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| Plan Name | CAL FRESCO/LEGACY FARMS BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | CAL FRESCO/LEGACY FARMS EMPLOYMENT SERVICES COMPANY, INC. |
| Employer identification number (EIN): | 820843792 |
| NAIC Classification: | 445110 |
| NAIC Description: | Supermarkets and Other Grocery (except Convenience) Stores |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2021-10-01 | CELINA ALVA | 2024-03-15 |
| 2021: CAL FRESCO/LEGACY FARMS BENEFIT PLAN 2021 form 5500 responses | ||
|---|---|---|
| 2021-10-01 | Type of plan entity | Single employer plan |
| 2021-10-01 | Submission has been amended | No |
| 2021-10-01 | This submission is the final filing | Yes |
| 2021-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-10-01 | Plan is a collectively bargained plan | No |
| 2021-10-01 | Plan funding arrangement – Insurance | Yes |
| 2021-10-01 | Plan benefit arrangement – Insurance | Yes |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) | |
| Policy contract number | 3343888 |
| Policy instance | 1 |
| CIGNA HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 0 ) | |
| Policy contract number | 3343888 |
| Policy instance | 2 |
| CIGNA DENTAL HEALTH OF CALIFORNIA,INC (National Association of Insurance Commissioners NAIC id number: 0 ) | |
| Policy contract number | 3343888 |
| Policy instance | 3 |
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