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SALT HOUSE LLC EMPLOYER HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameSALT HOUSE LLC EMPLOYER HEALTH AND WELFARE PLAN
Plan identification number 553

SALT HOUSE LLC EMPLOYER HEALTH AND WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental

401k Sponsoring company profile

SALT HOUSE RESTAURANT has sponsored the creation of one or more 401k plans.

Company Name:SALT HOUSE RESTAURANT
Employer identification number (EIN):203775090
NAIC Classification:722511
NAIC Description:Full-Service Restaurants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SALT HOUSE LLC EMPLOYER HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5532018-07-01PATRICIA PITPITAN2020-04-13
5532018-07-01PATRICIA PITPITAN2020-06-15
5532017-07-01PATRICIA PITPITAN2019-04-11
5532016-07-01
5532015-07-01PATRICIA PITPITAN

Plan Statistics for SALT HOUSE LLC EMPLOYER HEALTH AND WELFARE PLAN

401k plan membership statisitcs for SALT HOUSE LLC EMPLOYER HEALTH AND WELFARE PLAN

Measure Date Value
2018: SALT HOUSE LLC EMPLOYER HEALTH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-0130
Total number of active participants reported on line 7a of the Form 55002018-07-0126
Number of retired or separated participants receiving benefits2018-07-010
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-0126
Number of employers contributing to the scheme2018-07-010
2017: SALT HOUSE LLC EMPLOYER HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-0132
Total number of active participants reported on line 7a of the Form 55002017-07-0146
Number of retired or separated participants receiving benefits2017-07-010
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-0146
Number of employers contributing to the scheme2017-07-010
2016: SALT HOUSE LLC EMPLOYER HEALTH AND WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-0132
Total number of active participants reported on line 7a of the Form 55002016-07-0132
Number of retired or separated participants receiving benefits2016-07-010
Number of other retired or separated participants entitled to future benefits2016-07-010
Total of all active and inactive participants2016-07-0132
2015: SALT HOUSE LLC EMPLOYER HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-0130
Total number of active participants reported on line 7a of the Form 55002015-07-0132
Number of retired or separated participants receiving benefits2015-07-010
Number of other retired or separated participants entitled to future benefits2015-07-010
Total of all active and inactive participants2015-07-0132

Financial Data on SALT HOUSE LLC EMPLOYER HEALTH AND WELFARE PLAN

Measure Date Value
2019 : SALT HOUSE LLC EMPLOYER HEALTH AND WELFARE PLAN 2019 401k financial data
Transfers to/from the plan2019-06-30$0
Total plan liabilities at end of year2019-06-30$0
Total plan liabilities at beginning of year2019-06-30$0
Total income from all sources2019-06-30$111,881
Expenses. Total of all expenses incurred2019-06-30$111,881
Benefits paid (including direct rollovers)2019-06-30$39,666
Total plan assets at end of year2019-06-30$0
Total plan assets at beginning of year2019-06-30$0
Total contributions received or receivable from participants2019-06-30$2,047
Expenses. Other expenses not covered elsewhere2019-06-30$0
Contributions received from other sources (not participants or employers)2019-06-30$0
Other income received2019-06-30$0
Noncash contributions received2019-06-30$0
Net income (gross income less expenses)2019-06-30$0
Net plan assets at end of year (total assets less liabilities)2019-06-30$0
Net plan assets at beginning of year (total assets less liabilities)2019-06-30$0
Total contributions received or receivable from employer(s)2019-06-30$109,834
Value of certain deemed distributions of participant loans2019-06-30$0
Value of corrective distributions2019-06-30$0
Expenses. Administrative service providers (salaries,fees and commissions)2019-06-30$72,215
2017 : SALT HOUSE LLC EMPLOYER HEALTH AND WELFARE PLAN 2017 401k financial data
Total plan liabilities at beginning of year2017-06-30$0
Total income from all sources2017-06-30$109,369
Expenses. Total of all expenses incurred2017-06-30$109,369
Benefits paid (including direct rollovers)2017-06-30$54,681
Total plan assets at beginning of year2017-06-30$0
Total contributions received or receivable from participants2017-06-30$17,946
Net income (gross income less expenses)2017-06-30$0
Net plan assets at end of year (total assets less liabilities)2017-06-30$0
Net plan assets at beginning of year (total assets less liabilities)2017-06-30$0
Total contributions received or receivable from employer(s)2017-06-30$91,423
Expenses. Administrative service providers (salaries,fees and commissions)2017-06-30$54,688
2016 : SALT HOUSE LLC EMPLOYER HEALTH AND WELFARE PLAN 2016 401k financial data
Total plan liabilities at end of year2016-06-30$0
Total plan liabilities at beginning of year2016-06-30$0
Total income from all sources2016-06-30$49,481
Expenses. Total of all expenses incurred2016-06-30$49,481
Benefits paid (including direct rollovers)2016-06-30$24,505
Total plan assets at end of year2016-06-30$0
Total plan assets at beginning of year2016-06-30$0
Total contributions received or receivable from participants2016-06-30$6,159
Expenses. Other expenses not covered elsewhere2016-06-30$12,915
Contributions received from other sources (not participants or employers)2016-06-30$0
Other income received2016-06-30$0
Noncash contributions received2016-06-30$0
Net income (gross income less expenses)2016-06-30$0
Net plan assets at end of year (total assets less liabilities)2016-06-30$0
Net plan assets at beginning of year (total assets less liabilities)2016-06-30$0
Total contributions received or receivable from employer(s)2016-06-30$43,322
Value of certain deemed distributions of participant loans2016-06-30$0
Value of corrective distributions2016-06-30$0
Expenses. Administrative service providers (salaries,fees and commissions)2016-06-30$12,061

