401k Plan data: WHITE'S BOOTS, INC. LIFE AND DISABILITY PLAN plan

WHITE'S BOOTS, INC. LIFE AND DISABILITY PLAN 401k Plan overview

Plan Name	WHITE'S BOOTS, INC. LIFE AND DISABILITY PLAN
Plan identification number	502

WHITE'S BOOTS, INC. LIFE AND DISABILITY PLAN Benefits

401k Plan Type

Welfare Benefit

Plan Features/Benefits

Life insurance
Dental
Long-term disability cover
Death benefits (include travel accident but not life insurance)
Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.
Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

WHITE'S BOOTS, INC. has sponsored the creation of one or more 401k plans.

Company Name: WHITE'S BOOTS, INC.

Employer identification number (EIN): 910696210

NAIC Classification: 448210
NAIC Description: Shoe Stores

Additional information about WHITE'S BOOTS, INC.

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division

Incorporation Date: 1959-07-01

Company Identification Number: 328042229

Legal Registered Office Address: 711 CAPITOL WAY S STE 204

OLYMPIA
United States of America (USA)
985011267

More information about WHITE'S BOOTS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WHITE'S BOOTS, INC. LIFE AND DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2022-04-01 STEVEN H. MORMAN 2023-10-23
502 2017-04-01
502 2017-04-01 BRETT WILPONEN 2019-12-03
502 2016-04-01
502 2015-04-01 BARRY PIPELLA
502 2014-04-01 BARRY PIPELLA

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
502	2022-04-01	STEVEN H. MORMAN	2023-10-23
502	2017-04-01
502	2017-04-01	BRETT WILPONEN	2019-12-03
502	2016-04-01
502	2015-04-01	BARRY PIPELLA
502	2014-04-01	BARRY PIPELLA

Plan Statistics for WHITE'S BOOTS, INC. LIFE AND DISABILITY PLAN

401k plan membership statisitcs for WHITE'S BOOTS, INC. LIFE AND DISABILITY PLAN

Measure Date Value
2022: WHITE'S BOOTS, INC. LIFE AND DISABILITY PLAN 2022 401k membership
Total participants, beginning-of-year 2022-04-01 108
Total number of active participants reported on line 7a of the Form 5500 2022-04-01 0
Number of retired or separated participants receiving benefits 2022-04-01 0
Number of other retired or separated participants entitled to future benefits 2022-04-01 0
Total of all active and inactive participants 2022-04-01 0
2017: WHITE'S BOOTS, INC. LIFE AND DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year 2017-04-01 83
Total number of active participants reported on line 7a of the Form 5500 2017-04-01 80
Number of retired or separated participants receiving benefits 2017-04-01 0
Number of other retired or separated participants entitled to future benefits 2017-04-01 0
Total of all active and inactive participants 2017-04-01 80
2016: WHITE'S BOOTS, INC. LIFE AND DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year 2016-04-01 93
Total number of active participants reported on line 7a of the Form 5500 2016-04-01 90
Number of retired or separated participants receiving benefits 2016-04-01 1
Number of other retired or separated participants entitled to future benefits 2016-04-01 0
Total of all active and inactive participants 2016-04-01 91
2015: WHITE'S BOOTS, INC. LIFE AND DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year 2015-04-01 100
Total number of active participants reported on line 7a of the Form 5500 2015-04-01 98
Number of retired or separated participants receiving benefits 2015-04-01 2
Number of other retired or separated participants entitled to future benefits 2015-04-01 0
Total of all active and inactive participants 2015-04-01 100
2014: WHITE'S BOOTS, INC. LIFE AND DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year 2014-04-01 100
Total number of active participants reported on line 7a of the Form 5500 2014-04-01 98
Number of retired or separated participants receiving benefits 2014-04-01 2
Number of other retired or separated participants entitled to future benefits 2014-04-01 0
Total of all active and inactive participants 2014-04-01 100

Measure	Date	Value
2022: WHITE'S BOOTS, INC. LIFE AND DISABILITY PLAN 2022 401k membership
Total participants, beginning-of-year	2022-04-01	108
Total number of active participants reported on line 7a of the Form 5500	2022-04-01	0
Number of retired or separated participants receiving benefits	2022-04-01	0
Number of other retired or separated participants entitled to future benefits	2022-04-01	0
Total of all active and inactive participants	2022-04-01	0
2017: WHITE'S BOOTS, INC. LIFE AND DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year	2017-04-01	83
Total number of active participants reported on line 7a of the Form 5500	2017-04-01	80
Number of retired or separated participants receiving benefits	2017-04-01	0
Number of other retired or separated participants entitled to future benefits	2017-04-01	0
Total of all active and inactive participants	2017-04-01	80
2016: WHITE'S BOOTS, INC. LIFE AND DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year	2016-04-01	93
Total number of active participants reported on line 7a of the Form 5500	2016-04-01	90
Number of retired or separated participants receiving benefits	2016-04-01	1
Number of other retired or separated participants entitled to future benefits	2016-04-01	0
Total of all active and inactive participants	2016-04-01	91
2015: WHITE'S BOOTS, INC. LIFE AND DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year	2015-04-01	100
Total number of active participants reported on line 7a of the Form 5500	2015-04-01	98
Number of retired or separated participants receiving benefits	2015-04-01	2
Number of other retired or separated participants entitled to future benefits	2015-04-01	0
Total of all active and inactive participants	2015-04-01	100
2014: WHITE'S BOOTS, INC. LIFE AND DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-04-01	100
Total number of active participants reported on line 7a of the Form 5500	2014-04-01	98
Number of retired or separated participants receiving benefits	2014-04-01	2
Number of other retired or separated participants entitled to future benefits	2014-04-01	0
Total of all active and inactive participants	2014-04-01	100

