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| Plan Name | SQUARE ONE CONCEPTS WELFARE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | SQUARE ONE CONCEPTS |
| Employer identification number (EIN): | 274539075 |
| NAIC Classification: | 722511 |
| NAIC Description: | Full-Service Restaurants |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-05-01 | MARIA VERTES | 2023-11-13 |
| Measure | Date | Value |
|---|---|---|
| 2022: SQUARE ONE CONCEPTS WELFARE BENEFIT PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-05-01 | 161 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-05-01 | 157 |
| 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 | 157 |
| Number of employers contributing to the scheme | 2022-05-01 | 0 |
| 2022: SQUARE ONE CONCEPTS WELFARE BENEFIT PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-05-01 | Type of plan entity | Single employer plan |
| 2022-05-01 | First time form 5500 has been submitted | Yes |
| 2022-05-01 | Plan funding arrangement – Insurance | Yes |
| 2022-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |||||||||||||||||||||||||||||||||||||
| Policy contract number | 551005 | ||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||
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| DELTA DENTAL OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53597 ) | |||||||||||||||||||||||||||||||||||||
| Policy contract number | 32003 | ||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||
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