401k Plan data: LUCKYS FARMERS MARKETS HOLDINGS LLC 401(K) PLAN plan

LUCKYS FARMERS MARKETS HOLDINGS LLC 401(K) PLAN 401k Plan overview

Plan Name	LUCKYS FARMERS MARKETS HOLDINGS LLC 401(K) PLAN
Plan identification number	001

LUCKYS FARMERS MARKETS HOLDINGS LLC 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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.
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.

401k Sponsoring company profile

LUCKYS MARKET has sponsored the creation of one or more 401k plans.

Company Name: LUCKYS MARKET

Employer identification number (EIN): 455557224

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LUCKYS FARMERS MARKETS HOLDINGS LLC 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 PATRICIA WILLIAMSON PATRICIA WILLIAMSON 2017-08-08
001 2015-01-01 PATRICIA WILLIAMSON
001 2014-01-01 LINDA CHEDISTER

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2016-01-01	PATRICIA WILLIAMSON	PATRICIA WILLIAMSON	2017-08-08
001	2015-01-01	PATRICIA WILLIAMSON
001	2014-01-01	LINDA CHEDISTER

Plan Statistics for LUCKYS FARMERS MARKETS HOLDINGS LLC 401(K) PLAN

401k plan membership statisitcs for LUCKYS FARMERS MARKETS HOLDINGS LLC 401(K) PLAN

Measure Date Value
2016: LUCKYS FARMERS MARKETS HOLDINGS LLC 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1,384
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 1,542
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 54
Total of all active and inactive participants 2016-01-01 1,596
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 1,596
Number of participants with account balances 2016-01-01 220
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 50
2015: LUCKYS FARMERS MARKETS HOLDINGS LLC 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 863
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1,160
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 27
Total of all active and inactive participants 2015-01-01 1,187
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 1,187
Number of participants with account balances 2015-01-01 118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 28
2014: LUCKYS FARMERS MARKETS HOLDINGS LLC 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 342
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 774
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 6
Total of all active and inactive participants 2014-01-01 780
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 780
Number of participants with account balances 2014-01-01 51
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0

Measure	Date	Value
2016: LUCKYS FARMERS MARKETS HOLDINGS LLC 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1,384
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	1,542
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	54
Total of all active and inactive participants	2016-01-01	1,596
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	1,596
Number of participants with account balances	2016-01-01	220
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	50
2015: LUCKYS FARMERS MARKETS HOLDINGS LLC 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	863
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1,160
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	27
Total of all active and inactive participants	2015-01-01	1,187
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	1,187
Number of participants with account balances	2015-01-01	118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	28
2014: LUCKYS FARMERS MARKETS HOLDINGS LLC 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	342
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	774
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	6
Total of all active and inactive participants	2014-01-01	780
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	780
Number of participants with account balances	2014-01-01	51
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0

Financial Data on LUCKYS FARMERS MARKETS HOLDINGS LLC 401(K) PLAN

Measure	Date	Value
2016 : LUCKYS FARMERS MARKETS HOLDINGS LLC 401(K) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total transfer of assets to this plan	2016-12-31	$0
Total transfer of assets from this plan	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$649,877
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$66,863
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$52,627
Value of total corrective distributions	2016-12-31	$12,908
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$588,712
Value of total assets at end of year	2016-12-31	$945,281
Value of total assets at beginning of year	2016-12-31	$362,267
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$1,328
Total interest from all sources	2016-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$24,423
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$24,423
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$37,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$444,572
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$90,407
Other income not declared elsewhere	2016-12-31	$129
Administrative expenses (other) incurred	2016-12-31	$1,328
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$583,014
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$945,281
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$362,267
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$829,414
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$320,674
Value of interest in common/collective trusts at end of year	2016-12-31	$115,867
Value of interest in common/collective trusts at beginning of year	2016-12-31	$41,593
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$26,821
Net investment gain or loss from common/collective trusts	2016-12-31	$9,792
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$53,733
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$52,627
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	EKS&H
Accountancy firm EIN	2016-12-31	461497033
2015 : LUCKYS FARMERS MARKETS HOLDINGS LLC 401(K) PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total transfer of assets to this plan	2015-12-31	$0
Total transfer of assets from this plan	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$283,869
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$9,828
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$9,328
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$288,750
Value of total assets at end of year	2015-12-31	$362,267
Value of total assets at beginning of year	2015-12-31	$88,226
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$500
Total interest from all sources	2015-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$13,969
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$13,969
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$9,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$227,060
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$35,605
Administrative expenses (other) incurred	2015-12-31	$500
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$274,041
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$362,267
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$88,226
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$320,674
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$83,432
Value of interest in common/collective trusts at end of year	2015-12-31	$41,593
Value of interest in common/collective trusts at beginning of year	2015-12-31	$4,794
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-18,136
Net investment gain or loss from common/collective trusts	2015-12-31	$-714
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$26,085
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$9,328
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	EKS&H
Accountancy firm EIN	2015-12-31	461497033
2014 : LUCKYS FARMERS MARKETS HOLDINGS LLC 401(K) PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total transfer of assets to this plan	2014-12-31	$0
Total transfer of assets from this plan	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$91,771
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$3,545
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$3,345
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$90,234
Value of total assets at end of year	2014-12-31	$88,226
Value of total assets at beginning of year	2014-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$200
Total interest from all sources	2014-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$3,125
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$3,125
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$1,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$77,642
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$12,592
Administrative expenses (other) incurred	2014-12-31	$200
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$88,226
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$88,226
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$83,432
Value of interest in common/collective trusts at end of year	2014-12-31	$4,794
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$-1,700
Net investment gain or loss from common/collective trusts	2014-12-31	$112
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$3,345
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	EKS&H
Accountancy firm EIN	2014-12-31	461497033

Form 5500 Responses for LUCKYS FARMERS MARKETS HOLDINGS LLC 401(K) PLAN

2016: LUCKYS FARMERS MARKETS HOLDINGS LLC 401(K) 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 – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: LUCKYS FARMERS MARKETS HOLDINGS LLC 401(K) 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 – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: LUCKYS FARMERS MARKETS HOLDINGS LLC 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	First time form 5500 has been submitted	Yes
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 – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	LUCKYS MARKET
Employer identification number (EIN):	455557224
NAIC Classification:	445110
NAIC Description:	Supermarkets and Other Grocery (except Convenience) Stores