401k Plan data: QUALITY BEVERAGE LIMITED PARTNERSHIP HEALTH PLAN plan

QUALITY BEVERAGE LIMITED PARTNERSHIP HEALTH PLAN 401k Plan overview

Plan Name	QUALITY BEVERAGE LIMITED PARTNERSHIP HEALTH PLAN
Plan identification number	501

QUALITY BEVERAGE LIMITED PARTNERSHIP HEALTH PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision

401k Sponsoring company profile

QUALITY BEVERAGE LIMITED PARTNERSHIP has sponsored the creation of one or more 401k plans.

Company Name: QUALITY BEVERAGE LIMITED PARTNERSHIP

Employer identification number (EIN): 431683474

NAIC Classification: 424800

Form 5500 Filing Information

Submission information for form 5500 for 401k plan QUALITY BEVERAGE LIMITED PARTNERSHIP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-10-01 THEODORE AUDET 2024-04-22
501 2021-10-01 KIM JOHANSON IZZO 2023-04-17
501 2020-10-01 KIM JOHANSON IZZO 2022-03-10
501 2019-10-01 CINDY VANNIER 2021-04-15
501 2017-10-01 CINDY VANNIER
501 2016-10-01 THEODORE AUDET

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-10-01	THEODORE AUDET	2024-04-22
501	2021-10-01	KIM JOHANSON IZZO	2023-04-17
501	2020-10-01	KIM JOHANSON IZZO	2022-03-10
501	2019-10-01	CINDY VANNIER	2021-04-15
501	2017-10-01	CINDY VANNIER
501	2016-10-01	THEODORE AUDET

Plan Statistics for QUALITY BEVERAGE LIMITED PARTNERSHIP HEALTH PLAN

401k plan membership statisitcs for QUALITY BEVERAGE LIMITED PARTNERSHIP HEALTH PLAN

Measure Date Value
2022: QUALITY BEVERAGE LIMITED PARTNERSHIP HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year 2022-10-01 137
Total number of active participants reported on line 7a of the Form 5500 2022-10-01 136
Number of retired or separated participants receiving benefits 2022-10-01 0
Number of other retired or separated participants entitled to future benefits 2022-10-01 0
Total of all active and inactive participants 2022-10-01 136
2021: QUALITY BEVERAGE LIMITED PARTNERSHIP HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year 2021-10-01 144
Total number of active participants reported on line 7a of the Form 5500 2021-10-01 136
Number of retired or separated participants receiving benefits 2021-10-01 1
Number of other retired or separated participants entitled to future benefits 2021-10-01 0
Total of all active and inactive participants 2021-10-01 137
2020: QUALITY BEVERAGE LIMITED PARTNERSHIP HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year 2020-10-01 127
Total number of active participants reported on line 7a of the Form 5500 2020-10-01 142
Number of retired or separated participants receiving benefits 2020-10-01 2
Number of other retired or separated participants entitled to future benefits 2020-10-01 0
Total of all active and inactive participants 2020-10-01 144
2019: QUALITY BEVERAGE LIMITED PARTNERSHIP HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year 2019-10-01 132
Total number of active participants reported on line 7a of the Form 5500 2019-10-01 124
Number of retired or separated participants receiving benefits 2019-10-01 3
Number of other retired or separated participants entitled to future benefits 2019-10-01 0
Total of all active and inactive participants 2019-10-01 127
2017: QUALITY BEVERAGE LIMITED PARTNERSHIP HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year 2017-10-01 126
Total number of active participants reported on line 7a of the Form 5500 2017-10-01 128
Number of retired or separated participants receiving benefits 2017-10-01 3
Number of other retired or separated participants entitled to future benefits 2017-10-01 0
Total of all active and inactive participants 2017-10-01 131
2016: QUALITY BEVERAGE LIMITED PARTNERSHIP HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year 2016-10-01 118
Total number of active participants reported on line 7a of the Form 5500 2016-10-01 121
Number of retired or separated participants receiving benefits 2016-10-01 5
Number of other retired or separated participants entitled to future benefits 2016-10-01 0
Total of all active and inactive participants 2016-10-01 126

Measure	Date	Value
2022: QUALITY BEVERAGE LIMITED PARTNERSHIP HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year	2022-10-01	137
Total number of active participants reported on line 7a of the Form 5500	2022-10-01	136
Number of retired or separated participants receiving benefits	2022-10-01	0
Number of other retired or separated participants entitled to future benefits	2022-10-01	0
Total of all active and inactive participants	2022-10-01	136
2021: QUALITY BEVERAGE LIMITED PARTNERSHIP HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year	2021-10-01	144
Total number of active participants reported on line 7a of the Form 5500	2021-10-01	136
Number of retired or separated participants receiving benefits	2021-10-01	1
Number of other retired or separated participants entitled to future benefits	2021-10-01	0
Total of all active and inactive participants	2021-10-01	137
2020: QUALITY BEVERAGE LIMITED PARTNERSHIP HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year	2020-10-01	127
Total number of active participants reported on line 7a of the Form 5500	2020-10-01	142
Number of retired or separated participants receiving benefits	2020-10-01	2
Number of other retired or separated participants entitled to future benefits	2020-10-01	0
Total of all active and inactive participants	2020-10-01	144
2019: QUALITY BEVERAGE LIMITED PARTNERSHIP HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year	2019-10-01	132
Total number of active participants reported on line 7a of the Form 5500	2019-10-01	124
Number of retired or separated participants receiving benefits	2019-10-01	3
Number of other retired or separated participants entitled to future benefits	2019-10-01	0
Total of all active and inactive participants	2019-10-01	127
2017: QUALITY BEVERAGE LIMITED PARTNERSHIP HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year	2017-10-01	126
Total number of active participants reported on line 7a of the Form 5500	2017-10-01	128
Number of retired or separated participants receiving benefits	2017-10-01	3
Number of other retired or separated participants entitled to future benefits	2017-10-01	0
Total of all active and inactive participants	2017-10-01	131
2016: QUALITY BEVERAGE LIMITED PARTNERSHIP HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year	2016-10-01	118
Total number of active participants reported on line 7a of the Form 5500	2016-10-01	121
Number of retired or separated participants receiving benefits	2016-10-01	5
Number of other retired or separated participants entitled to future benefits	2016-10-01	0
Total of all active and inactive participants	2016-10-01	126

