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LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN 401k Plan overview

Plan NameLACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN
Plan identification number 501

LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

LACKS VALLEY STORES, LTD. has sponsored the creation of one or more 401k plans.

Company Name:LACKS VALLEY STORES, LTD.
Employer identification number (EIN):742730084
NAIC Classification:442110
NAIC Description:Furniture Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-06-01THELMA LEAL2024-10-09
5012022-06-01THELMA LEAL2023-11-30
5012021-06-01THELMA LEAL2022-12-13
5012020-06-01THELMA LEAL2021-11-12
5012019-06-01THELMA LEAL2021-03-09
5012018-06-01THELMA LEAL2021-03-09
5012017-06-01THELMA LEAL2021-03-09
5012016-06-01THELMA LEAL2021-03-09
5012015-06-01THELMA LEAL2021-03-09
5012014-06-01THELMA LEAL2021-03-09
5012013-06-01THELMA LEAL2021-03-09

Plan Statistics for LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN

401k plan membership statisitcs for LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN

Measure Date Value
2023: LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year2023-06-01348
Total number of active participants reported on line 7a of the Form 55002023-06-01214
Number of retired or separated participants receiving benefits2023-06-012
Number of other retired or separated participants entitled to future benefits2023-06-0114
Total of all active and inactive participants2023-06-01230
Number of employers contributing to the scheme2023-06-010
2022: LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-06-01296
Total number of active participants reported on line 7a of the Form 55002022-06-01360
Number of retired or separated participants receiving benefits2022-06-010
Number of other retired or separated participants entitled to future benefits2022-06-010
Total of all active and inactive participants2022-06-01360
Number of employers contributing to the scheme2022-06-010
2021: LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-06-01429
Total number of active participants reported on line 7a of the Form 55002021-06-01296
Number of retired or separated participants receiving benefits2021-06-010
Number of other retired or separated participants entitled to future benefits2021-06-010
Total of all active and inactive participants2021-06-01296
Number of employers contributing to the scheme2021-06-010
2020: LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-06-01329
Total number of active participants reported on line 7a of the Form 55002020-06-01429
Number of retired or separated participants receiving benefits2020-06-010
Number of other retired or separated participants entitled to future benefits2020-06-010
Total of all active and inactive participants2020-06-01429
Number of employers contributing to the scheme2020-06-010
2019: LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-06-01487
Total number of active participants reported on line 7a of the Form 55002019-06-01329
Number of retired or separated participants receiving benefits2019-06-010
Number of other retired or separated participants entitled to future benefits2019-06-010
Total of all active and inactive participants2019-06-01329
Number of employers contributing to the scheme2019-06-010
2018: LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-06-01361
Total number of active participants reported on line 7a of the Form 55002018-06-01487
Number of retired or separated participants receiving benefits2018-06-010
Number of other retired or separated participants entitled to future benefits2018-06-010
Total of all active and inactive participants2018-06-01487
Number of employers contributing to the scheme2018-06-010
2017: LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-06-01353
Total number of active participants reported on line 7a of the Form 55002017-06-01361
Number of retired or separated participants receiving benefits2017-06-010
Number of other retired or separated participants entitled to future benefits2017-06-010
Total of all active and inactive participants2017-06-01361
Number of employers contributing to the scheme2017-06-010
2016: LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-06-01425
Total number of active participants reported on line 7a of the Form 55002016-06-01353
Number of retired or separated participants receiving benefits2016-06-010
Number of other retired or separated participants entitled to future benefits2016-06-010
Total of all active and inactive participants2016-06-01353
Number of employers contributing to the scheme2016-06-010
2015: LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-06-01463
Total number of active participants reported on line 7a of the Form 55002015-06-01425
Number of retired or separated participants receiving benefits2015-06-010
Number of other retired or separated participants entitled to future benefits2015-06-010
Total of all active and inactive participants2015-06-01425
Number of employers contributing to the scheme2015-06-010
2014: LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-06-01562
Total number of active participants reported on line 7a of the Form 55002014-06-01463
Number of retired or separated participants receiving benefits2014-06-010
Number of other retired or separated participants entitled to future benefits2014-06-010
Total of all active and inactive participants2014-06-01463
Number of employers contributing to the scheme2014-06-010
2013: LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-06-01100
Total number of active participants reported on line 7a of the Form 55002013-06-01562
Number of retired or separated participants receiving benefits2013-06-010
Number of other retired or separated participants entitled to future benefits2013-06-010
Total of all active and inactive participants2013-06-01562
Number of employers contributing to the scheme2013-06-010

