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UFCW LOCAL NO. 21 SUPPLEMENTAL LIFE AND DISABILITY 401k Plan overview

Plan NameUFCW LOCAL NO. 21 SUPPLEMENTAL LIFE AND DISABILITY
Plan identification number 501

UFCW LOCAL NO. 21 SUPPLEMENTAL LIFE AND DISABILITY Benefits

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

401k Sponsoring company profile

UFCW LOCAL NO. 21 SUPPLEMENTAL LIFE AND DISABILITY FUND has sponsored the creation of one or more 401k plans.

Company Name:UFCW LOCAL NO. 21 SUPPLEMENTAL LIFE AND DISABILITY FUND
Employer identification number (EIN):911549422
NAIC Classification:525100
NAIC Description: Insurance and Employee Benefit Funds

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UFCW LOCAL NO. 21 SUPPLEMENTAL LIFE AND DISABILITY

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012012-01-01AIMEE ALLEN
5012011-01-01AIMEE ALLEN
5012009-01-01IEVA DILTS

Plan Statistics for UFCW LOCAL NO. 21 SUPPLEMENTAL LIFE AND DISABILITY

401k plan membership statisitcs for UFCW LOCAL NO. 21 SUPPLEMENTAL LIFE AND DISABILITY

Measure Date Value
2012: UFCW LOCAL NO. 21 SUPPLEMENTAL LIFE AND DISABILITY 2012 401k membership
Total participants, beginning-of-year2012-01-0121,116
Total number of active participants reported on line 7a of the Form 55002012-01-010
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-010
2011: UFCW LOCAL NO. 21 SUPPLEMENTAL LIFE AND DISABILITY 2011 401k membership
Total participants, beginning-of-year2011-01-0121,116
Total number of active participants reported on line 7a of the Form 55002011-01-0118,100
Number of other retired or separated participants entitled to future benefits2011-01-0122
Total of all active and inactive participants2011-01-0118,122
2009: UFCW LOCAL NO. 21 SUPPLEMENTAL LIFE AND DISABILITY 2009 401k membership
Total participants, beginning-of-year2009-01-0115,810
Total number of active participants reported on line 7a of the Form 55002009-01-0121,083
Number of other retired or separated participants entitled to future benefits2009-01-0170
Total of all active and inactive participants2009-01-0121,153

