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PUEBLO, INC. HEALTH PLAN 401k Plan overview

Plan NamePUEBLO, INC. HEALTH PLAN
Plan identification number 501

PUEBLO, INC. HEALTH PLAN Benefits

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

401k Sponsoring company profile

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

Company Name:PUEBLO, INC.
Employer identification number (EIN):660702072
NAIC Classification:445110
NAIC Description:Supermarkets and Other Grocery (except Convenience) Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PUEBLO, INC. HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-11-01WANDALIS LOPEZ RODRIGUEZ2023-05-31 NELSON D. VELEZ LUGO2023-05-31
5012020-11-01WANDALIS LOPEZ RODRIGUEZ2022-05-25 NELSON D. VELEZ LUGO2022-05-25
5012019-11-01WANDALIS LOPEZ RODRIGUEZ2021-07-09 NELSON D. VELEZ LUGO2021-07-09
5012018-11-01WANDALIS LOPEZ RODRIGUEZ2020-05-04 NELSON D VELEZ LUGO2020-05-04
5012017-11-01WANDALIS LOPEZ RODRIGUEZ2019-05-15 NELSON D VELEZ LUGO2019-05-15
5012016-11-01
5012015-11-01
5012014-11-01
5012013-11-01
5012012-11-01SHARON HEARN
5012011-11-01SHARON HEARN
5012010-11-01SHARON HEARN
5012009-11-012011-05-09
5012009-11-01SHARON HEARN

Plan Statistics for PUEBLO, INC. HEALTH PLAN

401k plan membership statisitcs for PUEBLO, INC. HEALTH PLAN

Measure Date Value
2021: PUEBLO, INC. HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-11-011,526
Total number of active participants reported on line 7a of the Form 55002021-11-011,791
Number of retired or separated participants receiving benefits2021-11-012
Total of all active and inactive participants2021-11-011,793
Total participants2021-11-011,793
2020: PUEBLO, INC. HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-11-011,530
Total number of active participants reported on line 7a of the Form 55002020-11-011,525
Number of retired or separated participants receiving benefits2020-11-011
Total of all active and inactive participants2020-11-011,526
Total participants2020-11-011,526
2019: PUEBLO, INC. HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-11-011,609
Total number of active participants reported on line 7a of the Form 55002019-11-011,528
Number of retired or separated participants receiving benefits2019-11-012
Total of all active and inactive participants2019-11-011,530
Total participants2019-11-011,530
2018: PUEBLO, INC. HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-11-011,366
Total number of active participants reported on line 7a of the Form 55002018-11-011,606
Number of retired or separated participants receiving benefits2018-11-013
Total of all active and inactive participants2018-11-011,609
Total participants2018-11-011,609
2017: PUEBLO, INC. HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-11-011,324
Total number of active participants reported on line 7a of the Form 55002017-11-011,361
Number of retired or separated participants receiving benefits2017-11-015
Total of all active and inactive participants2017-11-011,366
Total participants2017-11-011,366
2016: PUEBLO, INC. HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-11-011,288
Total number of active participants reported on line 7a of the Form 55002016-11-011,319
Number of retired or separated participants receiving benefits2016-11-015
Total of all active and inactive participants2016-11-011,324
Total participants2016-11-011,324
2015: PUEBLO, INC. HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-11-01415
Total number of active participants reported on line 7a of the Form 55002015-11-011,283
Number of retired or separated participants receiving benefits2015-11-015
Total of all active and inactive participants2015-11-011,288
Total participants2015-11-011,288
2014: PUEBLO, INC. HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-11-01418
Total number of active participants reported on line 7a of the Form 55002014-11-01408
Number of retired or separated participants receiving benefits2014-11-017
Total of all active and inactive participants2014-11-01415
Total participants2014-11-01415
2013: PUEBLO, INC. HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year2013-11-01417
Total number of active participants reported on line 7a of the Form 55002013-11-01415
Number of retired or separated participants receiving benefits2013-11-013
Total of all active and inactive participants2013-11-01418
Total participants2013-11-01418
2012: PUEBLO, INC. HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year2012-11-01381
Total number of active participants reported on line 7a of the Form 55002012-11-01416
Number of retired or separated participants receiving benefits2012-11-011
Total of all active and inactive participants2012-11-01417
Total participants2012-11-01417
2011: PUEBLO, INC. HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year2011-11-01371
Total number of active participants reported on line 7a of the Form 55002011-11-01374
Number of retired or separated participants receiving benefits2011-11-017
Total of all active and inactive participants2011-11-01381
Total participants2011-11-01381
2010: PUEBLO, INC. HEALTH PLAN 2010 401k membership
Total participants, beginning-of-year2010-11-01438
Total number of active participants reported on line 7a of the Form 55002010-11-01365
Number of retired or separated participants receiving benefits2010-11-016
Total of all active and inactive participants2010-11-01371
Total participants2010-11-01371
2009: PUEBLO, INC. HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year2009-11-01506
Total number of active participants reported on line 7a of the Form 55002009-11-01385
Number of retired or separated participants receiving benefits2009-11-0153
Total of all active and inactive participants2009-11-01438
Total participants2009-11-01438

