401k Plan data: FOOD 4 LESS & MEGA FOODS 401(K) PROFIT SHARING PLAN plan

FOOD 4 LESS & MEGA FOODS 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	FOOD 4 LESS & MEGA FOODS 401(K) PROFIT SHARING PLAN
Plan identification number	001

FOOD 4 LESS & MEGA FOODS 401(K) PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

BLAKE & ELLIS, INC. has sponsored the creation of one or more 401k plans.

Company Name: BLAKE & ELLIS, INC.

Employer identification number (EIN): 930961833

NAIC Classification: 424400

Additional information about BLAKE & ELLIS, INC.

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division

Incorporation Date: 1987-11-04

Company Identification Number: 9321787

Legal Registered Office Address: 3905 EOLA DR NW

SALEM
United States of America (USA)
97304

More information about BLAKE & ELLIS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FOOD 4 LESS & MEGA FOODS 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2013-01-01 BOBBY J. ELLIS
001 2012-01-01 BOBBY J. ELLIS
001 2011-01-01 CHARLES BLAKE BARTON 2012-06-14
001 2010-01-01 PENSION PLANNERS NORTHWEST 2011-06-22

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-01-01
001	2021-01-01
001	2013-01-01	BOBBY J. ELLIS
001	2012-01-01	BOBBY J. ELLIS
001	2011-01-01	CHARLES BLAKE BARTON	2012-06-14
001	2010-01-01	PENSION PLANNERS NORTHWEST	2011-06-22

Plan Statistics for FOOD 4 LESS & MEGA FOODS 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for FOOD 4 LESS & MEGA FOODS 401(K) PROFIT SHARING PLAN

Measure Date Value
2013: FOOD 4 LESS & MEGA FOODS 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 195
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 0
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 0
Number of participants with account balances 2013-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 1
2012: FOOD 4 LESS & MEGA FOODS 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 186
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 157
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 26
Total of all active and inactive participants 2012-01-01 183
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 183
Number of participants with account balances 2012-01-01 127
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 2

Measure	Date	Value
2013: FOOD 4 LESS & MEGA FOODS 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	195
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	0
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	0
Number of participants with account balances	2013-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	1
2012: FOOD 4 LESS & MEGA FOODS 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	186
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	157
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	26
Total of all active and inactive participants	2012-01-01	183
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	183
Number of participants with account balances	2012-01-01	127
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	2

Financial Data on FOOD 4 LESS & MEGA FOODS 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2013 : FOOD 4 LESS & MEGA FOODS 401(K) PROFIT SHARING PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$2,624
Total income from all sources (including contributions)	2013-12-31	$417,682
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$2,553,298
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$2,523,319
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$121,691
Value of total assets at end of year	2013-12-31	$0
Value of total assets at beginning of year	2013-12-31	$2,138,240
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$29,979
Total interest from all sources	2013-12-31	$116
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2013-12-31	$0
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$214,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$75,311
Liabilities. Value of operating payables at end of year	2013-12-31	$0
Liabilities. Value of operating payables at beginning of year	2013-12-31	$2,624
Total non interest bearing cash at end of year	2013-12-31	$0
Total non interest bearing cash at beginning of year	2013-12-31	$1,818
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$-2,135,616
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$2,135,616
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$2,051,129
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$116
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$25,302
Net investment gain/loss from pooled separate accounts	2013-12-31	$295,875
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$46,380
Employer contributions (assets) at end of year	2013-12-31	$0
Employer contributions (assets) at beginning of year	2013-12-31	$59,991
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$2,523,319
Contract administrator fees	2013-12-31	$29,979
Did the plan have assets held for investment	2013-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	FISCHER, HAYES, AND ASSOCIATES, PC
Accountancy firm EIN	2013-12-31	931090135
2012 : FOOD 4 LESS & MEGA FOODS 401(K) PROFIT SHARING PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$2,624
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$373,173
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$549,511
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$518,454
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$159,504
Value of total assets at end of year	2012-12-31	$2,138,240
Value of total assets at beginning of year	2012-12-31	$2,311,954
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$31,057
Total interest from all sources	2012-12-31	$405
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$214,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$98,331
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$1,182
Administrative expenses (other) incurred	2012-12-31	$12,458
Liabilities. Value of operating payables at end of year	2012-12-31	$2,624
Liabilities. Value of operating payables at beginning of year	2012-12-31	$0
Total non interest bearing cash at end of year	2012-12-31	$1,818
Total non interest bearing cash at beginning of year	2012-12-31	$3,165
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$-176,338
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$2,135,616
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$2,311,954
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$2,051,129
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$2,198,635
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$405
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$25,302
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$45,347
Net investment gain/loss from pooled separate accounts	2012-12-31	$213,264
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$59,991
Employer contributions (assets) at end of year	2012-12-31	$59,991
Employer contributions (assets) at beginning of year	2012-12-31	$64,807
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$518,454
Contract administrator fees	2012-12-31	$18,599
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	FISCHER, HAYES, AND ASSOCIATES, PC
Accountancy firm EIN	2012-12-31	931090135

Form 5500 Responses for FOOD 4 LESS & MEGA FOODS 401(K) PROFIT SHARING PLAN

2013: FOOD 4 LESS & MEGA FOODS 401(K) PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	Yes
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: FOOD 4 LESS & MEGA FOODS 401(K) PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

16229

Policy instance

Insurance contract or identification number	16229
Number of Individuals Covered	0
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $13,300
Total amount of fees paid to insurance company	USD $16,908
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	16908
Additional information about fees paid to insurance broker	TPA FEES AND COMPENSATION
Insurance broker organization code?	5
Commission paid to Insurance Broker	USD $13,300
Insurance broker name	WELLS FARGO ADVISORS INS AGENCY LLC

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Company Name:	BLAKE & ELLIS, INC.
Employer identification number (EIN):	930961833
NAIC Classification:	424400

Jurisdiction of Incorporation:	Oregon Secretary of State Corporations Division
Incorporation Date:	1987-11-04
Company Identification Number:	9321787
Legal Registered Office Address:	3905 EOLA DR NW SALEM United States of America (USA) 97304