Financial Data on UFCW LOCAL NO. 21 SUPPLEMENTAL LIFE AND DISABILITY

Measure Date Value
2012 : UFCW LOCAL NO. 21 SUPPLEMENTAL LIFE AND DISABILITY 2012 401k financial data
Total transfer of assets from this plan2012-09-30$5,071
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-09-30$51,331
Total income from all sources (including contributions)2012-09-30$188
Total loss/gain on sale of assets2012-09-30$74
Total of all expenses incurred2012-09-30$148,637
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-09-30$104,172
Value of total assets at beginning of year2012-09-30$204,851
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-09-30$44,465
Total interest from all sources2012-09-30$114
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-09-30No
Administrative expenses professional fees incurred2012-09-30$14,436
Was this plan covered by a fidelity bond2012-09-30Yes
Value of fidelity bond cover2012-09-30$2,740,000
If this is an individual account plan, was there a blackout period2012-09-30No
Were there any nonexempt tranactions with any party-in-interest2012-09-30No
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-09-30$88
Administrative expenses (other) incurred2012-09-30$11,586
Liabilities. Value of operating payables at beginning of year2012-09-30$974
Total non interest bearing cash at beginning of year2012-09-30$4,536
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-09-30No
Value of net income/loss2012-09-30$-148,449
Value of net assets at beginning of year (total assets less liabilities)2012-09-30$153,520
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2012-09-30No
Were any leases to which the plan was party in default or uncollectible2012-09-30No
Investment advisory and management fees2012-09-30$300
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-09-30$50,188
Income. Interest from US Government securities2012-09-30$114
Asset value of US Government securities at beginning of year2012-09-30$150,039
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-09-30Yes
Was there a failure to transmit to the plan any participant contributions2012-09-30No
Has the plan failed to provide any benefit when due under the plan2012-09-30No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-09-30$104,172
Contract administrator fees2012-09-30$18,143
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-09-30No
Liabilities. Value of benefit claims payable at beginning of year2012-09-30$50,357
Did the plan have assets held for investment2012-09-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-09-30No
Aggregate proceeds on sale of assets2012-09-30$150,113
Aggregate carrying amount (costs) on sale of assets2012-09-30$150,039
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-09-30No
Opinion of an independent qualified public accountant for this plan2012-09-30Unqualified
Accountancy firm name2012-09-30DON A CURTIS & ASSOCIATES PLLC
Accountancy firm EIN2012-09-30264388619
2011 : UFCW LOCAL NO. 21 SUPPLEMENTAL LIFE AND DISABILITY 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2011-12-31$40
Total unrealized appreciation/depreciation of assets2011-12-31$40
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$51,331
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$37,214
Total income from all sources (including contributions)2011-12-31$233,410
Total loss/gain on sale of assets2011-12-31$22
Total of all expenses incurred2011-12-31$375,125
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$332,624
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$231,916
Value of total assets at end of year2011-12-31$204,851
Value of total assets at beginning of year2011-12-31$332,449
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$42,501
Total interest from all sources2011-12-31$1,432
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Administrative expenses professional fees incurred2011-12-31$12,138
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$2,740,000
If this is an individual account plan, was there a blackout period2011-12-31No
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-12-31$88
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-12-31$286
Administrative expenses (other) incurred2011-12-31$1,548
Liabilities. Value of operating payables at end of year2011-12-31$974
Liabilities. Value of operating payables at beginning of year2011-12-31$1,400
Total non interest bearing cash at end of year2011-12-31$4,536
Total non interest bearing cash at beginning of year2011-12-31$42,439
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$-141,715
Value of net assets at end of year (total assets less liabilities)2011-12-31$153,520
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$295,235
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Investment advisory and management fees2011-12-31$1,800
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$50,188
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$79,671
Income. Interest from US Government securities2011-12-31$1,432
Asset value of US Government securities at end of year2011-12-31$150,039
Asset value of US Government securities at beginning of year2011-12-31$210,053
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31Yes
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$231,916
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$332,624
Contract administrator fees2011-12-31$27,015
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-12-31No
Liabilities. Value of benefit claims payable at end of year2011-12-31$50,357
Liabilities. Value of benefit claims payable at beginning of year2011-12-31$35,814
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Aggregate proceeds on sale of assets2011-12-31$410,000
Aggregate carrying amount (costs) on sale of assets2011-12-31$409,978
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31No
Opinion of an independent qualified public accountant for this plan2011-12-31Unqualified
Accountancy firm name2011-12-31DON A CURTIS & ASSOCIATES PLLC
Accountancy firm EIN2011-12-31264388619
2010 : UFCW LOCAL NO. 21 SUPPLEMENTAL LIFE AND DISABILITY 2010 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2010-12-31$159
Total unrealized appreciation/depreciation of assets2010-12-31$159
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$37,214
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$48,579
Total income from all sources (including contributions)2010-12-31$265,703
Total loss/gain on sale of assets2010-12-31$-1,818
Total of all expenses incurred2010-12-31$423,961
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$386,903
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$263,467
Value of total assets at end of year2010-12-31$332,449
Value of total assets at beginning of year2010-12-31$502,072
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$37,058
Total interest from all sources2010-12-31$3,895
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Administrative expenses professional fees incurred2010-12-31$12,029
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$2,640,000
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
Value of other receiveables (less allowance for doubtful accounts) at end of year2010-12-31$286
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2010-12-31$1,564
Administrative expenses (other) incurred2010-12-31$470
Liabilities. Value of operating payables at end of year2010-12-31$1,400
Liabilities. Value of operating payables at beginning of year2010-12-31$350
Total non interest bearing cash at end of year2010-12-31$42,439
Total non interest bearing cash at beginning of year2010-12-31$19,214
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$-158,258
Value of net assets at end of year (total assets less liabilities)2010-12-31$295,235
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$453,493
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
Investment advisory and management fees2010-12-31$1,800
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$79,671
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$73,641
Income. Interest from US Government securities2010-12-31$3,895
Asset value of US Government securities at end of year2010-12-31$210,053
Asset value of US Government securities at beginning of year2010-12-31$407,653
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31Yes
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$263,467
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$386,903
Contract administrator fees2010-12-31$22,759
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-12-31No
Liabilities. Value of benefit claims payable at end of year2010-12-31$35,814
Liabilities. Value of benefit claims payable at beginning of year2010-12-31$48,229
Did the plan have assets held for investment2010-12-31Yes
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
Aggregate proceeds on sale of assets2010-12-31$531,000
Aggregate carrying amount (costs) on sale of assets2010-12-31$532,818
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 name2010-12-31DON A CURTIS & ASSOCIATES PLLC
Accountancy firm EIN2010-12-31264388619

Form 5500 Responses for UFCW LOCAL NO. 21 SUPPLEMENTAL LIFE AND DISABILITY

2012: UFCW LOCAL NO. 21 SUPPLEMENTAL LIFE AND DISABILITY 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01This submission is the final filingYes
2012-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement - TrustYes
2011: UFCW LOCAL NO. 21 SUPPLEMENTAL LIFE AND DISABILITY 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement - TrustYes
2009: UFCW LOCAL NO. 21 SUPPLEMENTAL LIFE AND DISABILITY 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement - TrustYes

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