401k Plan data: K-VA-T FOOD STORES, INC. HEALTH AND WELFARE BENEFIT PLAN plan

K-VA-T FOOD STORES, INC. HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	K-VA-T FOOD STORES, INC. HEALTH AND WELFARE BENEFIT PLAN
Plan identification number	506

K-VA-T FOOD STORES, INC. HEALTH AND WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

K-VA-T FOOD STORES, INC. has sponsored the creation of one or more 401k plans.

Company Name: K-VA-T FOOD STORES, INC.

Employer identification number (EIN): 550421484

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

Additional information about K-VA-T FOOD STORES, INC.

Jurisdiction of Incorporation: Virginia Secretary of State

Incorporation Date: 1985-05-07

Company Identification Number: 0270501

Legal Registered Office Address: 1 FOOD CITY CIRCLE
P O BOX 1158
ABINGDON
United States of America (USA)
24210

More information about K-VA-T FOOD STORES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan K-VA-T FOOD STORES, INC. HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
506 2023-03-01 PAUL A COX 2024-12-13
506 2022-03-01 PAUL A. COX 2023-12-13
506 2021-03-01 PAUL A COX 2022-12-08
506 2020-03-01 PAUL A COX 2021-12-10
506 2019-03-01 PAUL A COX 2020-12-11
506 2018-03-01 PAUL A COX 2019-12-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
506	2023-03-01	PAUL A COX	2024-12-13
506	2022-03-01	PAUL A. COX	2023-12-13
506	2021-03-01	PAUL A COX	2022-12-08
506	2020-03-01	PAUL A COX	2021-12-10
506	2019-03-01	PAUL A COX	2020-12-11
506	2018-03-01	PAUL A COX	2019-12-13

Plan Statistics for K-VA-T FOOD STORES, INC. HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for K-VA-T FOOD STORES, INC. HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2023: K-VA-T FOOD STORES, INC. HEALTH AND WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year 2023-03-01 7,629
Total number of active participants reported on line 7a of the Form 5500 2023-03-01 7,441
Number of retired or separated participants receiving benefits 2023-03-01 0
Number of other retired or separated participants entitled to future benefits 2023-03-01 0
Total of all active and inactive participants 2023-03-01 7,441
Number of employers contributing to the scheme 2023-03-01 0
2022: K-VA-T FOOD STORES, INC. HEALTH AND WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-03-01 7,501
Total number of active participants reported on line 7a of the Form 5500 2022-03-01 8,012
Number of retired or separated participants receiving benefits 2022-03-01 0
Number of other retired or separated participants entitled to future benefits 2022-03-01 0
Total of all active and inactive participants 2022-03-01 8,012
Number of employers contributing to the scheme 2022-03-01 0
2021: K-VA-T FOOD STORES, INC. HEALTH AND WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-03-01 7,086
Total number of active participants reported on line 7a of the Form 5500 2021-03-01 7,501
Number of retired or separated participants receiving benefits 2021-03-01 0
Number of other retired or separated participants entitled to future benefits 2021-03-01 0
Total of all active and inactive participants 2021-03-01 7,501
Number of employers contributing to the scheme 2021-03-01 0
2020: K-VA-T FOOD STORES, INC. HEALTH AND WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-03-01 6,748
Total number of active participants reported on line 7a of the Form 5500 2020-03-01 7,086
Number of retired or separated participants receiving benefits 2020-03-01 0
Number of other retired or separated participants entitled to future benefits 2020-03-01 0
Total of all active and inactive participants 2020-03-01 7,086
Number of employers contributing to the scheme 2020-03-01 0
2019: K-VA-T FOOD STORES, INC. HEALTH AND WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-03-01 4,946
Total number of active participants reported on line 7a of the Form 5500 2019-03-01 6,748
Number of retired or separated participants receiving benefits 2019-03-01 0
Number of other retired or separated participants entitled to future benefits 2019-03-01 0
Total of all active and inactive participants 2019-03-01 6,748
Number of employers contributing to the scheme 2019-03-01 0
2018: K-VA-T FOOD STORES, INC. HEALTH AND WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-03-01 4,946
Total number of active participants reported on line 7a of the Form 5500 2018-03-01 4,946
Number of retired or separated participants receiving benefits 2018-03-01 0
Number of other retired or separated participants entitled to future benefits 2018-03-01 0
Total of all active and inactive participants 2018-03-01 4,946
Number of employers contributing to the scheme 2018-03-01 0

