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| Plan Name | EMPLOYEE HEALTH PLAN OF EXTRA PICKLES |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | EXTRA PICKLES |
| Employer identification number (EIN): | 842499296 |
| NAIC Classification: | 722513 |
| NAIC Description: | Limited-Service Restaurants |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-05-01 | ||||
| 501 | 2021-12-01 |
| Measure | Date | Value |
|---|---|---|
| 2022: EMPLOYEE HEALTH PLAN OF EXTRA PICKLES 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-05-01 | 8 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-05-01 | 8 |
| Number of retired or separated participants receiving benefits | 2022-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-05-01 | 0 |
| Total of all active and inactive participants | 2022-05-01 | 8 |
| 2021: EMPLOYEE HEALTH PLAN OF EXTRA PICKLES 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-12-01 | 4 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-12-01 | 5 |
| Number of retired or separated participants receiving benefits | 2021-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-12-01 | 0 |
| Total of all active and inactive participants | 2021-12-01 | 5 |
| Measure | Date | Value |
|---|---|---|
| 2023 : EMPLOYEE HEALTH PLAN OF EXTRA PICKLES 2023 401k financial data | ||
| Total income from all sources | 2023-04-30 | $26,876 |
| Expenses. Total of all expenses incurred | 2023-04-30 | $29,275 |
| Benefits paid (including direct rollovers) | 2023-04-30 | $13,820 |
| Total plan assets at beginning of year | 2023-04-30 | $2,399 |
| Value of fidelity bond covering the plan | 2023-04-30 | $2,000 |
| Expenses. Other expenses not covered elsewhere | 2023-04-30 | $15,455 |
| Net income (gross income less expenses) | 2023-04-30 | $-2,399 |
| Net plan assets at end of year (total assets less liabilities) | 2023-04-30 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2023-04-30 | $2,399 |
| Total contributions received or receivable from employer(s) | 2023-04-30 | $26,876 |
| 2022 : EMPLOYEE HEALTH PLAN OF EXTRA PICKLES 2022 401k financial data | ||
| Total income from all sources | 2022-04-30 | $10,700 |
| Expenses. Total of all expenses incurred | 2022-04-30 | $8,301 |
| Benefits paid (including direct rollovers) | 2022-04-30 | $2,639 |
| Total plan assets at end of year | 2022-04-30 | $2,399 |
| Value of fidelity bond covering the plan | 2022-04-30 | $1,000 |
| Expenses. Other expenses not covered elsewhere | 2022-04-30 | $5,662 |
| Net income (gross income less expenses) | 2022-04-30 | $2,399 |
| Net plan assets at end of year (total assets less liabilities) | 2022-04-30 | $2,399 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-04-30 | $0 |
| Total contributions received or receivable from employer(s) | 2022-04-30 | $10,700 |
| 2022: EMPLOYEE HEALTH PLAN OF EXTRA PICKLES 2022 form 5500 responses | ||
|---|---|---|
| 2022-05-01 | Type of plan entity | Single employer plan |
| 2022-05-01 | Submission has been amended | No |
| 2022-05-01 | This submission is the final filing | No |
| 2022-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-05-01 | Plan is a collectively bargained plan | No |
| 2022-05-01 | Plan funding arrangement – Insurance | Yes |
| 2022-05-01 | Plan funding arrangement – Trust | Yes |
| 2022-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-05-01 | Plan benefit arrangement - Trust | Yes |
| 2021: EMPLOYEE HEALTH PLAN OF EXTRA PICKLES 2021 form 5500 responses | ||
| 2021-12-01 | Type of plan entity | Single employer plan |
| 2021-12-01 | First time form 5500 has been submitted | Yes |
| 2021-12-01 | Submission has been amended | No |
| 2021-12-01 | This submission is the final filing | No |
| 2021-12-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2021-12-01 | Plan is a collectively bargained plan | No |
| 2021-12-01 | Plan funding arrangement – Insurance | Yes |
| 2021-12-01 | Plan funding arrangement – Trust | Yes |
| 2021-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-12-01 | Plan benefit arrangement - Trust | Yes |
| NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 ) | |||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 70500 NFA 0879 | ||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||
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| NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 ) | |||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 70500 NFA 0879 | ||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||
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