Form 5500 Responses for QUALITY BEVERAGE LIMITED PARTNERSHIP HEALTH PLAN

2022: QUALITY BEVERAGE LIMITED PARTNERSHIP HEALTH PLAN 2022 form 5500 responses
2022-10-01	Type of plan entity	Single employer plan
2022-10-01	Submission has been amended	No
2022-10-01	This submission is the final filing	No
2022-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-10-01	Plan is a collectively bargained plan	No
2022-10-01	Plan funding arrangement – Insurance	Yes
2022-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-10-01	Plan benefit arrangement – Insurance	Yes
2021: QUALITY BEVERAGE LIMITED PARTNERSHIP HEALTH PLAN 2021 form 5500 responses
2021-10-01	Type of plan entity	Single employer plan
2021-10-01	Submission has been amended	No
2021-10-01	This submission is the final filing	No
2021-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-10-01	Plan is a collectively bargained plan	No
2021-10-01	Plan funding arrangement – Insurance	Yes
2021-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-10-01	Plan benefit arrangement – Insurance	Yes
2020: QUALITY BEVERAGE LIMITED PARTNERSHIP HEALTH PLAN 2020 form 5500 responses
2020-10-01	Type of plan entity	Single employer plan
2020-10-01	Submission has been amended	No
2020-10-01	This submission is the final filing	No
2020-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-10-01	Plan is a collectively bargained plan	No
2020-10-01	Plan funding arrangement – Insurance	Yes
2020-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-10-01	Plan benefit arrangement – Insurance	Yes
2020-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: QUALITY BEVERAGE LIMITED PARTNERSHIP HEALTH PLAN 2019 form 5500 responses
2019-10-01	Type of plan entity	Single employer plan
2019-10-01	Submission has been amended	No
2019-10-01	This submission is the final filing	No
2019-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-10-01	Plan is a collectively bargained plan	No
2019-10-01	Plan funding arrangement – Insurance	Yes
2019-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-10-01	Plan benefit arrangement – Insurance	Yes
2019-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: QUALITY BEVERAGE LIMITED PARTNERSHIP HEALTH PLAN 2017 form 5500 responses
2017-10-01	Type of plan entity	Single employer plan
2017-10-01	Submission has been amended	No
2017-10-01	This submission is the final filing	No
2017-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-10-01	Plan is a collectively bargained plan	No
2017-10-01	Plan funding arrangement – Insurance	Yes
2017-10-01	Plan benefit arrangement – Insurance	Yes
2016: QUALITY BEVERAGE LIMITED PARTNERSHIP HEALTH PLAN 2016 form 5500 responses
2016-10-01	Type of plan entity	Single employer plan
2016-10-01	First time form 5500 has been submitted	Yes
2016-10-01	Submission has been amended	No
2016-10-01	This submission is the final filing	No
2016-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-10-01	Plan is a collectively bargained plan	No
2016-10-01	Plan funding arrangement – Insurance	Yes
2016-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number	7065_5
Policy instance	7
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number	4956725
Policy instance	1
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number	7060_1
Policy instance	2
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number	7060_2
Policy instance	3
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number	7060_3
Policy instance	4
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number	7060_4
Policy instance	5
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	96978481001
Policy instance	6
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number	7060_1
Policy instance	2
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number	4956725
Policy instance	1
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number	7065_5
Policy instance	7
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	96978481001
Policy instance	6
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number	7060_4
Policy instance	5
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number	7060_3
Policy instance	4
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number	7060_2
Policy instance	3
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number	4956725
Policy instance	1
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number	7060_1
Policy instance	2
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number	7060_2
Policy instance	3
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number	7060_3
Policy instance	4
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number	7060_4
Policy instance	5
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	96978481001
Policy instance	6
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number	96978481001
Policy instance	6
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number	7060_4
Policy instance	5
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number	7060_3
Policy instance	4
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number	7060_2
Policy instance	3
ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 )
Policy contract number	7060_1
Policy instance	2
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number	4956725
Policy instance	1

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Company Name:	QUALITY BEVERAGE LIMITED PARTNERSHIP
Employer identification number (EIN):	431683474
NAIC Classification:	424800