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FIESTA MART, LLC VOLUNTARY BENEFITS PLAN 401k Plan overview

Plan NameFIESTA MART, LLC VOLUNTARY BENEFITS PLAN
Plan identification number 504

FIESTA MART, LLC VOLUNTARY BENEFITS PLAN Benefits

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

401k Sponsoring company profile

BODEGA LATINA DBA EL SUPER AND FIESTA MART has sponsored the creation of one or more 401k plans.

Company Name:BODEGA LATINA DBA EL SUPER AND FIESTA MART
Employer identification number (EIN):741874033
NAIC Classification:445110
NAIC Description:Supermarkets and Other Grocery (except Convenience) Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FIESTA MART, LLC VOLUNTARY BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5042021-10-01JACK HOOK2023-04-25
5042020-10-01JACK HOOK2022-07-12
5042019-10-01JACK HOOK2021-07-08
5042019-01-01JACK HOOK2020-07-10
5042018-01-01

Plan Statistics for FIESTA MART, LLC VOLUNTARY BENEFITS PLAN

401k plan membership statisitcs for FIESTA MART, LLC VOLUNTARY BENEFITS PLAN

Measure Date Value
2021: FIESTA MART, LLC VOLUNTARY BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-10-011,184
Total number of active participants reported on line 7a of the Form 55002021-10-011,890
Number of retired or separated participants receiving benefits2021-10-010
Number of other retired or separated participants entitled to future benefits2021-10-010
Total of all active and inactive participants2021-10-011,890
Number of employers contributing to the scheme2021-10-010
2020: FIESTA MART, LLC VOLUNTARY BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-10-011,235
Total number of active participants reported on line 7a of the Form 55002020-10-011,184
Number of retired or separated participants receiving benefits2020-10-010
Number of other retired or separated participants entitled to future benefits2020-10-010
Total of all active and inactive participants2020-10-011,184
Number of employers contributing to the scheme2020-10-010
2019: FIESTA MART, LLC VOLUNTARY BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year2019-10-011,151
Total number of active participants reported on line 7a of the Form 55002019-10-011,235
Number of retired or separated participants receiving benefits2019-10-010
Number of other retired or separated participants entitled to future benefits2019-10-010
Total of all active and inactive participants2019-10-011,235
Number of employers contributing to the scheme2019-10-010
Total participants, beginning-of-year2019-01-011,476
Total number of active participants reported on line 7a of the Form 55002019-01-011,151
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-011,151
Number of employers contributing to the scheme2019-01-010
2018: FIESTA MART, LLC VOLUNTARY BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-011,528
Total number of active participants reported on line 7a of the Form 55002018-01-011,476
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-011,476
Number of employers contributing to the scheme2018-01-010

Form 5500 Responses for FIESTA MART, LLC VOLUNTARY BENEFITS PLAN

2021: FIESTA MART, LLC VOLUNTARY BENEFITS PLAN 2021 form 5500 responses
2021-10-01Type of plan entitySingle employer plan
2021-10-01Plan funding arrangement – InsuranceYes
2021-10-01Plan benefit arrangement – InsuranceYes
2020: FIESTA MART, LLC VOLUNTARY BENEFITS PLAN 2020 form 5500 responses
2020-10-01Type of plan entitySingle employer plan
2020-10-01Plan funding arrangement – InsuranceYes
2020-10-01Plan benefit arrangement – InsuranceYes
2019: FIESTA MART, LLC VOLUNTARY BENEFITS PLAN 2019 form 5500 responses
2019-10-01Type of plan entitySingle employer plan
2019-10-01Plan funding arrangement – InsuranceYes
2019-10-01Plan benefit arrangement – InsuranceYes
2019-01-01Type of plan entitySingle employer plan
2019-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: FIESTA MART, LLC VOLUNTARY BENEFITS PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01First time form 5500 has been submittedYes
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number8837934
Policy instance 2
Insurance contract or identification number8837934
Number of Individuals Covered1890
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $146,028
Total amount of fees paid to insurance companyUSD $21,761
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $587,784
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $129,499
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number802423
Policy instance 1
Insurance contract or identification number802423
Number of Individuals Covered1714
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $208,630
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $796,164
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $208,630
Amount paid for insurance broker fees0
Insurance broker organization code?3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number8837934
Policy instance 2
Insurance contract or identification number8837934
Number of Individuals Covered419
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $71,714
Total amount of fees paid to insurance companyUSD $10,675
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $247,724
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $54,997
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number802423
Policy instance 1
Insurance contract or identification number802423
Number of Individuals Covered1999
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $191,737
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $859,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $191,737
Amount paid for insurance broker fees0
Insurance broker organization code?3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number8837934
Policy instance 2
Insurance contract or identification number8837934
Number of Individuals Covered940
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $135,736
Total amount of fees paid to insurance companyUSD $17,460
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $286,111
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $132,442
Amount paid for insurance broker fees16735
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number802423
Policy instance 1
Insurance contract or identification number802423
Number of Individuals Covered2047
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $292,707
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $826,211
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $292,707
Amount paid for insurance broker fees0
Insurance broker organization code?3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number12184339
Policy instance 2
Insurance contract or identification number12184339
Number of Individuals Covered562
Insurance policy start date2019-01-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $102,239
Total amount of fees paid to insurance companyUSD $14,370
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $128,177
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $102,239
Amount paid for insurance broker fees14370
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number802423
Policy instance 1
Insurance contract or identification number802423
Number of Individuals Covered1838
Insurance policy start date2019-01-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $141,767
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $547,256
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $82,013
Amount paid for insurance broker fees0
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4501862
Policy instance 2
Insurance contract or identification numberE4501862
Number of Individuals Covered1476
Insurance policy start date2018-07-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $159,882
Total amount of fees paid to insurance companyUSD $11,817
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $547,079
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $49,926
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerFEES
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4501862
Policy instance 1
Insurance contract or identification numberE4501862
Number of Individuals Covered1309
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $315,138
Total amount of fees paid to insurance companyUSD $50,055
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $1,102,109
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $146,457
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerFEES

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