401k Plan data: FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN plan

FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN 401k Plan overview

Plan Name	FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN
Plan identification number	503

FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental

401k Sponsoring company profile

FOX BROS. PIGGLY WIGGLY, INC. has sponsored the creation of one or more 401k plans.

Company Name: FOX BROS. PIGGLY WIGGLY, INC.

Employer identification number (EIN): 391611134

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2018-06-01 MARY LIEBLANG 2019-12-13
503 2017-06-01
503 2016-06-01 PATRICK V. FOX
503 2015-06-01 PATRICK V. FOX
503 2014-06-01 PATRICK V. FOX
503 2013-06-01 PATRICK V. FOX
503 2012-11-01 PATRICK V. FOX
503 2011-11-01 PATRICK V FOX

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
503	2018-06-01	MARY LIEBLANG	2019-12-13
503	2017-06-01
503	2016-06-01	PATRICK V. FOX
503	2015-06-01	PATRICK V. FOX
503	2014-06-01	PATRICK V. FOX
503	2013-06-01	PATRICK V. FOX
503	2012-11-01	PATRICK V. FOX
503	2011-11-01	PATRICK V FOX

Plan Statistics for FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN

401k plan membership statisitcs for FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN

Measure Date Value
2018: FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN 2018 401k membership
Total participants, beginning-of-year 2018-06-01 241
Total number of active participants reported on line 7a of the Form 5500 2018-06-01 0
Number of retired or separated participants receiving benefits 2018-06-01 0
Number of other retired or separated participants entitled to future benefits 2018-06-01 0
Total of all active and inactive participants 2018-06-01 0
2017: FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN 2017 401k membership
Total participants, beginning-of-year 2017-06-01 164
Total number of active participants reported on line 7a of the Form 5500 2017-06-01 163
Number of retired or separated participants receiving benefits 2017-06-01 0
Number of other retired or separated participants entitled to future benefits 2017-06-01 0
Total of all active and inactive participants 2017-06-01 163
2016: FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN 2016 401k membership
Total participants, beginning-of-year 2016-06-01 173
Total number of active participants reported on line 7a of the Form 5500 2016-06-01 164
Total of all active and inactive participants 2016-06-01 164
Total participants 2016-06-01 164
2015: FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN 2015 401k membership
Total participants, beginning-of-year 2015-06-01 180
Total number of active participants reported on line 7a of the Form 5500 2015-06-01 173
Total of all active and inactive participants 2015-06-01 173
Total participants 2015-06-01 0
2014: FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN 2014 401k membership
Total participants, beginning-of-year 2014-06-01 154
Total number of active participants reported on line 7a of the Form 5500 2014-06-01 180
Total of all active and inactive participants 2014-06-01 180
Total participants 2014-06-01 0
2013: FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN 2013 401k membership
Total participants, beginning-of-year 2013-06-01 145
Total number of active participants reported on line 7a of the Form 5500 2013-06-01 154
Total of all active and inactive participants 2013-06-01 154
Total participants 2013-06-01 0
2012: FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-11-01 140
Total number of active participants reported on line 7a of the Form 5500 2012-11-01 145
Total of all active and inactive participants 2012-11-01 145
Total participants 2012-11-01 0
2011: FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year 2011-11-01 119
Total number of active participants reported on line 7a of the Form 5500 2011-11-01 140
Total of all active and inactive participants 2011-11-01 140
Total participants 2011-11-01 140

Measure	Date	Value
2018: FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN 2018 401k membership
Total participants, beginning-of-year	2018-06-01	241
Total number of active participants reported on line 7a of the Form 5500	2018-06-01	0
Number of retired or separated participants receiving benefits	2018-06-01	0
Number of other retired or separated participants entitled to future benefits	2018-06-01	0
Total of all active and inactive participants	2018-06-01	0
2017: FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN 2017 401k membership
Total participants, beginning-of-year	2017-06-01	164
Total number of active participants reported on line 7a of the Form 5500	2017-06-01	163
Number of retired or separated participants receiving benefits	2017-06-01	0
Number of other retired or separated participants entitled to future benefits	2017-06-01	0
Total of all active and inactive participants	2017-06-01	163
2016: FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN 2016 401k membership
Total participants, beginning-of-year	2016-06-01	173
Total number of active participants reported on line 7a of the Form 5500	2016-06-01	164
Total of all active and inactive participants	2016-06-01	164
Total participants	2016-06-01	164
2015: FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN 2015 401k membership
Total participants, beginning-of-year	2015-06-01	180
Total number of active participants reported on line 7a of the Form 5500	2015-06-01	173
Total of all active and inactive participants	2015-06-01	173
Total participants	2015-06-01	0
2014: FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN 2014 401k membership
Total participants, beginning-of-year	2014-06-01	154
Total number of active participants reported on line 7a of the Form 5500	2014-06-01	180
Total of all active and inactive participants	2014-06-01	180
Total participants	2014-06-01	0
2013: FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN 2013 401k membership
Total participants, beginning-of-year	2013-06-01	145
Total number of active participants reported on line 7a of the Form 5500	2013-06-01	154
Total of all active and inactive participants	2013-06-01	154
Total participants	2013-06-01	0
2012: FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-11-01	140
Total number of active participants reported on line 7a of the Form 5500	2012-11-01	145
Total of all active and inactive participants	2012-11-01	145
Total participants	2012-11-01	0
2011: FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year	2011-11-01	119
Total number of active participants reported on line 7a of the Form 5500	2011-11-01	140
Total of all active and inactive participants	2011-11-01	140
Total participants	2011-11-01	140

Form 5500 Responses for FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN

2018: FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN 2018 form 5500 responses
2018-06-01	Type of plan entity	Single employer plan
2018-06-01	This submission is the final filing	Yes
2018-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN 2017 form 5500 responses
2017-06-01	Type of plan entity	Single employer plan
2017-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN 2016 form 5500 responses
2016-06-01	Type of plan entity	Single employer plan
2016-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN 2015 form 5500 responses
2015-06-01	Type of plan entity	Single employer plan
2015-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN 2014 form 5500 responses
2014-06-01	Type of plan entity	Single employer plan
2014-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN 2013 form 5500 responses
2013-06-01	Type of plan entity	Single employer plan
2013-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN 2012 form 5500 responses
2012-11-01	Type of plan entity	Single employer plan
2012-11-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2012-11-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-11-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: FOX BROS. PIGGLY WIGGLY, INC. GROUP DENTAL PLAN 2011 form 5500 responses
2011-11-01	Type of plan entity	Single employer plan
2011-11-01	First time form 5500 has been submitted	Yes
2011-11-01	Submission has been amended	Yes
2011-11-01	Plan funding arrangement – Insurance	Yes
2011-11-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 )

Policy contract number

93812 00000

Policy instance

Insurance contract or identification number	93812 00000
Number of Individuals Covered	140
Insurance policy start date	2012-02-01
Insurance policy end date	2012-10-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,563
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1014286

Policy instance

Insurance contract or identification number	1014286
Number of Individuals Covered	263
Insurance policy start date	2011-11-01
Insurance policy end date	2012-01-31
Total amount of commissions paid to insurance broker	USD $975
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,381
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

FOX BROS. CONVENIENCE STORES 401(K) PLAN [EIN = 472059446]

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Company Name:	FOX BROS. PIGGLY WIGGLY, INC.
Employer identification number (EIN):	391611134
NAIC Classification:	445110
NAIC Description:	Supermarkets and Other Grocery (except Convenience) Stores