401k Plan data: EICKHOFF SUPERMARKETS 401(K) PLAN plan

EICKHOFF SUPERMARKETS 401(K) PLAN 401k Plan overview

Plan Name	EICKHOFF SUPERMARKETS 401(K) PLAN
Plan identification number	003

EICKHOFF SUPERMARKETS 401(K) 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.
Participant-directed brokerage accounts provided as an investment option under the plan.
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

EICKHOFF SUPERMARKETS, INC. has sponsored the creation of one or more 401k plans.

Company Name: EICKHOFF SUPERMARKETS, INC.

Employer identification number (EIN): 223532818

NAIC Classification: 445110
NAIC Description: Supermarkets and Other Grocery (except Convenience) Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EICKHOFF SUPERMARKETS 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
003 2016-10-01
003 2015-10-01 IAN HARING 2017-07-14
003 2014-10-01 KRISTEN DIXON
003 2013-10-01 KRISTEN DIXON
003 2012-10-01 KRISTEN DIXON KRISTEN DIXON 2015-06-16
003 2011-10-01 KRISTEN DIXON

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
003	2016-10-01
003	2015-10-01	IAN HARING	2017-07-14
003	2014-10-01	KRISTEN DIXON
003	2013-10-01	KRISTEN DIXON
003	2012-10-01	KRISTEN DIXON		KRISTEN DIXON	2015-06-16
003	2011-10-01	KRISTEN DIXON

Plan Statistics for EICKHOFF SUPERMARKETS 401(K) PLAN

401k plan membership statisitcs for EICKHOFF SUPERMARKETS 401(K) PLAN

Measure Date Value
2014: EICKHOFF SUPERMARKETS 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-10-01 60
Total number of active participants reported on line 7a of the Form 5500 2014-10-01 42
Number of retired or separated participants receiving benefits 2014-10-01 2
Number of other retired or separated participants entitled to future benefits 2014-10-01 19
Total of all active and inactive participants 2014-10-01 63
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-10-01 0
Total participants 2014-10-01 63
Number of participants with account balances 2014-10-01 63
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-10-01 4
2013: EICKHOFF SUPERMARKETS 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-10-01 62
Total number of active participants reported on line 7a of the Form 5500 2013-10-01 42
Number of retired or separated participants receiving benefits 2013-10-01 2
Number of other retired or separated participants entitled to future benefits 2013-10-01 16
Total of all active and inactive participants 2013-10-01 60
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-10-01 0
Total participants 2013-10-01 60
Number of participants with account balances 2013-10-01 60
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-10-01 4
2012: EICKHOFF SUPERMARKETS 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-10-01 61
Total number of active participants reported on line 7a of the Form 5500 2012-10-01 42
Number of retired or separated participants receiving benefits 2012-10-01 2
Number of other retired or separated participants entitled to future benefits 2012-10-01 18
Total of all active and inactive participants 2012-10-01 62
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-10-01 0
Total participants 2012-10-01 62
Number of participants with account balances 2012-10-01 62
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-10-01 4
2011: EICKHOFF SUPERMARKETS 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-10-01 57
Total number of active participants reported on line 7a of the Form 5500 2011-10-01 44
Number of retired or separated participants receiving benefits 2011-10-01 1
Number of other retired or separated participants entitled to future benefits 2011-10-01 16
Total of all active and inactive participants 2011-10-01 61
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-10-01 0
Total participants 2011-10-01 61
Number of participants with account balances 2011-10-01 61
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-10-01 4

