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SALT LAKE BREWING CO., L.C. HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan NameSALT LAKE BREWING CO., L.C. HEALTH AND WELFARE BENEFIT PLAN
Plan identification number 501

SALT LAKE BREWING CO., L.C. HEALTH AND WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare 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

SALT LAKE BREWING COMPANY, LLC has sponsored the creation of one or more 401k plans.

Company Name:SALT LAKE BREWING COMPANY, LLC
Employer identification number (EIN):870518311
NAIC Classification:722300
NAIC Description: Special Food Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SALT LAKE BREWING CO., L.C. HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-04-01ROBIN HARMAN2023-06-15
5012015-10-01ALI VILLARRUEL
5012014-10-01ALI VILLARRUEL
5012013-10-01LESLIE MILLER LESLIE MILLER2015-04-14
5012012-10-01NICOLE KENDRICK

Plan Statistics for SALT LAKE BREWING CO., L.C. HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for SALT LAKE BREWING CO., L.C. HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2022: SALT LAKE BREWING CO., L.C. HEALTH AND WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-04-01197
Total number of active participants reported on line 7a of the Form 55002022-04-01197
Number of retired or separated participants receiving benefits2022-04-010
Number of other retired or separated participants entitled to future benefits2022-04-010
Total of all active and inactive participants2022-04-01197
Number of employers contributing to the scheme2022-04-010
2015: SALT LAKE BREWING CO., L.C. HEALTH AND WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-10-01192
Total number of active participants reported on line 7a of the Form 55002015-10-01266
Total of all active and inactive participants2015-10-01266
Total participants2015-10-01266
2014: SALT LAKE BREWING CO., L.C. HEALTH AND WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-10-01278
Total number of active participants reported on line 7a of the Form 55002014-10-01192
Total of all active and inactive participants2014-10-01192
Total participants2014-10-01192
2013: SALT LAKE BREWING CO., L.C. HEALTH AND WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-10-01243
Total number of active participants reported on line 7a of the Form 55002013-10-01278
Total of all active and inactive participants2013-10-01278
Total participants2013-10-01278
2012: SALT LAKE BREWING CO., L.C. HEALTH AND WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-10-01243
Total number of active participants reported on line 7a of the Form 55002012-10-01243
Total of all active and inactive participants2012-10-01243
Total participants2012-10-01243

Form 5500 Responses for SALT LAKE BREWING CO., L.C. HEALTH AND WELFARE BENEFIT PLAN

2022: SALT LAKE BREWING CO., L.C. HEALTH AND WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-04-01Type of plan entitySingle employer plan
2022-04-01This return/report is a short plan year return/report (less than 12 months)Yes
2022-04-01Plan funding arrangement – InsuranceYes
2022-04-01Plan benefit arrangement – InsuranceYes
2015: SALT LAKE BREWING CO., L.C. HEALTH AND WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01Submission has been amendedNo
2015-10-01This submission is the final filingNo
2015-10-01This return/report is a short plan year return/report (less than 12 months)No
2015-10-01Plan is a collectively bargained planNo
2015-10-01Plan funding arrangement – InsuranceYes
2015-10-01Plan funding arrangement – General assets of the sponsorYes
2015-10-01Plan benefit arrangement – InsuranceYes
2015-10-01Plan benefit arrangement – General assets of the sponsorYes
2014: SALT LAKE BREWING CO., L.C. HEALTH AND WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-10-01Type of plan entitySingle employer plan
2014-10-01Submission has been amendedNo
2014-10-01This submission is the final filingNo
2014-10-01This return/report is a short plan year return/report (less than 12 months)No
2014-10-01Plan is a collectively bargained planNo
2014-10-01Plan funding arrangement – InsuranceYes
2014-10-01Plan funding arrangement – General assets of the sponsorYes
2014-10-01Plan benefit arrangement – InsuranceYes
2014-10-01Plan benefit arrangement – General assets of the sponsorYes
2013: SALT LAKE BREWING CO., L.C. HEALTH AND WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-10-01Type of plan entitySingle employer plan
2013-10-01Submission has been amendedNo
2013-10-01This submission is the final filingNo
2013-10-01This return/report is a short plan year return/report (less than 12 months)No
2013-10-01Plan is a collectively bargained planNo
2013-10-01Plan funding arrangement – InsuranceYes
2013-10-01Plan funding arrangement – General assets of the sponsorYes
2013-10-01Plan benefit arrangement – InsuranceYes
2013-10-01Plan benefit arrangement – General assets of the sponsorYes
2012: SALT LAKE BREWING CO., L.C. HEALTH AND WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-10-01Type of plan entitySingle employer plan
2012-10-01First time form 5500 has been submittedYes
2012-10-01Submission has been amendedNo
2012-10-01This submission is the final filingNo
2012-10-01This return/report is a short plan year return/report (less than 12 months)No
2012-10-01Plan is a collectively bargained planNo
2012-10-01Plan funding arrangement – InsuranceYes
2012-10-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract numberGRP00006611
Policy instance 1
Insurance contract or identification numberGRP00006611
Number of Individuals Covered177
Insurance policy start date2022-04-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $4,434
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $80,408
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,991
Amount paid for insurance broker fees0
Insurance broker organization code?3
REGENCE BLUECROSS BLUESHIELD OF UTAH (National Association of Insurance Commissioners NAIC id number: 54550 )
Policy contract number10053154
Policy instance 2
Insurance contract or identification number10053154
Number of Individuals Covered294
Insurance policy start date2022-03-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $28,559
Total amount of fees paid to insurance companyUSD $9,850
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $953,605
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $28,559
Amount paid for insurance broker fees9850
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
MONY (National Association of Insurance Commissioners NAIC id number: 78077 )
Policy contract number12564
Policy instance 3
Insurance contract or identification number12564
Number of Individuals Covered197
Insurance policy start date2022-02-17
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $6,031
Total amount of fees paid to insurance companyUSD $1,905
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $40,386
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,031
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS

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