401k Plan data: ALPINE FOOD DISTRIBUTING, INC. EMPLOYEE BENEFITS PLAN plan

ALPINE FOOD DISTRIBUTING, INC. EMPLOYEE BENEFITS PLAN 401k Plan overview

Plan Name	ALPINE FOOD DISTRIBUTING, INC. EMPLOYEE BENEFITS PLAN
Plan identification number	504

ALPINE FOOD DISTRIBUTING, INC. EMPLOYEE BENEFITS PLAN Benefits

401k Plan Type	Welfare 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

ALPINE FOOD DISTRIBUTING, INC. has sponsored the creation of one or more 401k plans.

Company Name: ALPINE FOOD DISTRIBUTING, INC.

Employer identification number (EIN): 930936768

NAIC Classification: 424400

Additional information about ALPINE FOOD DISTRIBUTING, INC.

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division

Incorporation Date: 1986-12-30

Company Identification Number: 5852983

Legal Registered Office Address: 9200 SE SUNNYBROOK BLVD STE 210

CLACKAMAS
United States of America (USA)
97015

More information about ALPINE FOOD DISTRIBUTING, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ALPINE FOOD DISTRIBUTING, INC. EMPLOYEE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2022-01-01 DEBBIE TURRENTINE 2023-07-31

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
504	2022-01-01	DEBBIE TURRENTINE	2023-07-31

Plan Statistics for ALPINE FOOD DISTRIBUTING, INC. EMPLOYEE BENEFITS PLAN

401k plan membership statisitcs for ALPINE FOOD DISTRIBUTING, INC. EMPLOYEE BENEFITS PLAN

Measure Date Value
2022: ALPINE FOOD DISTRIBUTING, INC. EMPLOYEE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 144
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 144
Number of employers contributing to the scheme 2022-01-01 0

Measure	Date	Value
2022: ALPINE FOOD DISTRIBUTING, INC. EMPLOYEE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	144
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	144
Number of employers contributing to the scheme	2022-01-01	0

Form 5500 Responses for ALPINE FOOD DISTRIBUTING, INC. EMPLOYEE BENEFITS PLAN

2022: ALPINE FOOD DISTRIBUTING, INC. EMPLOYEE BENEFITS PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	First time form 5500 has been submitted	Yes
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

23514

Policy instance

Insurance contract or identification number	23514
Number of Individuals Covered	149
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $20,529
Total amount of fees paid to insurance company	USD $165
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $743,340
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,529
Amount paid for insurance broker fees	165
Additional information about fees paid to insurance broker	RETENTION BONUS, NON-MONETARY COMPENSATION
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

756593

Policy instance

Insurance contract or identification number	756593
Number of Individuals Covered	107
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,908
Total amount of fees paid to insurance company	USD $441
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,908
Amount paid for insurance broker fees	441
Additional information about fees paid to insurance broker	CONTINGENT COMPENSATION
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

617220

Policy instance

Insurance contract or identification number	617220
Number of Individuals Covered	144
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $8,365
Total amount of fees paid to insurance company	USD $2,376
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $67,440
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,365
Amount paid for insurance broker fees	2376
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

Potentially related plans

ALPINE FOOD SERVICES INC. 401K PLAN [EIN = 200258911]

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Company Name:	ALPINE FOOD DISTRIBUTING, INC.
Employer identification number (EIN):	930936768
NAIC Classification:	424400

Jurisdiction of Incorporation:	Oregon Secretary of State Corporations Division
Incorporation Date:	1986-12-30
Company Identification Number:	5852983
Legal Registered Office Address:	9200 SE SUNNYBROOK BLVD STE 210 CLACKAMAS United States of America (USA) 97015