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EGG ROCK HOLDINGS 401k Plan overview

Plan NameEGG ROCK HOLDINGS
Plan identification number 501

EGG ROCK HOLDINGS Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

EGG ROCK HOLDINGS has sponsored the creation of one or more 401k plans.

Company Name:EGG ROCK HOLDINGS
Employer identification number (EIN):813422228
NAIC Classification:722515
NAIC Description:Snack and Nonalcoholic Beverage Bars

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EGG ROCK HOLDINGS

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-10-01HUNTER LEHNERT2023-01-18
5012020-10-01HUNTER LEHNERT2022-01-07
5012019-10-01KELLY TENNER2021-02-25
5012019-10-01HUNTER LEHNERT2022-01-07

Plan Statistics for EGG ROCK HOLDINGS

401k plan membership statisitcs for EGG ROCK HOLDINGS

Measure Date Value
2021: EGG ROCK HOLDINGS 2021 401k membership
Total participants, beginning-of-year2021-10-01149
Total number of active participants reported on line 7a of the Form 55002021-10-01111
Number of retired or separated participants receiving benefits2021-10-010
Number of other retired or separated participants entitled to future benefits2021-10-010
Total of all active and inactive participants2021-10-01111
Number of employers contributing to the scheme2021-10-010
2020: EGG ROCK HOLDINGS 2020 401k membership
Total participants, beginning-of-year2020-10-01154
Total number of active participants reported on line 7a of the Form 55002020-10-01149
Number of retired or separated participants receiving benefits2020-10-010
Number of other retired or separated participants entitled to future benefits2020-10-010
Total of all active and inactive participants2020-10-01149
Number of employers contributing to the scheme2020-10-010
2019: EGG ROCK HOLDINGS 2019 401k membership
Total participants, beginning-of-year2019-10-01153
Total number of active participants reported on line 7a of the Form 55002019-10-01152
Number of retired or separated participants receiving benefits2019-10-010
Number of other retired or separated participants entitled to future benefits2019-10-010
Total of all active and inactive participants2019-10-01152
Number of employers contributing to the scheme2019-10-010

Form 5500 Responses for EGG ROCK HOLDINGS

2021: EGG ROCK HOLDINGS 2021 form 5500 responses
2021-10-01Type of plan entitySingle employer plan
2021-10-01Plan funding arrangement – InsuranceYes
2021-10-01Plan benefit arrangement – InsuranceYes
2020: EGG ROCK HOLDINGS 2020 form 5500 responses
2020-10-01Type of plan entitySingle employer plan
2020-10-01Plan funding arrangement – InsuranceYes
2020-10-01Plan benefit arrangement – InsuranceYes
2019: EGG ROCK HOLDINGS 2019 form 5500 responses
2019-10-01Type of plan entitySingle employer plan
2019-10-01First time form 5500 has been submittedYes
2019-10-01Submission has been amendedYes
2019-10-01Plan funding arrangement – InsuranceYes
2019-10-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number282661
Policy instance 1
Insurance contract or identification number282661
Number of Individuals Covered140
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $45,178
Total amount of fees paid to insurance companyUSD $38,659
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $799,225
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $45,178
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerFEES
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number234559
Policy instance 2
Insurance contract or identification number234559
Number of Individuals Covered24
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $6,658
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
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
Welfare Benefit Premiums Paid to CarrierUSD $122,420
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,658
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number282661
Policy instance 1
Insurance contract or identification number282661
Number of Individuals Covered194
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $47,996
Total amount of fees paid to insurance companyUSD $8,770
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $884,311
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $47,996
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerFEES
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number234559
Policy instance 2
Insurance contract or identification number234559
Number of Individuals Covered0
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $6,216
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
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
Welfare Benefit Premiums Paid to CarrierUSD $121,982
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,216
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number282661
Policy instance 1
Insurance contract or identification number282661
Number of Individuals Covered163
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $44,769
Total amount of fees paid to insurance companyUSD $31,914
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $844,804
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $44,769
Amount paid for insurance broker fees23736
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3

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