Form 5500 Responses for PUEBLO, INC. HEALTH PLAN

2021: PUEBLO, INC. HEALTH PLAN 2021 form 5500 responses
2021-11-01Type of plan entitySingle employer plan
2021-11-01Submission has been amendedNo
2021-11-01This submission is the final filingNo
2021-11-01This return/report is a short plan year return/report (less than 12 months)No
2021-11-01Plan is a collectively bargained planNo
2021-11-01Plan funding arrangement – InsuranceYes
2021-11-01Plan funding arrangement – General assets of the sponsorYes
2021-11-01Plan benefit arrangement – InsuranceYes
2021-11-01Plan benefit arrangement – General assets of the sponsorYes
2020: PUEBLO, INC. HEALTH 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)No
2020-11-01Plan is a collectively bargained planNo
2020-11-01Plan funding arrangement – InsuranceYes
2020-11-01Plan funding arrangement – General assets of the sponsorYes
2020-11-01Plan benefit arrangement – InsuranceYes
2020-11-01Plan benefit arrangement – General assets of the sponsorYes
2019: PUEBLO, INC. HEALTH PLAN 2019 form 5500 responses
2019-11-01Type of plan entitySingle employer plan
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 – General assets of the sponsorYes
2019-11-01Plan benefit arrangement – InsuranceYes
2019-11-01Plan benefit arrangement – General assets of the sponsorYes
2018: PUEBLO, INC. HEALTH PLAN 2018 form 5500 responses
2018-11-01Type of plan entitySingle employer plan
2018-11-01Submission has been amendedNo
2018-11-01This submission is the final filingNo
2018-11-01This return/report is a short plan year return/report (less than 12 months)No
2018-11-01Plan is a collectively bargained planNo
2018-11-01Plan funding arrangement – InsuranceYes
2018-11-01Plan funding arrangement – General assets of the sponsorYes
2018-11-01Plan benefit arrangement – InsuranceYes
2018-11-01Plan benefit arrangement – General assets of the sponsorYes
2017: PUEBLO, INC. HEALTH PLAN 2017 form 5500 responses
2017-11-01Type of plan entitySingle employer plan
2017-11-01Submission has been amendedNo
2017-11-01This submission is the final filingNo
2017-11-01This return/report is a short plan year return/report (less than 12 months)No
2017-11-01Plan is a collectively bargained planNo
2017-11-01Plan funding arrangement – InsuranceYes
2017-11-01Plan funding arrangement – General assets of the sponsorYes
2017-11-01Plan benefit arrangement – InsuranceYes
2017-11-01Plan benefit arrangement – General assets of the sponsorYes
2016: PUEBLO, INC. HEALTH PLAN 2016 form 5500 responses
2016-11-01Type of plan entitySingle employer plan
2016-11-01Submission has been amendedNo
2016-11-01This submission is the final filingNo
2016-11-01This return/report is a short plan year return/report (less than 12 months)No
2016-11-01Plan is a collectively bargained planNo
2016-11-01Plan funding arrangement – InsuranceYes
2016-11-01Plan funding arrangement – General assets of the sponsorYes
2016-11-01Plan benefit arrangement – InsuranceYes
2016-11-01Plan benefit arrangement – General assets of the sponsorYes
2015: PUEBLO, INC. HEALTH PLAN 2015 form 5500 responses
2015-11-01Type of plan entitySingle employer plan
2015-11-01Submission has been amendedNo
2015-11-01This submission is the final filingNo
2015-11-01This return/report is a short plan year return/report (less than 12 months)No
2015-11-01Plan is a collectively bargained planNo
2015-11-01Plan funding arrangement – InsuranceYes
2015-11-01Plan funding arrangement – General assets of the sponsorYes
2015-11-01Plan benefit arrangement – InsuranceYes
2015-11-01Plan benefit arrangement – General assets of the sponsorYes
2014: PUEBLO, INC. HEALTH PLAN 2014 form 5500 responses
2014-11-01Type of plan entitySingle employer plan
2014-11-01Submission has been amendedNo
2014-11-01This submission is the final filingNo
2014-11-01This return/report is a short plan year return/report (less than 12 months)No
2014-11-01Plan is a collectively bargained planNo
2014-11-01Plan funding arrangement – General assets of the sponsorYes
2014-11-01Plan benefit arrangement – General assets of the sponsorYes
2013: PUEBLO, INC. HEALTH PLAN 2013 form 5500 responses
2013-11-01Type of plan entitySingle employer plan
2013-11-01Submission has been amendedNo
2013-11-01This submission is the final filingNo
2013-11-01This return/report is a short plan year return/report (less than 12 months)No
2013-11-01Plan is a collectively bargained planNo
2013-11-01Plan funding arrangement – General assets of the sponsorYes
2013-11-01Plan benefit arrangement – General assets of the sponsorYes
2012: PUEBLO, INC. HEALTH PLAN 2012 form 5500 responses
2012-11-01Type of plan entitySingle employer plan
2012-11-01Submission has been amendedNo
2012-11-01This submission is the final filingNo
2012-11-01This return/report is a short plan year return/report (less than 12 months)No
2012-11-01Plan is a collectively bargained planNo
2012-11-01Plan funding arrangement – General assets of the sponsorYes
2012-11-01Plan benefit arrangement – General assets of the sponsorYes
2011: PUEBLO, INC. HEALTH PLAN 2011 form 5500 responses
2011-11-01Type of plan entitySingle employer plan
2011-11-01Submission has been amendedNo
2011-11-01This submission is the final filingNo
2011-11-01This return/report is a short plan year return/report (less than 12 months)No
2011-11-01Plan is a collectively bargained planNo
2011-11-01Plan funding arrangement – InsuranceYes
2011-11-01Plan funding arrangement – General assets of the sponsorYes
2011-11-01Plan benefit arrangement – InsuranceYes
2011-11-01Plan benefit arrangement – General assets of the sponsorYes
2010: PUEBLO, INC. HEALTH PLAN 2010 form 5500 responses
2010-11-01Type of plan entitySingle employer plan
2010-11-01Submission has been amendedNo
2010-11-01This submission is the final filingNo
2010-11-01This return/report is a short plan year return/report (less than 12 months)No
2010-11-01Plan is a collectively bargained planNo
2010-11-01Plan funding arrangement – InsuranceYes
2010-11-01Plan funding arrangement – General assets of the sponsorYes
2010-11-01Plan benefit arrangement – InsuranceYes
2010-11-01Plan benefit arrangement – General assets of the sponsorYes
2009: PUEBLO, INC. HEALTH PLAN 2009 form 5500 responses
2009-11-01Type of plan entitySingle employer plan
2009-11-01Submission has been amendedNo
2009-11-01This submission is the final filingNo
2009-11-01This return/report is a short plan year return/report (less than 12 months)No
2009-11-01Plan is a collectively bargained planNo
2009-11-01Plan funding arrangement – InsuranceYes
2009-11-01Plan funding arrangement – General assets of the sponsorYes
2009-11-01Plan benefit arrangement – InsuranceYes
2009-11-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

UNIVERSAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60041 )
Policy contract numberGL/ADD1811-0443
Policy instance 1
Insurance contract or identification numberGL/ADD1811-0443
Number of Individuals Covered1791
Insurance policy start date2021-11-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $12,275
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 BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,275
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
UNIVERSAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60041 )
Policy contract numberGL/ADD1811-0443
Policy instance 1
Insurance contract or identification numberGL/ADD1811-0443
Number of Individuals Covered1525
Insurance policy start date2020-11-01
Insurance policy end date2021-10-31
Total amount of commissions paid to insurance brokerUSD $10,900
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 BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,900
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
UNIVERSAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60041 )
Policy contract numberGL/ADD1811-0443
Policy instance 1
Insurance contract or identification numberGL/ADD1811-0443
Number of Individuals Covered1528
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
Total amount of commissions paid to insurance brokerUSD $10,845
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 BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,845
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
UNIVERSAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60041 )
Policy contract numberGL/ADD1811-0443
Policy instance 1
Insurance contract or identification numberGL/ADD1811-0443
Number of Individuals Covered1606
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $10,825
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 BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,825
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
MULTINATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 72087 )
Policy contract number1-4719-000
Policy instance 1
Insurance contract or identification number1-4719-000
Number of Individuals Covered1361
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
Total amount of commissions paid to insurance brokerUSD $8,614
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 BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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