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FARMER BOYS FOOD, INC. GROUP HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameFARMER BOYS FOOD, INC. GROUP HEALTH AND WELFARE PLAN
Plan identification number 501

FARMER BOYS FOOD, INC. GROUP HEALTH AND WELFARE 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

FARMER BOYS FOOD, INC. has sponsored the creation of one or more 401k plans.

Company Name:FARMER BOYS FOOD, INC.
Employer identification number (EIN):330761136
NAIC Classification:722513
NAIC Description:Limited-Service Restaurants

Additional information about FARMER BOYS FOOD, INC.

Jurisdiction of Incorporation: California Department of State
Incorporation Date: 1997-03-07
Company Identification Number: C1980045
Legal Registered Office Address: 555 Marin Street, Suite 140

Thousand Oaks
United States of America (USA)
91360

More information about FARMER BOYS FOOD, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FARMER BOYS FOOD, INC. GROUP HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-01-01JOSEPH ORTIZ2024-07-02
5012022-01-01JOSEPH ORTIZ2023-08-23
5012021-01-01JOSEPH ORTIZ2022-06-15
5012020-01-01ARLENE PETOKAS2021-10-06
5012019-01-01ARLENE PETOKAS2020-08-26
5012018-01-01
5012017-01-01
5012016-01-01JUDY LEWIS
5012015-01-01JUDY H LEWIS

Plan Statistics for FARMER BOYS FOOD, INC. GROUP HEALTH AND WELFARE PLAN

401k plan membership statisitcs for FARMER BOYS FOOD, INC. GROUP HEALTH AND WELFARE PLAN

Measure Date Value
2023: FARMER BOYS FOOD, INC. GROUP HEALTH AND WELFARE PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-01133
Total number of active participants reported on line 7a of the Form 55002023-01-01105
Number of retired or separated participants receiving benefits2023-01-010
Number of other retired or separated participants entitled to future benefits2023-01-013
Total of all active and inactive participants2023-01-01108
Number of employers contributing to the scheme2023-01-010
2022: FARMER BOYS FOOD, INC. GROUP HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01141
Total number of active participants reported on line 7a of the Form 55002022-01-01156
Number of retired or separated participants receiving benefits2022-01-013
Number of other retired or separated participants entitled to future benefits2022-01-012
Total of all active and inactive participants2022-01-01161
Number of employers contributing to the scheme2022-01-010
2021: FARMER BOYS FOOD, INC. GROUP HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01234
Total number of active participants reported on line 7a of the Form 55002021-01-01206
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01206
Number of employers contributing to the scheme2021-01-010
2020: FARMER BOYS FOOD, INC. GROUP HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01205
Total number of active participants reported on line 7a of the Form 55002020-01-01234
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01234
Number of employers contributing to the scheme2020-01-010
2019: FARMER BOYS FOOD, INC. GROUP HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01203
Total number of active participants reported on line 7a of the Form 55002019-01-01205
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01205
Number of employers contributing to the scheme2019-01-010
2018: FARMER BOYS FOOD, INC. GROUP HEALTH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01224
Total number of active participants reported on line 7a of the Form 55002018-01-01203
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01203
Number of employers contributing to the scheme2018-01-010
2017: FARMER BOYS FOOD, INC. GROUP HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01322
Total number of active participants reported on line 7a of the Form 55002017-01-01301
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01301
2016: FARMER BOYS FOOD, INC. GROUP HEALTH AND WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01301
Total number of active participants reported on line 7a of the Form 55002016-01-01288
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01288
2015: FARMER BOYS FOOD, INC. GROUP HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01290
Total number of active participants reported on line 7a of the Form 55002015-01-01275
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01275

Form 5500 Responses for FARMER BOYS FOOD, INC. GROUP HEALTH AND WELFARE PLAN

2023: FARMER BOYS FOOD, INC. GROUP HEALTH AND WELFARE PLAN 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – InsuranceYes
2022: FARMER BOYS FOOD, INC. GROUP HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: FARMER BOYS FOOD, INC. GROUP HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: FARMER BOYS FOOD, INC. GROUP HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: FARMER BOYS FOOD, INC. GROUP HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: FARMER BOYS FOOD, INC. GROUP HEALTH AND WELFARE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: FARMER BOYS FOOD, INC. GROUP HEALTH AND WELFARE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: FARMER BOYS FOOD, INC. GROUP HEALTH AND WELFARE PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: FARMER BOYS FOOD, INC. GROUP HEALTH AND WELFARE PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01First time form 5500 has been submittedYes
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5399205
Policy instance 4
Insurance contract or identification number5399205
Number of Individuals Covered168
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $3,683
Total amount of fees paid to insurance companyUSD $188
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $23,198
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number175270HNO
Policy instance 3
Insurance contract or identification number175270HNO
Number of Individuals Covered112
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $30,029
Total amount of fees paid to insurance companyUSD $5,000
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $545,763
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number175270
Policy instance 2
Insurance contract or identification number175270
Number of Individuals Covered199
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $19,884
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $317,505
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 number232987
Policy instance 1
Insurance contract or identification number232987
Number of Individuals Covered19
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $150,367
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number280874
Policy instance 3
Insurance contract or identification number280874
Number of Individuals Covered166
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $42,517
Total amount of fees paid to insurance companyUSD $3,898
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $794,962
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number28571
Policy instance 2
Insurance contract or identification number28571
Number of Individuals Covered154
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $9,228
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $78,639
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 number232987
Policy instance 1
Insurance contract or identification number232987
Number of Individuals Covered15
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $5,815
Total amount of fees paid to insurance companyUSD $65
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $119,134
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 number232987
Policy instance 1
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number136-009441
Policy instance 2
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number280874
Policy instance 3
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number280874
Policy instance 3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number136-009441
Policy instance 2
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number232987
Policy instance 1
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number280874
Policy instance 4
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number136-009441
Policy instance 3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number919464
Policy instance 2
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number232987
Policy instance 1
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5473696
Policy instance 6
UDC DENTAL OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 52031 )
Policy contract number5473696
Policy instance 5
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number136-009441
Policy instance 4
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number280874
Policy instance 3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number232987
Policy instance 2
HEALTH PLAN OF NEVADA (National Association of Insurance Commissioners NAIC id number: 96342 )
Policy contract number60003698
Policy instance 1
HEALTH PLAN OF NEVADA (National Association of Insurance Commissioners NAIC id number: 96342 )
Policy contract number60003698
Policy instance 1
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number232987
Policy instance 2
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number280874
Policy instance 3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number136-009441
Policy instance 4
UDC DENTAL OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 52031 )
Policy contract number5473696
Policy instance 5
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number280874
Policy instance 6
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5474493
Policy instance 7
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number136-009441
Policy instance 4
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 95567 )
Policy contract number17214A/L7122A
Policy instance 3
UDC DENTAL OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 52031 )
Policy contract number5473696
Policy instance 2
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5473696
Policy instance 1

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