Form 5500 Responses for LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN

2023: LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-06-01Type of plan entitySingle employer plan
2023-06-01Plan funding arrangement – InsuranceYes
2023-06-01Plan benefit arrangement – InsuranceYes
2022: LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-06-01Type of plan entitySingle employer plan
2022-06-01Plan funding arrangement – InsuranceYes
2022-06-01Plan benefit arrangement – InsuranceYes
2021: LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-06-01Type of plan entitySingle employer plan
2021-06-01Plan funding arrangement – InsuranceYes
2021-06-01Plan benefit arrangement – InsuranceYes
2020: LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-06-01Type of plan entitySingle employer plan
2020-06-01Plan funding arrangement – InsuranceYes
2020-06-01Plan benefit arrangement – InsuranceYes
2019: LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-06-01Type of plan entitySingle employer plan
2019-06-01Plan funding arrangement – InsuranceYes
2019-06-01Plan benefit arrangement – InsuranceYes
2018: LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-06-01Type of plan entitySingle employer plan
2018-06-01Plan funding arrangement – InsuranceYes
2018-06-01Plan benefit arrangement – InsuranceYes
2017: LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-06-01Type of plan entitySingle employer plan
2017-06-01Plan funding arrangement – InsuranceYes
2017-06-01Plan benefit arrangement – InsuranceYes
2016: LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-06-01Type of plan entitySingle employer plan
2016-06-01Plan funding arrangement – InsuranceYes
2016-06-01Plan benefit arrangement – InsuranceYes
2015: LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-06-01Type of plan entitySingle employer plan
2015-06-01Plan funding arrangement – InsuranceYes
2015-06-01Plan benefit arrangement – InsuranceYes
2014: LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-06-01Type of plan entitySingle employer plan
2014-06-01Plan funding arrangement – InsuranceYes
2014-06-01Plan benefit arrangement – InsuranceYes
2013: LACKS VALLEY STORES, LTD. WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-06-01Type of plan entitySingle employer plan
2013-06-01First time form 5500 has been submittedYes
2013-06-01Plan funding arrangement – InsuranceYes
2013-06-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5917528
Policy instance 4
Insurance contract or identification number5917528
Number of Individuals Covered184
Insurance policy start date2023-06-01
Insurance policy end date2024-05-31
Total amount of commissions paid to insurance brokerUSD $27,938
Total amount of fees paid to insurance companyUSD $9,502
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENT, HOSPITAL,CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $155,068
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0C492
Policy instance 3
Insurance contract or identification numberGLUG0C492
Number of Individuals Covered214
Insurance policy start date2023-06-01
Insurance policy end date2024-05-31
Total amount of commissions paid to insurance brokerUSD $39,361
Total amount of fees paid to insurance companyUSD $9,032
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $206,331
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number96406
Policy instance 2
Insurance contract or identification number96406
Number of Individuals Covered25
Insurance policy start date2023-06-01
Insurance policy end date2024-05-31
Total amount of commissions paid to insurance brokerUSD $846
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedCANCER
Welfare Benefit Premiums Paid to CarrierUSD $11,646
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number366705
Policy instance 1
Insurance contract or identification number366705
Number of Individuals Covered176
Insurance policy start date2023-06-01
Insurance policy end date2024-05-31
Total amount of commissions paid to insurance brokerUSD $72,930
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,357,104
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0C492
Policy instance 4
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5917528
Policy instance 3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number96406
Policy instance 2
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number924456
Policy instance 1
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number924456
Policy instance 1
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number96406
Policy instance 2
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5917528
Policy instance 3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5917528
Policy instance 3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number96406
Policy instance 2
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number268255
Policy instance 1
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number268255
Policy instance 1
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number96406
Policy instance 2
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5917528
Policy instance 3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5917528
Policy instance 3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number96406
Policy instance 2
HUMANA HEALTH PLAN OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95024 )
Policy contract number767742
Policy instance 1
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5917528
Policy instance 4
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number96406
Policy instance 3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number846851
Policy instance 2
HUMANA HEALTH PLAN OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95024 )
Policy contract number767742
Policy instance 1
HUMANA HEALTH PLAN OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95024 )
Policy contract number767742
Policy instance 1
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5917528
Policy instance 2
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number846851
Policy instance 3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number96406
Policy instance 4
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number145485
Policy instance 1
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberKM05917528
Policy instance 2
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number846851
Policy instance 3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number96406
Policy instance 4
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number145485
Policy instance 1
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberKM05917528
Policy instance 2
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number846851
Policy instance 3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number96406
Policy instance 4
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number96406
Policy instance 4
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number846851
Policy instance 3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number303624
Policy instance 2
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number752135
Policy instance 1

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