401k Plan data: ENVISION FOODS EMPLOYEE HEALTH & WELFARE plan

ENVISION FOODS EMPLOYEE HEALTH & WELFARE 401k Plan overview

Plan Name	ENVISION FOODS EMPLOYEE HEALTH & WELFARE
Plan identification number	501

ENVISION FOODS EMPLOYEE HEALTH & WELFARE Benefits

401k Plan Type

Welfare Benefit

Plan Features/Benefits

Health (other than dental or vision)
Life insurance
Dental
Vision
Long-term disability cover
Death benefits (include travel accident but not life insurance)
Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.
Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

ENVISION FOODS, LLC has sponsored the creation of one or more 401k plans.

Company Name: ENVISION FOODS, LLC

Employer identification number (EIN): 204278964

NAIC Classification: 722511
NAIC Description: Full-Service Restaurants

Additional information about ENVISION FOODS, LLC

Jurisdiction of Incorporation: California Department of State

Incorporation Date:

Company Identification Number: 200531110017

More information about ENVISION FOODS, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ENVISION FOODS EMPLOYEE HEALTH & WELFARE

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 BRENT DUNKIN 2024-09-24
501 2022-01-01 BRENT DUNKIN 2023-09-15
501 2021-01-01 RENEER GREER 2022-07-06
501 2020-01-01 HAMID SHARAFATIAN 2021-10-14
501 2019-01-01 HAMID SHARAFATIAN 2020-10-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-01-01	BRENT DUNKIN	2024-09-24
501	2022-01-01	BRENT DUNKIN	2023-09-15
501	2021-01-01	RENEER GREER	2022-07-06
501	2020-01-01	HAMID SHARAFATIAN	2021-10-14
501	2019-01-01	HAMID SHARAFATIAN	2020-10-13

Form 5500 Responses for ENVISION FOODS EMPLOYEE HEALTH & WELFARE

2023: ENVISION FOODS EMPLOYEE HEALTH & WELFARE 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2022: ENVISION FOODS EMPLOYEE HEALTH & WELFARE 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: ENVISION FOODS EMPLOYEE HEALTH & WELFARE 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: ENVISION FOODS EMPLOYEE HEALTH & WELFARE 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: ENVISION FOODS EMPLOYEE HEALTH & WELFARE 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	First time form 5500 has been submitted	Yes
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 )

Policy contract number

17625

Policy instance

Insurance contract or identification number	17625
Number of Individuals Covered	189
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $3,746
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Welfare Benefit Premiums Paid to Carrier	USD $66,130
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

10248731

Policy instance

Insurance contract or identification number	10248731
Number of Individuals Covered	834
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $2,787
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $18,569
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

229097

Policy instance

Insurance contract or identification number	229097
Number of Individuals Covered	169
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $26,891
Total amount of fees paid to insurance company	USD $2
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $576,920
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 number

17625

Policy instance

Insurance contract or identification number	17625
Number of Individuals Covered	194
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,880
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Welfare Benefit Premiums Paid to Carrier	USD $67,734
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

10248731

Policy instance

Insurance contract or identification number	10248731
Number of Individuals Covered	0
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,281
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $8,542
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

229097

Policy instance

Insurance contract or identification number	229097
Number of Individuals Covered	182
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $32,048
Total amount of fees paid to insurance company	USD $591
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $606,573
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

10248731

Policy instance

PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 )

Policy contract number

17625

Policy instance

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

229097

Policy instance

PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 )

Policy contract number

17625

Policy instance

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

Policy contract number

10248731

Policy instance

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

229097

Policy instance

HEALTHY ALLIANCE LIFE INSURANCE COMPANY (G0262) (National Association of Insurance Commissioners NAIC id number: 78972 )

Policy contract number

253043

Policy instance

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

Policy contract number

10248731

Policy instance

PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 )

Policy contract number

17625

Policy instance

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

229097

Policy instance

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Company Name:	ENVISION FOODS, LLC
Employer identification number (EIN):	204278964
NAIC Classification:	722511
NAIC Description:	Full-Service Restaurants

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:
Company Identification Number:	200531110017