MEDICAL/DENTAL BENEFIT PLAN OF Z, INC. DBA PAUL'S MARKET 2015 401k membership
Total participants, beginning-of-year2015-04-01187
Total number of active participants reported on line 7a of the Form 55002015-04-01196
Number of retired or separated participants receiving benefits2015-04-011
Number of other retired or separated participants entitled to future benefits2015-04-010
Total of all active and inactive participants2015-04-01197
2014: MEDICAL/DENTAL BENEFIT PLAN OF Z, INC. DBA PAUL'S MARKET 2014 401k membership
Total participants, beginning-of-year2014-04-01200
Total number of active participants reported on line 7a of the Form 55002014-04-01187
Number of retired or separated participants receiving benefits2014-04-012
Number of other retired or separated participants entitled to future benefits2014-04-010
Total of all active and inactive participants2014-04-01189
2013: MEDICAL/DENTAL BENEFIT PLAN OF Z, INC. DBA PAUL'S MARKET 2013 401k membership
Total participants, beginning-of-year2013-04-01213
Total number of active participants reported on line 7a of the Form 55002013-04-01200
Number of retired or separated participants receiving benefits2013-04-011
Total of all active and inactive participants2013-04-01201
2012: MEDICAL/DENTAL BENEFIT PLAN OF Z, INC. DBA PAUL'S MARKET 2012 401k membership
Total participants, beginning-of-year2012-04-01217
Total number of active participants reported on line 7a of the Form 55002012-04-01213
Number of retired or separated participants receiving benefits2012-04-010
Total of all active and inactive participants2012-04-01213
Total participants, beginning-of-year2012-01-01204
Total number of active participants reported on line 7a of the Form 55002012-01-01217
Number of retired or separated participants receiving benefits2012-01-011
Total of all active and inactive participants2012-01-01218
2011: MEDICAL/DENTAL BENEFIT PLAN OF Z, INC. DBA PAUL'S MARKET 2011 401k membership
Total participants, beginning-of-year2011-01-01292
Total number of active participants reported on line 7a of the Form 55002011-01-01204
Total of all active and inactive participants2011-01-01204
2010: MEDICAL/DENTAL BENEFIT PLAN OF Z, INC. DBA PAUL'S MARKET 2010 401k membership
Total participants, beginning-of-year2010-01-01306
Total number of active participants reported on line 7a of the Form 55002010-01-01292
Total of all active and inactive participants2010-01-01292
2009: MEDICAL/DENTAL BENEFIT PLAN OF Z, INC. DBA PAUL'S MARKET 2009 401k membership
Total participants, beginning-of-year2009-01-01343
Total number of active participants reported on line 7a of the Form 55002009-01-01306
Total of all active and inactive participants2009-01-01306

Financial Data on MEDICAL/DENTAL BENEFIT PLAN OF Z, INC. DBA PAUL'S MARKET

Measure Date Value
2010 : MEDICAL/DENTAL BENEFIT PLAN OF Z, INC. DBA PAUL'S MARKET 2010 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$127,190
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$103,566
Total income from all sources (including contributions)2010-12-31$1,132,531
Total of all expenses incurred2010-12-31$1,156,585
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$1,036,542
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$1,132,531
Value of total assets at end of year2010-12-31$102,216
Value of total assets at beginning of year2010-12-31$102,646
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$120,043
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$1,000,000
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$503,461
Participant contributions at end of year2010-12-31$38,514
Participant contributions at beginning of year2010-12-31$37,843
Assets. Other investments not covered elsewhere at end of year2010-12-31$62,000
Assets. Other investments not covered elsewhere at beginning of year2010-12-31$62,000
Income. Received or receivable in cash from other sources (including rollovers)2010-12-31$8,406
Value of other receiveables (less allowance for doubtful accounts) at end of year2010-12-31$1,702
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2010-12-31$2,803
Administrative expenses (other) incurred2010-12-31$25,128
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$-24,054
Value of net assets at end of year (total assets less liabilities)2010-12-31$-24,974
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$-920
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2010-12-31$307,833
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$620,664
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$728,709
Contract administrator fees2010-12-31$94,915
Liabilities. Value of benefit claims payable at end of year2010-12-31$127,190
Liabilities. Value of benefit claims payable at beginning of year2010-12-31$103,566
Did the plan have assets held for investment2010-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31No
Opinion of an independent qualified public accountant for this plan2010-12-31Unqualified
Accountancy firm name2010-12-31RIPLEY DOORN & COMPANY, P.L.L.C.
Accountancy firm EIN2010-12-31820476132

