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| Plan Name | GEISSLER'S SUPERMARKET, INC. STD AND LTD INSURANCE PLAN |
| Plan identification number | 504 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | GEISSLER'S SUPERMARKET, INC. |
| Employer identification number (EIN): | 060698871 |
| NAIC Classification: | 445110 |
| NAIC Description: | Supermarkets and Other Grocery (except Convenience) Stores |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 504 | 2015-10-01 | JAMES H NILSSON JR | JAMES H NILSSON JR | 2017-01-26 | |
| 504 | 2014-10-01 | 2017-01-26 | |||
| 504 | 2014-10-01 | JAMES H NILSSON JR | JAMES H NILSSON JR | 2017-01-26 | |
| 504 | 2013-10-01 | JAMES NILSSON JR | JAMES NILSSON JR | 2017-01-26 |
| Measure | Date | Value |
|---|---|---|
| 2015: GEISSLER'S SUPERMARKET, INC. STD AND LTD INSURANCE PLAN 2015 401k membership | ||
| Total participants, beginning-of-year | 2015-10-01 | 122 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-10-01 | 0 |
| Total of all active and inactive participants | 2015-10-01 | 0 |
| 2014: GEISSLER'S SUPERMARKET, INC. STD AND LTD INSURANCE PLAN 2014 401k membership | ||
| Total participants, beginning-of-year | 2014-10-01 | 124 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-10-01 | 122 |
| Total of all active and inactive participants | 2014-10-01 | 122 |
| 2013: GEISSLER'S SUPERMARKET, INC. STD AND LTD INSURANCE PLAN 2013 401k membership | ||
| Total participants, beginning-of-year | 2013-10-01 | 112 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-10-01 | 124 |
| Total of all active and inactive participants | 2013-10-01 | 124 |
| Total participants | 2013-10-01 | 124 |
| 2015: GEISSLER'S SUPERMARKET, INC. STD AND LTD INSURANCE PLAN 2015 form 5500 responses | ||
|---|---|---|
| 2015-10-01 | Type of plan entity | Single employer plan |
| 2015-10-01 | Submission has been amended | No |
| 2015-10-01 | This submission is the final filing | Yes |
| 2015-10-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2015-10-01 | Plan is a collectively bargained plan | No |
| 2015-10-01 | Plan funding arrangement – Insurance | Yes |
| 2015-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: GEISSLER'S SUPERMARKET, INC. STD AND LTD INSURANCE PLAN 2014 form 5500 responses | ||
| 2014-10-01 | Type of plan entity | Single employer plan |
| 2014-10-01 | Submission has been amended | Yes |
| 2014-10-01 | This submission is the final filing | No |
| 2014-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-10-01 | Plan is a collectively bargained plan | No |
| 2014-10-01 | Plan funding arrangement – Insurance | Yes |
| 2014-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: GEISSLER'S SUPERMARKET, INC. STD AND LTD INSURANCE PLAN 2013 form 5500 responses | ||
| 2013-10-01 | Type of plan entity | Single employer plan |
| 2013-10-01 | First time form 5500 has been submitted | Yes |
| 2013-10-01 | Submission has been amended | No |
| 2013-10-01 | This submission is the final filing | No |
| 2013-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-10-01 | Plan is a collectively bargained plan | No |
| 2013-10-01 | Plan funding arrangement – Insurance | Yes |
| 2013-10-01 | Plan benefit arrangement – Insurance | Yes |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 214579 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 214579 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 214579 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 214579 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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