Measure	Date	Value
2023: K-VA-T FOOD STORES, INC. HEALTH AND WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year	2023-03-01	7,629
Total number of active participants reported on line 7a of the Form 5500	2023-03-01	7,441
Number of retired or separated participants receiving benefits	2023-03-01	0
Number of other retired or separated participants entitled to future benefits	2023-03-01	0
Total of all active and inactive participants	2023-03-01	7,441
Number of employers contributing to the scheme	2023-03-01	0
2022: K-VA-T FOOD STORES, INC. HEALTH AND WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-03-01	7,501
Total number of active participants reported on line 7a of the Form 5500	2022-03-01	8,012
Number of retired or separated participants receiving benefits	2022-03-01	0
Number of other retired or separated participants entitled to future benefits	2022-03-01	0
Total of all active and inactive participants	2022-03-01	8,012
Number of employers contributing to the scheme	2022-03-01	0
2021: K-VA-T FOOD STORES, INC. HEALTH AND WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-03-01	7,086
Total number of active participants reported on line 7a of the Form 5500	2021-03-01	7,501
Number of retired or separated participants receiving benefits	2021-03-01	0
Number of other retired or separated participants entitled to future benefits	2021-03-01	0
Total of all active and inactive participants	2021-03-01	7,501
Number of employers contributing to the scheme	2021-03-01	0
2020: K-VA-T FOOD STORES, INC. HEALTH AND WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-03-01	6,748
Total number of active participants reported on line 7a of the Form 5500	2020-03-01	7,086
Number of retired or separated participants receiving benefits	2020-03-01	0
Number of other retired or separated participants entitled to future benefits	2020-03-01	0
Total of all active and inactive participants	2020-03-01	7,086
Number of employers contributing to the scheme	2020-03-01	0
2019: K-VA-T FOOD STORES, INC. HEALTH AND WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-03-01	4,946
Total number of active participants reported on line 7a of the Form 5500	2019-03-01	6,748
Number of retired or separated participants receiving benefits	2019-03-01	0
Number of other retired or separated participants entitled to future benefits	2019-03-01	0
Total of all active and inactive participants	2019-03-01	6,748
Number of employers contributing to the scheme	2019-03-01	0
2018: K-VA-T FOOD STORES, INC. HEALTH AND WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-03-01	4,946
Total number of active participants reported on line 7a of the Form 5500	2018-03-01	4,946
Number of retired or separated participants receiving benefits	2018-03-01	0
Number of other retired or separated participants entitled to future benefits	2018-03-01	0
Total of all active and inactive participants	2018-03-01	4,946
Number of employers contributing to the scheme	2018-03-01	0

Form 5500 Responses for K-VA-T FOOD STORES, INC. HEALTH AND WELFARE BENEFIT PLAN

2023: K-VA-T FOOD STORES, INC. HEALTH AND WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-03-01	Type of plan entity	Single employer plan
2023-03-01	Plan funding arrangement – Insurance	Yes
2023-03-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-03-01	Plan benefit arrangement – Insurance	Yes
2023-03-01	Plan benefit arrangement – General assets of the sponsor	Yes
2022: K-VA-T FOOD STORES, INC. HEALTH AND WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-03-01	Type of plan entity	Single employer plan
2022-03-01	Plan funding arrangement – Insurance	Yes
2022-03-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-03-01	Plan benefit arrangement – Insurance	Yes
2022-03-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: K-VA-T FOOD STORES, INC. HEALTH AND WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-03-01	Type of plan entity	Single employer plan
2021-03-01	Plan funding arrangement – Insurance	Yes
2021-03-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-03-01	Plan benefit arrangement – Insurance	Yes
2021-03-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: K-VA-T FOOD STORES, INC. HEALTH AND WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-03-01	Type of plan entity	Single employer plan
2020-03-01	Plan funding arrangement – Insurance	Yes
2020-03-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-03-01	Plan benefit arrangement – Insurance	Yes
2020-03-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: K-VA-T FOOD STORES, INC. HEALTH AND WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-03-01	Type of plan entity	Single employer plan
2019-03-01	Plan funding arrangement – Insurance	Yes
2019-03-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-03-01	Plan benefit arrangement – Insurance	Yes
2019-03-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: K-VA-T FOOD STORES, INC. HEALTH AND WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-03-01	Type of plan entity	Single employer plan
2018-03-01	First time form 5500 has been submitted	Yes
2018-03-01	Plan funding arrangement – Insurance	Yes
2018-03-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-03-01	Plan benefit arrangement – Insurance	Yes
2018-03-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

959133

Policy instance

Insurance contract or identification number	959133
Number of Individuals Covered	8890
Insurance policy start date	2023-03-01
Insurance policy end date	2024-02-29
Total amount of commissions paid to insurance broker	USD $86,756
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $1,300,759
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

164377

Policy instance

Insurance contract or identification number	164377
Number of Individuals Covered	0
Insurance policy start date	2023-03-01
Insurance policy end date	2024-02-29
Total amount of commissions paid to insurance broker	USD $8,042
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )

Policy contract number

125218

Policy instance

Insurance contract or identification number	125218
Number of Individuals Covered	7441
Insurance policy start date	2023-03-01
Insurance policy end date	2024-02-29
Total amount of commissions paid to insurance broker	USD $45,432
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,795,729
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )

Policy contract number

130481

Policy instance

Insurance contract or identification number	130481
Number of Individuals Covered	6218
Insurance policy start date	2023-03-01
Insurance policy end date	2024-02-29
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,178,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CAREBRIDGE CORPORATION (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

EAP

Policy instance

Insurance contract or identification number	EAP
Number of Individuals Covered	18734
Insurance policy start date	2023-03-01
Insurance policy end date	2024-02-29
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $75,925
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CAREBRIDGE CORPORATION (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

EAP

Policy instance

BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )

Policy contract number

130481

Policy instance

BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )

Policy contract number

125218

Policy instance

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

164377

Policy instance

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

164377

Policy instance

BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )

Policy contract number

125218

Policy instance

BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )

Policy contract number

130481

Policy instance

CAREBRIDGE CORPORATION (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

EAP

Policy instance

CAREBRIDGE CORPORATION (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

EAP

Policy instance

BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )

Policy contract number

130481

Policy instance

BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )

Policy contract number

125218

Policy instance

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

164377

Policy instance

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

164379

Policy instance

CAREBRIDGE CORPORATION (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

EAP

Policy instance

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

164379

Policy instance

CAREBRIDGE CORPORATION (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

Policy instance

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Company Name:	K-VA-T FOOD STORES, INC.
Employer identification number (EIN):	550421484
NAIC Classification:	445110
NAIC Description:	Supermarkets and Other Grocery (except Convenience) Stores

Jurisdiction of Incorporation:	Virginia Secretary of State
Incorporation Date:	1985-05-07
Company Identification Number:	0270501
Legal Registered Office Address:	1 FOOD CITY CIRCLE P O BOX 1158 ABINGDON United States of America (USA) 24210