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DI BRUNO BROS. HOLDINGS, INC. GROUP MEDICAL PLAN 401k Plan overview

Plan NameDI BRUNO BROS. HOLDINGS, INC. GROUP MEDICAL PLAN
Plan identification number 501

DI BRUNO BROS. HOLDINGS, INC. GROUP MEDICAL PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

401k Sponsoring company profile

DI BRUNO BROS. HOLDINGS, INC. has sponsored the creation of one or more 401k plans.

Company Name:DI BRUNO BROS. HOLDINGS, INC.
Employer identification number (EIN):472593694
NAIC Classification:445299
NAIC Description:All Other Specialty Food Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DI BRUNO BROS. HOLDINGS, INC. GROUP MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-07-01
5012020-11-01
5012019-11-01
5012019-11-01

Plan Statistics for DI BRUNO BROS. HOLDINGS, INC. GROUP MEDICAL PLAN

401k plan membership statisitcs for DI BRUNO BROS. HOLDINGS, INC. GROUP MEDICAL PLAN

Measure Date Value
2021: DI BRUNO BROS. HOLDINGS, INC. GROUP MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-01108
Total number of active participants reported on line 7a of the Form 55002021-07-01139
Number of retired or separated participants receiving benefits2021-07-010
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-01139
2020: DI BRUNO BROS. HOLDINGS, INC. GROUP MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year2020-11-01104
Total number of active participants reported on line 7a of the Form 55002020-11-01108
Number of retired or separated participants receiving benefits2020-11-010
Number of other retired or separated participants entitled to future benefits2020-11-010
Total of all active and inactive participants2020-11-01108
2019: DI BRUNO BROS. HOLDINGS, INC. GROUP MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year2019-11-01113
Total number of active participants reported on line 7a of the Form 55002019-11-01101
Number of retired or separated participants receiving benefits2019-11-013
Number of other retired or separated participants entitled to future benefits2019-11-010
Total of all active and inactive participants2019-11-01104

Financial Data on DI BRUNO BROS. HOLDINGS, INC. GROUP MEDICAL PLAN

Measure Date Value
2021 : DI BRUNO BROS. HOLDINGS, INC. GROUP MEDICAL PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-06-30$163,105
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-06-30$96,807
Total income from all sources (including contributions)2021-06-30$517,348
Total loss/gain on sale of assets2021-06-30$0
Total of all expenses incurred2021-06-30$616,131
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-06-30$543,336
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-06-30$517,259
Value of total assets at end of year2021-06-30$26,162
Value of total assets at beginning of year2021-06-30$58,647
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-06-30$72,795
Total interest from all sources2021-06-30$89
Total dividends received (eg from common stock, registered investment company shares)2021-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-06-30No
Administrative expenses professional fees incurred2021-06-30$72,795
Was this plan covered by a fidelity bond2021-06-30Yes
Value of fidelity bond cover2021-06-30$385,000
If this is an individual account plan, was there a blackout period2021-06-30No
Were there any nonexempt tranactions with any party-in-interest2021-06-30No
Liabilities. Value of operating payables at end of year2021-06-30$81,972
Liabilities. Value of operating payables at beginning of year2021-06-30$35,008
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-06-30No
Value of net income/loss2021-06-30$-98,783
Value of net assets at end of year (total assets less liabilities)2021-06-30$-136,943
Value of net assets at beginning of year (total assets less liabilities)2021-06-30$-38,160
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2021-06-30No
Were any leases to which the plan was party in default or uncollectible2021-06-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-06-30$26,162
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-06-30$58,647
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-06-30$58,647
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-06-30$89
Expenses. Payments to insurance carriers foe the provision of benefits2021-06-30$121,582
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-06-30No
Was there a failure to transmit to the plan any participant contributions2021-06-30No
Has the plan failed to provide any benefit when due under the plan2021-06-30No
Contributions received in cash from employer2021-06-30$517,259
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-06-30$421,754
Liabilities. Value of benefit claims payable at end of year2021-06-30$81,133
Liabilities. Value of benefit claims payable at beginning of year2021-06-30$61,799
Did the plan have assets held for investment2021-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-06-30No
Opinion of an independent qualified public accountant for this plan2021-06-30Unqualified
Accountancy firm name2021-06-30BDF-CPAS
Accountancy firm EIN2021-06-30222625944
2020 : DI BRUNO BROS. HOLDINGS, INC. GROUP MEDICAL PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-10-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-10-31$96,807
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-10-31$0
Total income from all sources (including contributions)2020-10-31$795,946
Total loss/gain on sale of assets2020-10-31$0
Total of all expenses incurred2020-10-31$834,106
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-10-31$697,325
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-10-31$795,846
Value of total assets at end of year2020-10-31$58,647
Value of total assets at beginning of year2020-10-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-10-31$136,781
Total interest from all sources2020-10-31$100
Total dividends received (eg from common stock, registered investment company shares)2020-10-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-10-31No
Administrative expenses professional fees incurred2020-10-31$136,781
Was this plan covered by a fidelity bond2020-10-31Yes
Value of fidelity bond cover2020-10-31$500,000
If this is an individual account plan, was there a blackout period2020-10-31No
Were there any nonexempt tranactions with any party-in-interest2020-10-31No
Liabilities. Value of operating payables at end of year2020-10-31$35,008
Liabilities. Value of operating payables at beginning of year2020-10-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-10-31No
Value of net income/loss2020-10-31$-38,160
Value of net assets at end of year (total assets less liabilities)2020-10-31$-38,160
Value of net assets at beginning of year (total assets less liabilities)2020-10-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-10-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-10-31No
Were any leases to which the plan was party in default or uncollectible2020-10-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-10-31$58,647
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-10-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-10-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-10-31$100
Expenses. Payments to insurance carriers foe the provision of benefits2020-10-31$697,325
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-10-31No
Was there a failure to transmit to the plan any participant contributions2020-10-31No
Has the plan failed to provide any benefit when due under the plan2020-10-31No
Contributions received in cash from employer2020-10-31$795,846
Liabilities. Value of benefit claims payable at end of year2020-10-31$61,799
Liabilities. Value of benefit claims payable at beginning of year2020-10-31$0
Did the plan have assets held for investment2020-10-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-10-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-10-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-10-31No
Opinion of an independent qualified public accountant for this plan2020-10-31Unqualified
Accountancy firm name2020-10-31BDF-CPAS
Accountancy firm EIN2020-10-31222625944

