401k Plan data: SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN plan

SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN 401k Plan overview

Plan Name	SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN
Plan identification number	507

SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision Temporary disability (accident and sickness) Death benefits (include travel accident but not life insurance) Other welfare benefit cover 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.

401k Sponsoring company profile

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

Company Name: SUPERVALU INC.

Employer identification number (EIN): 410617000

NAIC Classification: 424400

Additional information about SUPERVALU INC.

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 0194304

More information about SUPERVALU INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
507 2017-01-01 LAURA DALY LAURA DALY 2018-08-03
507 2016-01-01 LAURA DALY LAURA DALY 2017-07-26
507 2015-01-01 LAURA DALY LAURA DALY 2016-04-18
507 2014-01-01 LAURA DALY LAURA DALY 2015-04-23
507 2013-01-01 LAURA DALY LAURA DALY 2014-04-11
507 2012-01-01 LAURA DALY LAURA DALY 2013-07-18
507 2011-01-01 PATRICIA TUMA
507 2009-01-01 PATRICIA TUMA PATRICIA TUMA 2010-07-19

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
507	2017-01-01	LAURA DALY	LAURA DALY	2018-08-03
507	2016-01-01	LAURA DALY	LAURA DALY	2017-07-26
507	2015-01-01	LAURA DALY	LAURA DALY	2016-04-18
507	2014-01-01	LAURA DALY	LAURA DALY	2015-04-23
507	2013-01-01	LAURA DALY	LAURA DALY	2014-04-11
507	2012-01-01	LAURA DALY	LAURA DALY	2013-07-18
507	2011-01-01	PATRICIA TUMA
507	2009-01-01	PATRICIA TUMA	PATRICIA TUMA	2010-07-19

Plan Statistics for SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN

401k plan membership statisitcs for SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN

Measure Date Value
2017: SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 590
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 0
Number of retired or separated participants receiving benefits 2017-01-01 59
Total of all active and inactive participants 2017-01-01 59
2016: SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 731
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 602
Number of retired or separated participants receiving benefits 2016-01-01 8
Total of all active and inactive participants 2016-01-01 610
2015: SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 595
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 697
Number of retired or separated participants receiving benefits 2015-01-01 5
Total of all active and inactive participants 2015-01-01 702
2014: SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 582
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 599
Number of retired or separated participants receiving benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 599
2013: SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 611
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 610
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 2013-01-01 610
2012: SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 636
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 599
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 0
Total of all active and inactive participants 2012-01-01 599
2011: SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 751
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 737
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 737
2009: SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 880
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 721
Number of retired or separated participants receiving benefits 2009-01-01 3
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 724

Measure	Date	Value
2017: SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	590
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	0
Number of retired or separated participants receiving benefits	2017-01-01	59
Total of all active and inactive participants	2017-01-01	59
2016: SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	731
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	602
Number of retired or separated participants receiving benefits	2016-01-01	8
Total of all active and inactive participants	2016-01-01	610
2015: SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	595
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	697
Number of retired or separated participants receiving benefits	2015-01-01	5
Total of all active and inactive participants	2015-01-01	702
2014: SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	582
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	599
Number of retired or separated participants receiving benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	599
2013: SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	611
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	610
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	610
2012: SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	636
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	599
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	0
Total of all active and inactive participants	2012-01-01	599
2011: SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	751
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	737
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	737
2009: SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	880
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	721
Number of retired or separated participants receiving benefits	2009-01-01	3
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	724

Form 5500 Responses for SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN

2017: SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT 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	No
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 – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT 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 – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: SUPERVALU, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	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

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Company Name:	SUPERVALU INC.
Employer identification number (EIN):	410617000
NAIC Classification:	424400

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	0194304