Form 5500 Responses for WHITE'S BOOTS, INC. LIFE AND DISABILITY PLAN

2022: WHITE'S BOOTS, INC. LIFE AND DISABILITY PLAN 2022 form 5500 responses
2022-04-01	Type of plan entity	Single employer plan
2022-04-01	Submission has been amended	No
2022-04-01	This submission is the final filing	Yes
2022-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-04-01	Plan is a collectively bargained plan	No
2022-04-01	Plan funding arrangement – Insurance	Yes
2022-04-01	Plan benefit arrangement – Insurance	Yes
2017: WHITE'S BOOTS, INC. LIFE AND DISABILITY PLAN 2017 form 5500 responses
2017-04-01	Type of plan entity	Single employer plan
2017-04-01	Submission has been amended	No
2017-04-01	This submission is the final filing	No
2017-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-04-01	Plan is a collectively bargained plan	No
2017-04-01	Plan funding arrangement – Insurance	Yes
2017-04-01	Plan benefit arrangement – Insurance	Yes
2016: WHITE'S BOOTS, INC. LIFE AND DISABILITY PLAN 2016 form 5500 responses
2016-04-01	Type of plan entity	Single employer plan
2016-04-01	Submission has been amended	No
2016-04-01	This submission is the final filing	No
2016-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-04-01	Plan is a collectively bargained plan	No
2016-04-01	Plan funding arrangement – Insurance	Yes
2016-04-01	Plan benefit arrangement – Insurance	Yes
2015: WHITE'S BOOTS, INC. LIFE AND DISABILITY PLAN 2015 form 5500 responses
2015-04-01	Type of plan entity	Single employer plan
2015-04-01	Submission has been amended	No
2015-04-01	This submission is the final filing	No
2015-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-04-01	Plan is a collectively bargained plan	No
2015-04-01	Plan funding arrangement – Insurance	Yes
2015-04-01	Plan benefit arrangement – Insurance	Yes
2014: WHITE'S BOOTS, INC. LIFE AND DISABILITY PLAN 2014 form 5500 responses
2014-04-01	Type of plan entity	Single employer plan
2014-04-01	First time form 5500 has been submitted	Yes
2014-04-01	Submission has been amended	No
2014-04-01	This submission is the final filing	No
2014-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-04-01	Plan is a collectively bargained plan	No
2014-04-01	Plan funding arrangement – Insurance	Yes
2014-04-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1091096

Policy instance

Insurance contract or identification number	1091096
Number of Individuals Covered	171
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $5,220
Total amount of fees paid to insurance company	USD $0
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $73,229
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,220
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H34210

Policy instance

Insurance contract or identification number	H34210
Number of Individuals Covered	147
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $4,818
Total amount of fees paid to insurance company	USD $0
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $71,215
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,818
Insurance broker organization code?	3
Insurance broker name	MERCER HEALTH AND BENEFITS, LLC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H34210

Policy instance

Insurance contract or identification number	H34210
Number of Individuals Covered	171
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $5,114
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $79,028
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,114
Insurance broker organization code?	3
Insurance broker name	MERCER HEALTH AND BENEFITS, LLC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

H34210

Policy instance

Insurance contract or identification number	H34210
Number of Individuals Covered	202
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $4,554
Total amount of fees paid to insurance company	USD $502
Are there contracts with allocated funds for individual policies?	No
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $70,377
Commission paid to Insurance Broker	USD $1,343
Amount paid for insurance broker fees	502
Additional information about fees paid to insurance broker	MARKET SERVICE REVENUE
Insurance broker organization code?	3
Insurance broker name	FIDELITY ASSOC FINANCIAL SVCS INC.

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Company Name:	WHITE'S BOOTS, INC.
Employer identification number (EIN):	910696210
NAIC Classification:	448210
NAIC Description:	Shoe Stores

Jurisdiction of Incorporation:	Washington Secretary of State Corporations Division
Incorporation Date:	1959-07-01
Company Identification Number:	328042229
Legal Registered Office Address:	711 CAPITOL WAY S STE 204 OLYMPIA United States of America (USA) 985011267