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| Plan Name | EL PALOMAR RESTAURANT EMPLOYER HEALTH & WELFARE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | EL PALOMAR RESTAURANT |
| Employer identification number (EIN): | 770242874 |
| NAIC Classification: | 722511 |
| NAIC Description: | Full-Service Restaurants |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2015-07-01 | MICHAEL N BEJOVICH |
| Measure | Date | Value |
|---|---|---|
| 2015: EL PALOMAR RESTAURANT EMPLOYER HEALTH & WELFARE PLAN 2015 401k membership | ||
| Total participants, beginning-of-year | 2015-07-01 | 51 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-07-01 | 51 |
| Number of retired or separated participants receiving benefits | 2015-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-07-01 | 0 |
| Total of all active and inactive participants | 2015-07-01 | 51 |
| Measure | Date | Value |
|---|---|---|
| 2016 : EL PALOMAR RESTAURANT EMPLOYER HEALTH & WELFARE PLAN 2016 401k financial data | ||
| Total income from all sources | 2016-06-30 | $161,923 |
| Expenses. Total of all expenses incurred | 2016-06-30 | $159,851 |
| Benefits paid (including direct rollovers) | 2016-06-30 | $80,711 |
| Total plan assets at end of year | 2016-06-30 | $2,072 |
| Total contributions received or receivable from participants | 2016-06-30 | $0 |
| Expenses. Other expenses not covered elsewhere | 2016-06-30 | $64,010 |
| Contributions received from other sources (not participants or employers) | 2016-06-30 | $0 |
| Noncash contributions received | 2016-06-30 | $0 |
| Net income (gross income less expenses) | 2016-06-30 | $2,072 |
| Net plan assets at end of year (total assets less liabilities) | 2016-06-30 | $2,072 |
| 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 | $161,923 |
| Value of certain deemed distributions of participant loans | 2016-06-30 | $0 |
| Value of corrective distributions | 2016-06-30 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-06-30 | $15,130 |
| 2015: EL PALOMAR RESTAURANT EMPLOYER HEALTH & WELFARE PLAN 2015 form 5500 responses | ||
|---|---|---|
| 2015-07-01 | Type of plan entity | Single employer plan |
| 2015-07-01 | First time form 5500 has been submitted | Yes |
| 2015-07-01 | Submission has been amended | No |
| 2015-07-01 | This submission is the final filing | No |
| 2015-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-07-01 | Plan is a collectively bargained plan | No |
| 2015-07-01 | Plan funding arrangement – Insurance | Yes |
| 2015-07-01 | Plan funding arrangement – Trust | Yes |
| 2015-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-07-01 | Plan benefit arrangement - Trust | Yes |
| 2015-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION (National Association of Insurance Commissioners NAIC id number: 96030 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | KM05929592 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| BENEFIT AND RISK MANAGEMENT SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 00 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | KM05929592 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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