Form 5500 Responses for MEDICAL/DENTAL BENEFIT PLAN OF Z, INC. DBA PAUL'S MARKET

2016: MEDICAL/DENTAL BENEFIT PLAN OF Z, INC. DBA PAUL'S MARKET 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01This submission is the final filingYes
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan funding arrangement – General assets of the sponsorYes
2016-04-01Plan benefit arrangement – InsuranceYes
2016-04-01Plan benefit arrangement – General assets of the sponsorYes
2015: MEDICAL/DENTAL BENEFIT PLAN OF Z, INC. DBA PAUL'S MARKET 2015 form 5500 responses
2015-04-01Type of plan entitySingle employer plan
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan funding arrangement – General assets of the sponsorYes
2015-04-01Plan benefit arrangement – InsuranceYes
2015-04-01Plan benefit arrangement – General assets of the sponsorYes
2014: MEDICAL/DENTAL BENEFIT PLAN OF Z, INC. DBA PAUL'S MARKET 2014 form 5500 responses
2014-04-01Type of plan entitySingle employer plan
2014-04-01Plan funding arrangement – InsuranceYes
2014-04-01Plan funding arrangement – General assets of the sponsorYes
2014-04-01Plan benefit arrangement – InsuranceYes
2014-04-01Plan benefit arrangement – General assets of the sponsorYes
2013: MEDICAL/DENTAL BENEFIT PLAN OF Z, INC. DBA PAUL'S MARKET 2013 form 5500 responses
2013-04-01Type of plan entitySingle employer plan
2013-04-01Plan funding arrangement – InsuranceYes
2013-04-01Plan funding arrangement – General assets of the sponsorYes
2013-04-01Plan benefit arrangement – InsuranceYes
2013-04-01Plan benefit arrangement – General assets of the sponsorYes
2012: MEDICAL/DENTAL BENEFIT PLAN OF Z, INC. DBA PAUL'S MARKET 2012 form 5500 responses
2012-04-01Type of plan entitySingle employer plan
2012-04-01Plan funding arrangement – InsuranceYes
2012-04-01Plan funding arrangement – General assets of the sponsorYes
2012-04-01Plan benefit arrangement – InsuranceYes
2012-04-01Plan benefit arrangement – General assets of the sponsorYes
2012-01-01Type of plan entitySingle employer plan
2012-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: MEDICAL/DENTAL BENEFIT PLAN OF Z, INC. DBA PAUL'S MARKET 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: MEDICAL/DENTAL BENEFIT PLAN OF Z, INC. DBA PAUL'S MARKET 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: MEDICAL/DENTAL BENEFIT PLAN OF Z, INC. DBA PAUL'S MARKET 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract number947-1806
Policy instance 2
Insurance contract or identification number947-1806
Number of Individuals Covered287
Insurance policy start date2015-10-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $1,444
Other welfare benefits providedORGAN TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $14,440
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,444
Insurance broker organization code?3
Insurance broker nameLEFTLANE, INC.
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract number947-1160
Policy instance 1
Insurance contract or identification number947-1160
Number of Individuals Covered287
Insurance policy start date2015-04-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $1,315
Other welfare benefits providedORGAN TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $13,154
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,315
Insurance broker organization code?3
Insurance broker nameSHEFFIELD, OLSON & MCQUEEN
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract number947-0061
Policy instance 1
Insurance contract or identification number947-0061
Insurance policy start date2014-04-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $1,348
Other welfare benefits providedORGAN TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $13,484
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,348
Insurance broker organization code?3
Insurance broker nameSHEFFIELD, OLSON & MCQUEEN
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract number947-0288
Policy instance 2
Insurance contract or identification number947-0288
Number of Individuals Covered190
Insurance policy start date2014-10-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $1,267
Other welfare benefits providedORGAN TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $12,674
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,267
Insurance broker organization code?3
Insurance broker nameLEFTLANE, INC.
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract number949-6125
Policy instance 1
Insurance contract or identification number949-6125
Number of Individuals Covered176
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $2,424
Other welfare benefits providedORGAN TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $24,241
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,424
Insurance broker organization code?3
Insurance broker nameSHEFFIELD, OLSON & MCQUEEN
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract number949-0978
Policy instance 1
Insurance contract or identification number949-0978
Number of Individuals Covered181
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $2,804
Other welfare benefits providedORGAN TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $28,038
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,804
Insurance broker organization code?3
Insurance broker nameSHEFFIELD, OLSON & MCQUEEN
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract number949-0978
Policy instance 1
Insurance contract or identification number949-0978
Number of Individuals Covered189
Insurance policy start date2012-01-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $549
Other welfare benefits providedORGAN TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $5,494
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract number949-0061
Policy instance 1
Insurance contract or identification number949-0061
Number of Individuals Covered179
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $2,173
Other welfare benefits providedORGAN TRANSPLANT
Welfare Benefit Premiums Paid to CarrierUSD $21,730
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
REGENCE BLUESHIELD OF IDAHO (National Association of Insurance Commissioners NAIC id number: 60131 )
Policy contract number60021146
Policy instance 1
Insurance contract or identification number60021146
Number of Individuals Covered193
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $25,128
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $222,183
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,128
Insurance broker organization code?3
Insurance broker nameCORNILLES FINANCIAL SERVICES, LLC
WILLAMETTE DENTAL OF IDAHO, INC. (National Association of Insurance Commissioners NAIC id number: 95819 )
Policy contract numberZ1867
Policy instance 2
Insurance contract or identification numberZ1867
Number of Individuals Covered139
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $3,483
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $69,746
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,483
Insurance broker organization code?3
Insurance broker nameWILLAMETTE DENTAL
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number585751
Policy instance 3
Insurance contract or identification number585751
Number of Individuals Covered336
Insurance policy start date2009-05-01
Insurance policy end date2010-05-01
Total amount of commissions paid to insurance brokerUSD $2,045
Life Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $15,904
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,045
Insurance broker organization code?3
Insurance broker nameCORNILLES FINANCIAL SERVICES, LLC

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