Measure	Date	Value
2014: EICKHOFF SUPERMARKETS 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-10-01	60
Total number of active participants reported on line 7a of the Form 5500	2014-10-01	42
Number of retired or separated participants receiving benefits	2014-10-01	2
Number of other retired or separated participants entitled to future benefits	2014-10-01	19
Total of all active and inactive participants	2014-10-01	63
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-10-01	0
Total participants	2014-10-01	63
Number of participants with account balances	2014-10-01	63
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-10-01	4
2013: EICKHOFF SUPERMARKETS 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-10-01	62
Total number of active participants reported on line 7a of the Form 5500	2013-10-01	42
Number of retired or separated participants receiving benefits	2013-10-01	2
Number of other retired or separated participants entitled to future benefits	2013-10-01	16
Total of all active and inactive participants	2013-10-01	60
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-10-01	0
Total participants	2013-10-01	60
Number of participants with account balances	2013-10-01	60
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-10-01	4
2012: EICKHOFF SUPERMARKETS 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-10-01	61
Total number of active participants reported on line 7a of the Form 5500	2012-10-01	42
Number of retired or separated participants receiving benefits	2012-10-01	2
Number of other retired or separated participants entitled to future benefits	2012-10-01	18
Total of all active and inactive participants	2012-10-01	62
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-10-01	0
Total participants	2012-10-01	62
Number of participants with account balances	2012-10-01	62
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-10-01	4
2011: EICKHOFF SUPERMARKETS 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-10-01	57
Total number of active participants reported on line 7a of the Form 5500	2011-10-01	44
Number of retired or separated participants receiving benefits	2011-10-01	1
Number of other retired or separated participants entitled to future benefits	2011-10-01	16
Total of all active and inactive participants	2011-10-01	61
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-10-01	0
Total participants	2011-10-01	61
Number of participants with account balances	2011-10-01	61
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-10-01	4

Financial Data on EICKHOFF SUPERMARKETS 401(K) PLAN

Measure	Date	Value
2015 : EICKHOFF SUPERMARKETS 401(K) PLAN 2015 401k financial data
Transfers to/from the plan	2015-09-30	$0
Total plan liabilities at end of year	2015-09-30	$0
Total plan liabilities at beginning of year	2015-09-30	$0
Total income from all sources	2015-09-30	$593,131
Expenses. Total of all expenses incurred	2015-09-30	$522,862
Benefits paid (including direct rollovers)	2015-09-30	$521,557
Total plan assets at end of year	2015-09-30	$6,662,764
Total plan assets at beginning of year	2015-09-30	$6,592,495
Value of fidelity bond covering the plan	2015-09-30	$500,000
Total contributions received or receivable from participants	2015-09-30	$295,619
Expenses. Other expenses not covered elsewhere	2015-09-30	$0
Contributions received from other sources (not participants or employers)	2015-09-30	$0
Other income received	2015-09-30	$-24,445
Noncash contributions received	2015-09-30	$0
Net income (gross income less expenses)	2015-09-30	$70,269
Net plan assets at end of year (total assets less liabilities)	2015-09-30	$6,662,764
Net plan assets at beginning of year (total assets less liabilities)	2015-09-30	$6,592,495
Assets. Value of participant loans	2015-09-30	$45,040
Total contributions received or receivable from employer(s)	2015-09-30	$321,957
Value of certain deemed distributions of participant loans	2015-09-30	$0
Value of corrective distributions	2015-09-30	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-09-30	$1,305
2014 : EICKHOFF SUPERMARKETS 401(K) PLAN 2014 401k financial data
Transfers to/from the plan	2014-09-30	$0
Total plan liabilities at end of year	2014-09-30	$0
Total income from all sources	2014-09-30	$1,565,592
Expenses. Total of all expenses incurred	2014-09-30	$120,112
Benefits paid (including direct rollovers)	2014-09-30	$118,990
Total plan assets at end of year	2014-09-30	$6,592,495
Total plan assets at beginning of year	2014-09-30	$5,147,015
Value of fidelity bond covering the plan	2014-09-30	$500,000
Total contributions received or receivable from participants	2014-09-30	$312,324
Expenses. Other expenses not covered elsewhere	2014-09-30	$0
Contributions received from other sources (not participants or employers)	2014-09-30	$0
Other income received	2014-09-30	$914,735
Noncash contributions received	2014-09-30	$0
Net income (gross income less expenses)	2014-09-30	$1,445,480
Net plan assets at end of year (total assets less liabilities)	2014-09-30	$6,592,495
Net plan assets at beginning of year (total assets less liabilities)	2014-09-30	$5,147,015
Assets. Value of participant loans	2014-09-30	$46,456
Total contributions received or receivable from employer(s)	2014-09-30	$338,533
Value of certain deemed distributions of participant loans	2014-09-30	$0
Value of corrective distributions	2014-09-30	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-09-30	$1,122
2013 : EICKHOFF SUPERMARKETS 401(K) PLAN 2013 401k financial data
Total income from all sources	2013-09-30	$1,174,861
Expenses. Total of all expenses incurred	2013-09-30	$558,845
Benefits paid (including direct rollovers)	2013-09-30	$585,926
Total plan assets at end of year	2013-09-30	$5,147,015
Total plan assets at beginning of year	2013-09-30	$4,530,999
Value of fidelity bond covering the plan	2013-09-30	$500,000
Total contributions received or receivable from participants	2013-09-30	$337,716
Other income received	2013-09-30	$644,858
Net income (gross income less expenses)	2013-09-30	$616,016
Net plan assets at end of year (total assets less liabilities)	2013-09-30	$5,147,015
Net plan assets at beginning of year (total assets less liabilities)	2013-09-30	$4,530,999
Assets. Value of participant loans	2013-09-30	$37,667
Total contributions received or receivable from employer(s)	2013-09-30	$192,287
Expenses. Administrative service providers (salaries,fees and commissions)	2013-09-30	$-27,081
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-09-30	$0
2012 : EICKHOFF SUPERMARKETS 401(K) PLAN 2012 401k financial data
Total income from all sources	2012-09-30	$907,161
Expenses. Total of all expenses incurred	2012-09-30	$189,016
Benefits paid (including direct rollovers)	2012-09-30	$163,182
Total plan assets at end of year	2012-09-30	$4,530,999
Total plan assets at beginning of year	2012-09-30	$3,812,854
Value of fidelity bond covering the plan	2012-09-30	$500,000
Total contributions received or receivable from participants	2012-09-30	$261,798
Other income received	2012-09-30	$358,311
Net income (gross income less expenses)	2012-09-30	$718,145
Net plan assets at end of year (total assets less liabilities)	2012-09-30	$4,530,999
Net plan assets at beginning of year (total assets less liabilities)	2012-09-30	$3,812,854
Assets. Value of participant loans	2012-09-30	$47,971
Total contributions received or receivable from employer(s)	2012-09-30	$287,052
Value of certain deemed distributions of participant loans	2012-09-30	$3,282
Expenses. Administrative service providers (salaries,fees and commissions)	2012-09-30	$22,552
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-09-30	$0

