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ZUPANS ENTERPRISES HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameZUPANS ENTERPRISES HEALTH AND WELFARE PLAN
Plan identification number 501

ZUPANS ENTERPRISES HEALTH AND WELFARE PLAN Benefits

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

401k Sponsoring company profile

ZUPAN ENTERPRISES OREGON INC has sponsored the creation of one or more 401k plans.

Company Name:ZUPAN ENTERPRISES OREGON INC
Employer identification number (EIN):823755798
NAIC Classification:445110
NAIC Description:Supermarkets and Other Grocery (except Convenience) Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ZUPANS ENTERPRISES HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01MARIT CADWELL2023-10-13
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01MARIT CADWELL MARIT CADWELL2019-05-16
5012017-01-01MARIT CADWELL MARIT CADWELL2018-07-19

Plan Statistics for ZUPANS ENTERPRISES HEALTH AND WELFARE PLAN

401k plan membership statisitcs for ZUPANS ENTERPRISES HEALTH AND WELFARE PLAN

Measure Date Value
2022: ZUPANS ENTERPRISES HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01192
Total number of active participants reported on line 7a of the Form 55002022-01-01185
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01185
Number of employers contributing to the scheme2022-01-010
2021: ZUPANS ENTERPRISES HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01223
Total number of active participants reported on line 7a of the Form 55002021-01-01215
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01215
2020: ZUPANS ENTERPRISES HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01220
Total number of active participants reported on line 7a of the Form 55002020-01-01223
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01223
2019: ZUPANS ENTERPRISES HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01326
Total number of active participants reported on line 7a of the Form 55002019-01-01220
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 participants2019-01-01220
2018: ZUPANS ENTERPRISES HEALTH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01309
Total number of active participants reported on line 7a of the Form 55002018-01-01325
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 participants2018-01-01325
2017: ZUPANS ENTERPRISES HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01364
Total number of active participants reported on line 7a of the Form 55002017-01-01309
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01309

Form 5500 Responses for ZUPANS ENTERPRISES HEALTH AND WELFARE PLAN

2022: ZUPANS ENTERPRISES HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: ZUPANS ENTERPRISES HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: ZUPANS ENTERPRISES HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: ZUPANS ENTERPRISES HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: ZUPANS ENTERPRISES HEALTH AND WELFARE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: ZUPANS ENTERPRISES HEALTH AND WELFARE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number632028
Policy instance 2
Insurance contract or identification number632028
Number of Individuals Covered185
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $4,211
Total amount of fees paid to insurance companyUSD $1,081
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 BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $33,154
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,211
Amount paid for insurance broker fees1081
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number16022
Policy instance 1
Insurance contract or identification number16022
Number of Individuals Covered208
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $38,895
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,296,498
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,895
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number699771
Policy instance 3
Insurance contract or identification number699771
Number of Individuals Covered21
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $951
Total amount of fees paid to insurance companyUSD $127
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $6,342
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $951
Amount paid for insurance broker fees127
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number632028
Policy instance 2
Insurance contract or identification number632028
Number of Individuals Covered192
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,978
Total amount of fees paid to insurance companyUSD $399
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $19,930
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,978
Amount paid for insurance broker fees399
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number16022
Policy instance 1
Insurance contract or identification number16022
Number of Individuals Covered215
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $39,419
Total amount of fees paid to insurance companyUSD $1,438
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,313,973
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,419
Amount paid for insurance broker fees1438
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number632028
Policy instance 2
Insurance contract or identification number632028
Number of Individuals Covered197
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $3,767
Total amount of fees paid to insurance companyUSD $368
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $20,251
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,767
Amount paid for insurance broker fees368
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number16022
Policy instance 1
Insurance contract or identification number16022
Number of Individuals Covered223
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $41,952
Total amount of fees paid to insurance companyUSD $1,165
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,193,616
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $41,952
Amount paid for insurance broker fees1165
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number699772
Policy instance 3
Insurance contract or identification number699772
Number of Individuals Covered186
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $2,065
Total amount of fees paid to insurance companyUSD $275
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $13,766
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,065
Amount paid for insurance broker fees275
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number632028
Policy instance 2
Insurance contract or identification number632028
Number of Individuals Covered191
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $156
Total amount of fees paid to insurance companyUSD $12
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $19,195
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $156
Amount paid for insurance broker fees12
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number16022
Policy instance 1
Insurance contract or identification number16022
Number of Individuals Covered220
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $35,275
Total amount of fees paid to insurance companyUSD $7
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,184,392
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,275
Amount paid for insurance broker fees7
Additional information about fees paid to insurance brokerNONMONETARY COMP
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number632028
Policy instance 2
Insurance contract or identification number632028
Number of Individuals Covered180
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,898
Total amount of fees paid to insurance companyUSD $121
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $18,985
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,898
Amount paid for insurance broker fees121
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number16022
Policy instance 1
Insurance contract or identification number16022
Number of Individuals Covered325
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $34,054
Total amount of fees paid to insurance companyUSD $12
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,136,021
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,054
Amount paid for insurance broker fees12
Additional information about fees paid to insurance brokerNONMONETARY COMP
Insurance broker organization code?3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberU6688
Policy instance 3
Insurance contract or identification numberU6688
Number of Individuals Covered33
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,036
Total amount of fees paid to insurance companyUSD $26
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,106
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,958
Amount paid for insurance broker fees18
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?3
Insurance broker nameMEGAN J STEVENSON
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number632028
Policy instance 2
Insurance contract or identification number632028
Number of Individuals Covered96
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,039
Total amount of fees paid to insurance companyUSD $260
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $18,524
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,039
Amount paid for insurance broker fees260
Additional information about fees paid to insurance brokerADDTL COMP
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number16022
Policy instance 1
Insurance contract or identification number16022
Number of Individuals Covered309
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $34,390
Total amount of fees paid to insurance companyUSD $578
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,136,016
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,390
Amount paid for insurance broker fees578
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC

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