401k Plan data: SALAD COLLECTIVE HEALTH AND WELFARE BENEFITS PLAN plan

SALAD COLLECTIVE HEALTH AND WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	SALAD COLLECTIVE HEALTH AND WELFARE BENEFITS PLAN
Plan identification number	501

SALAD COLLECTIVE HEALTH AND WELFARE 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

SALAD COLLECTIVE has sponsored the creation of one or more 401k plans.

Company Name: SALAD COLLECTIVE

Employer identification number (EIN): 800099677

NAIC Classification: 722513
NAIC Description: Limited-Service Restaurants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SALAD COLLECTIVE HEALTH AND WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2024-01-01 WENDY HULL
501 2023-01-01 WENDY HULL 2024-09-27

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2024-01-01	WENDY HULL
501	2023-01-01	WENDY HULL	2024-09-27

Form 5500 Responses for SALAD COLLECTIVE HEALTH AND WELFARE BENEFITS PLAN

2023: SALAD COLLECTIVE HEALTH AND WELFARE BENEFITS PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )

Policy contract number

12334

Policy instance

Insurance contract or identification number	12334
Number of Individuals Covered	155
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,065
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30042287

Policy instance

Insurance contract or identification number	30042287
Number of Individuals Covered	87
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $818
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,324
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )

Policy contract number

E5920269

Policy instance

Insurance contract or identification number	E5920269
Number of Individuals Covered	3
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $922
Total amount of fees paid to insurance company	USD $188
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $2,183
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10223463

Policy instance

Insurance contract or identification number	10223463
Number of Individuals Covered	470
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,986
Total amount of fees paid to insurance company	USD $7,499
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 $76,301
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	SALAD COLLECTIVE
Employer identification number (EIN):	800099677
NAIC Classification:	722513
NAIC Description:	Limited-Service Restaurants