Form 5500 Responses for EICKHOFF SUPERMARKETS 401(K) PLAN

2014: EICKHOFF SUPERMARKETS 401(K) PLAN 2014 form 5500 responses
2014-10-01	Type of plan entity	Single employer plan
2014-10-01	Submission has been amended	No
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 – Trust	Yes
2014-10-01	Plan benefit arrangement - Trust	Yes
2013: EICKHOFF SUPERMARKETS 401(K) PLAN 2013 form 5500 responses
2013-10-01	Type of plan entity	Single employer plan
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 – Trust	Yes
2013-10-01	Plan benefit arrangement - Trust	Yes
2012: EICKHOFF SUPERMARKETS 401(K) PLAN 2012 form 5500 responses
2012-10-01	Type of plan entity	Single employer plan
2012-10-01	Submission has been amended	No
2012-10-01	This submission is the final filing	No
2012-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-10-01	Plan is a collectively bargained plan	No
2012-10-01	Plan funding arrangement – Trust	Yes
2012-10-01	Plan benefit arrangement - Trust	Yes
2011: EICKHOFF SUPERMARKETS 401(K) PLAN 2011 form 5500 responses
2011-10-01	Type of plan entity	Single employer plan
2011-10-01	Submission has been amended	No
2011-10-01	This submission is the final filing	No
2011-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-10-01	Plan is a collectively bargained plan	No
2011-10-01	Plan funding arrangement – Insurance	Yes
2011-10-01	Plan funding arrangement – Trust	Yes
2011-10-01	Plan benefit arrangement – Insurance	Yes
2011-10-01	Plan benefit arrangement - Trust	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

45817

Policy instance

Insurance contract or identification number	45817
Number of Individuals Covered	0
Insurance policy start date	2011-10-01
Insurance policy end date	2011-11-30
Total amount of commissions paid to insurance broker	USD $3,024
Total amount of fees paid to insurance company	USD $150
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	EICKHOFF SUPERMARKETS, INC.
Employer identification number (EIN):	223532818
NAIC Classification:	445110
NAIC Description:	Supermarkets and Other Grocery (except Convenience) Stores