Form 5500 Responses for SALT HOUSE LLC EMPLOYER HEALTH AND WELFARE PLAN

2018: SALT HOUSE LLC EMPLOYER HEALTH AND WELFARE PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Submission has been amendedYes
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan funding arrangement – TrustYes
2018-07-01Plan benefit arrangement – InsuranceYes
2018-07-01Plan benefit arrangement - TrustYes
2017: SALT HOUSE LLC EMPLOYER HEALTH AND WELFARE PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan funding arrangement – TrustYes
2017-07-01Plan benefit arrangement – InsuranceYes
2017-07-01Plan benefit arrangement - TrustYes
2016: SALT HOUSE LLC EMPLOYER HEALTH AND WELFARE PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Submission has been amendedNo
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)No
2016-07-01Plan is a collectively bargained planNo
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan funding arrangement – TrustYes
2016-07-01Plan funding arrangement – General assets of the sponsorYes
2016-07-01Plan benefit arrangement – InsuranceYes
2016-07-01Plan benefit arrangement - TrustYes
2016-07-01Plan benefit arrangement – General assets of the sponsorYes
2015: SALT HOUSE LLC EMPLOYER HEALTH AND WELFARE PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01First time form 5500 has been submittedYes
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingNo
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan funding arrangement – TrustYes
2015-07-01Plan funding arrangement – General assets of the sponsorYes
2015-07-01Plan benefit arrangement – InsuranceYes
2015-07-01Plan benefit arrangement - TrustYes
2015-07-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

BENEFIT AND RISK MANAGEMENT SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00
Policy instance 1
Insurance contract or identification number00
Number of Individuals Covered26
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 )
Policy contract number17802
Policy instance 2
Insurance contract or identification number17802
Number of Individuals Covered15
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $445
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,617
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $445
Amount paid for insurance broker fees0
Insurance broker organization code?3
BENEFIT AND RISK MANAGEMENT SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number10598
Policy instance 1
Insurance contract or identification number10598
Number of Individuals Covered46
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 )
Policy contract number17801
Policy instance 2
Insurance contract or identification number17801
Number of Individuals Covered17
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $564
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,431
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION (National Association of Insurance Commissioners NAIC id number: 96030 )
Policy contract numberKM05929295
Policy instance 1
Insurance contract or identification numberKM05929295
Number of Individuals Covered26
Insurance policy start date2015-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $530
Total amount of fees paid to insurance companyUSD $147
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $5,336
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $530
Amount paid for insurance broker fees147
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameNFP CORPORATE SERVICES
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00
Policy instance 2
Insurance contract or identification number00
Number of Individuals Covered35
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $12,915
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes

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