401k Plan data: TIMES SUPER MARKET FLEXIBLE BENEFITS PLAN plan

TIMES SUPER MARKET FLEXIBLE BENEFITS PLAN 401k Plan overview

Plan Name	TIMES SUPER MARKET FLEXIBLE BENEFITS PLAN
Plan identification number	508

TIMES SUPER MARKET FLEXIBLE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20. Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

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

Company Name: QSI, INC.

Employer identification number (EIN): 260041527

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

Additional information about QSI, INC.

Jurisdiction of Incorporation: California Department of State

Incorporation Date: 1998-10-01

Company Identification Number: C2121827

Legal Registered Office Address: 1902 Wright Place Suite #200

Carlsbad
United States of America (USA)
92008

More information about QSI, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TIMES SUPER MARKET FLEXIBLE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
508 2020-01-01
508 2019-01-01
508 2018-01-01 REID MATSUMOTO
508 2009-01-01 JOHN QUINN JOHN QUINN 2010-10-12
508 2007-01-01 JANICE BLOUDOFF JANICE BLOUDOFF 2010-03-26

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
508	2020-01-01
508	2019-01-01
508	2018-01-01	REID MATSUMOTO
508	2009-01-01	JOHN QUINN	JOHN QUINN	2010-10-12
508	2007-01-01	JANICE BLOUDOFF	JANICE BLOUDOFF	2010-03-26

Plan Statistics for TIMES SUPER MARKET FLEXIBLE BENEFITS PLAN

401k plan membership statisitcs for TIMES SUPER MARKET FLEXIBLE BENEFITS PLAN

Measure Date Value
2020: TIMES SUPER MARKET FLEXIBLE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 113
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 93
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 93
2019: TIMES SUPER MARKET FLEXIBLE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 106
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 113
Number of retired or separated participants receiving benefits 2019-01-01 7
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 120
2018: TIMES SUPER MARKET FLEXIBLE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 121
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 106
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 106
2009: TIMES SUPER MARKET FLEXIBLE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 585
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 857
Total of all active and inactive participants 2009-01-01 857
2007: TIMES SUPER MARKET FLEXIBLE BENEFITS PLAN 2007 401k membership
Total participants, beginning-of-year 2007-01-01 558
Total number of active participants reported on line 7a of the Form 5500 2007-01-01 558
Total of all active and inactive participants 2007-01-01 558

Measure	Date	Value
2020: TIMES SUPER MARKET FLEXIBLE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	113
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	93
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	93
2019: TIMES SUPER MARKET FLEXIBLE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	106
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	113
Number of retired or separated participants receiving benefits	2019-01-01	7
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	120
2018: TIMES SUPER MARKET FLEXIBLE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	121
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	106
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	106
2009: TIMES SUPER MARKET FLEXIBLE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	585
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	857
Total of all active and inactive participants	2009-01-01	857
2007: TIMES SUPER MARKET FLEXIBLE BENEFITS PLAN 2007 401k membership
Total participants, beginning-of-year	2007-01-01	558
Total number of active participants reported on line 7a of the Form 5500	2007-01-01	558
Total of all active and inactive participants	2007-01-01	558

Form 5500 Responses for TIMES SUPER MARKET FLEXIBLE BENEFITS PLAN

2020: TIMES SUPER MARKET FLEXIBLE BENEFITS PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: TIMES SUPER MARKET FLEXIBLE BENEFITS PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: TIMES SUPER MARKET FLEXIBLE BENEFITS PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: TIMES SUPER MARKET FLEXIBLE BENEFITS PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2007: TIMES SUPER MARKET FLEXIBLE BENEFITS PLAN 2007 form 5500 responses
2007-01-01	Type of plan entity	Single employer plan
2007-01-01	Submission has been amended	Yes
2007-01-01	This submission is the final filing	No
2007-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2007-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

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Company Name:	QSI, INC.
Employer identification number (EIN):	260041527
NAIC Classification:	445110
NAIC Description:	Supermarkets and Other Grocery (except Convenience) Stores

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:	1998-10-01
Company Identification Number:	C2121827
Legal Registered Office Address:	1902 Wright Place Suite #200 Carlsbad United States of America (USA) 92008