401k Plan data: CALIFORNIA FOOD MANAGEMENT, LLC HEALTH & WELFARE PLAN plan

CALIFORNIA FOOD MANAGEMENT, LLC HEALTH & WELFARE PLAN 401k Plan overview

Plan Name	CALIFORNIA FOOD MANAGEMENT, LLC HEALTH & WELFARE PLAN
Plan identification number	501

CALIFORNIA FOOD MANAGEMENT, LLC HEALTH & WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision 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.

401k Sponsoring company profile

CALIFORNIA FOOD MANAGEMENT, LLC has sponsored the creation of one or more 401k plans.

Company Name: CALIFORNIA FOOD MANAGEMENT, LLC

Employer identification number (EIN): 273221304

NAIC Classification: 722513
NAIC Description: Limited-Service Restaurants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CALIFORNIA FOOD MANAGEMENT, LLC HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-08-01 KATHI CHURCHILL 2024-02-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-08-01	KATHI CHURCHILL	2024-02-13

Plan Statistics for CALIFORNIA FOOD MANAGEMENT, LLC HEALTH & WELFARE PLAN

401k plan membership statisitcs for CALIFORNIA FOOD MANAGEMENT, LLC HEALTH & WELFARE PLAN

Measure Date Value
2022: CALIFORNIA FOOD MANAGEMENT, LLC HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-08-01 126
Total number of active participants reported on line 7a of the Form 5500 2022-08-01 94
Number of retired or separated participants receiving benefits 2022-08-01 0
Number of other retired or separated participants entitled to future benefits 2022-08-01 0
Total of all active and inactive participants 2022-08-01 94

Measure	Date	Value
2022: CALIFORNIA FOOD MANAGEMENT, LLC HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-08-01	126
Total number of active participants reported on line 7a of the Form 5500	2022-08-01	94
Number of retired or separated participants receiving benefits	2022-08-01	0
Number of other retired or separated participants entitled to future benefits	2022-08-01	0
Total of all active and inactive participants	2022-08-01	94

Form 5500 Responses for CALIFORNIA FOOD MANAGEMENT, LLC HEALTH & WELFARE PLAN

2022: CALIFORNIA FOOD MANAGEMENT, LLC HEALTH & WELFARE PLAN 2022 form 5500 responses
2022-08-01	Type of plan entity	Single employer plan
2022-08-01	First time form 5500 has been submitted	Yes
2022-08-01	Submission has been amended	No
2022-08-01	This submission is the final filing	No
2022-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-08-01	Plan is a collectively bargained plan	No
2022-08-01	Plan funding arrangement – Insurance	Yes
2022-08-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

230948

Policy instance

Insurance contract or identification number	230948
Number of Individuals Covered	57
Insurance policy start date	2022-08-01
Insurance policy end date	2023-07-31
Total amount of commissions paid to insurance broker	USD $17,209
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	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 $489,937
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,015
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00464371

Policy instance

Insurance contract or identification number	00464371
Number of Individuals Covered	94
Insurance policy start date	2022-08-01
Insurance policy end date	2023-07-31
Total amount of commissions paid to insurance broker	USD $6,809
Total amount of fees paid to insurance company	USD $2,349
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	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 $68,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,809
Amount paid for insurance broker fees	2349
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

30024142

Policy instance

Insurance contract or identification number	30024142
Number of Individuals Covered	92
Insurance policy start date	2022-08-01
Insurance policy end date	2023-07-31
Total amount of commissions paid to insurance broker	USD $1,199
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	No
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
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 $14,099
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,320
Insurance broker organization code?	3

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Company Name:	CALIFORNIA FOOD MANAGEMENT, LLC
Employer identification number (EIN):	273221304
NAIC Classification:	722513
NAIC Description:	Limited-Service Restaurants