Form 5500 Responses for DI BRUNO BROS. HOLDINGS, INC. GROUP MEDICAL PLAN

2021: DI BRUNO BROS. HOLDINGS, INC. GROUP MEDICAL PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Submission has been amendedNo
2021-07-01This submission is the final filingNo
2021-07-01This return/report is a short plan year return/report (less than 12 months)No
2021-07-01Plan is a collectively bargained planNo
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan funding arrangement – General assets of the sponsorYes
2021-07-01Plan benefit arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – General assets of the sponsorYes
2020: DI BRUNO BROS. HOLDINGS, INC. GROUP MEDICAL PLAN 2020 form 5500 responses
2020-11-01Type of plan entitySingle employer plan
2020-11-01Submission has been amendedNo
2020-11-01This submission is the final filingNo
2020-11-01This return/report is a short plan year return/report (less than 12 months)Yes
2020-11-01Plan is a collectively bargained planNo
2020-11-01Plan funding arrangement – InsuranceYes
2020-11-01Plan funding arrangement – TrustYes
2020-11-01Plan benefit arrangement – InsuranceYes
2020-11-01Plan benefit arrangement - TrustYes
2019: DI BRUNO BROS. HOLDINGS, INC. GROUP MEDICAL PLAN 2019 form 5500 responses
2019-11-01Type of plan entitySingle employer plan
2019-11-01First time form 5500 has been submittedYes
2019-11-01Submission has been amendedNo
2019-11-01This submission is the final filingNo
2019-11-01This return/report is a short plan year return/report (less than 12 months)No
2019-11-01Plan is a collectively bargained planNo
2019-11-01Plan funding arrangement – InsuranceYes
2019-11-01Plan funding arrangement – TrustYes
2019-11-01Plan benefit arrangement – InsuranceYes
2019-11-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number407720
Policy instance 1
Insurance contract or identification number407720
Number of Individuals Covered139
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $238,550
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30500483
Policy instance 1
Insurance contract or identification number30500483
Number of Individuals Covered0
Insurance policy start date2020-11-01
Insurance policy end date2020-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $28,612
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number407720
Policy instance 2
Insurance contract or identification number407720
Number of Individuals Covered108
Insurance policy start date2021-01-01
Insurance policy end date2021-06-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $92,970
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30500483
Policy instance 1
Insurance contract or identification number30500483
Number of Individuals Covered104
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $180,874
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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