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| Plan Name | SUPERVALUE PHARMACY WELFARE BENEFIT PLAN PRIME WELFARE BENEFIT TRUST |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | SUPERVALUE PHARMACY |
| Employer identification number (EIN): | 752567026 |
| NAIC Classification: | 446110 |
| NAIC Description: | Pharmacies and Drug Stores |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2013-01-01 | WALTRAUD FRANCES ALLEN | 2013-09-23 | ||
| 501 | 2012-01-01 | JAYNE LAUGHBAUM | 2013-07-22 | ||
| 501 | 2011-01-01 | JAYNE LAUGHBAUM | 2012-09-21 | ||
| 501 | 2010-01-01 | JAYNE LAUGHBAUM | 2011-09-26 | ||
| 501 | 2009-01-01 | JAYNE LAUGHBAUM |
| Measure | Date | Value |
|---|---|---|
| 2009: SUPERVALUE PHARMACY WELFARE BENEFIT PLAN PRIME WELFARE BENEFIT TRUST 2009 401k membership | ||
| Total participants, beginning-of-year | 2009-01-01 | 2 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 2 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 2 |
| 2009: SUPERVALUE PHARMACY WELFARE BENEFIT PLAN PRIME WELFARE BENEFIT TRUST 2009 form 5500 responses | ||
|---|---|---|
| 2009-01-01 | Type of plan entity | Mulitple employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – Trust | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement - Trust | Yes |
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