401k Plan data: CAFE RIO, INC. 401(K) PLAN plan

CAFE RIO, INC. 401(K) PLAN 401k Plan overview

Plan Name	CAFE RIO, INC. 401(K) PLAN
Plan identification number	002

CAFE RIO, INC. 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

CAFE RIO, INC. has sponsored the creation of one or more 401k plans.

Company Name: CAFE RIO, INC.

Employer identification number (EIN): 841417768

NAIC Classification: 722511
NAIC Description: Full-Service Restaurants

Additional information about CAFE RIO, INC.

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 2004-04-05

Company Identification Number: 3036056

Legal Registered Office Address: 44 SHAGWONG DRIVE
Suffolk
SOUND BEACH
United States of America (USA)
11789

More information about CAFE RIO, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CAFE RIO, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2022-01-01 CORTNEY WORLE 2023-10-05
002 2021-01-01 CORTNEY WORLE 2022-10-04
002 2020-01-01
002 2019-01-01
002 2018-01-01
002 2017-01-01 CORTNEY WORLE CORTNEY WORLE 2018-09-14
002 2016-01-01 CORTNEY WORLE CORTNEY WORLE 2017-09-18
002 2015-01-01 ALICIA MASTERSON ALICIA MASTERSON 2016-10-09
002 2014-01-01 ALICIA MASTERSON ALICIA MASTERSON 2015-10-15
002 2013-01-01 KIMBERLI PETERSON KIMBERLI PETERSON 2014-10-06
002 2012-01-01 KIMBERLI PETERSON KIMBERLI PETERSON 2013-10-15

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2022-01-01	CORTNEY WORLE	2023-10-05
002	2021-01-01	CORTNEY WORLE	2022-10-04
002	2020-01-01
002	2019-01-01
002	2018-01-01
002	2017-01-01	CORTNEY WORLE		CORTNEY WORLE	2018-09-14
002	2016-01-01	CORTNEY WORLE		CORTNEY WORLE	2017-09-18
002	2015-01-01	ALICIA MASTERSON		ALICIA MASTERSON	2016-10-09
002	2014-01-01	ALICIA MASTERSON		ALICIA MASTERSON	2015-10-15
002	2013-01-01	KIMBERLI PETERSON		KIMBERLI PETERSON	2014-10-06
002	2012-01-01	KIMBERLI PETERSON		KIMBERLI PETERSON	2013-10-15

Plan Statistics for CAFE RIO, INC. 401(K) PLAN

401k plan membership statisitcs for CAFE RIO, INC. 401(K) PLAN

Measure Date Value
2022: CAFE RIO, INC. 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 4,002
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 2,354
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 186
Total of all active and inactive participants 2022-01-01 2,540
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 2,540
Number of participants with account balances 2022-01-01 695
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 5
2021: CAFE RIO, INC. 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 2,849
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 1,729
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 512
Total of all active and inactive participants 2021-01-01 2,241
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 2,241
Number of participants with account balances 2021-01-01 967
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 5
2020: CAFE RIO, INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 2,826
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 1,914
Number of retired or separated participants receiving benefits 2020-01-01 34
Number of other retired or separated participants entitled to future benefits 2020-01-01 347
Total of all active and inactive participants 2020-01-01 2,295
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 2,295
Number of participants with account balances 2020-01-01 840
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 8
2019: CAFE RIO, INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 2,619
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 1,571
Number of retired or separated participants receiving benefits 2019-01-01 10
Number of other retired or separated participants entitled to future benefits 2019-01-01 239
Total of all active and inactive participants 2019-01-01 1,820
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 1,820
Number of participants with account balances 2019-01-01 592
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 12
2018: CAFE RIO, INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 2,320
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 1,451
Number of retired or separated participants receiving benefits 2018-01-01 14
Number of other retired or separated participants entitled to future benefits 2018-01-01 140
Total of all active and inactive participants 2018-01-01 1,605
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 1,605
Number of participants with account balances 2018-01-01 497
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 8
2017: CAFE RIO, INC. 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 2,208
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 1,620
Number of retired or separated participants receiving benefits 2017-01-01 9
Number of other retired or separated participants entitled to future benefits 2017-01-01 86
Total of all active and inactive participants 2017-01-01 1,715
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 1,715
Number of participants with account balances 2017-01-01 394
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 5
2016: CAFE RIO, INC. 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1,859
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 1,092
Number of retired or separated participants receiving benefits 2016-01-01 6
Number of other retired or separated participants entitled to future benefits 2016-01-01 56
Total of all active and inactive participants 2016-01-01 1,154
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 1,154
Number of participants with account balances 2016-01-01 256
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 56
2015: CAFE RIO, INC. 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 947
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 817
Number of retired or separated participants receiving benefits 2015-01-01 2
Number of other retired or separated participants entitled to future benefits 2015-01-01 25
Total of all active and inactive participants 2015-01-01 844
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 844
Number of participants with account balances 2015-01-01 75
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 13
2014: CAFE RIO, INC. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 865
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 702
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 19
Total of all active and inactive participants 2014-01-01 721
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 721
Number of participants with account balances 2014-01-01 63
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 8
2013: CAFE RIO, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 857
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 694
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 9
Total of all active and inactive participants 2013-01-01 703
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 703
Number of participants with account balances 2013-01-01 54
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 8
2012: CAFE RIO, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 652
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 634
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 7
Total of all active and inactive participants 2012-01-01 641
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 641
Number of participants with account balances 2012-01-01 53
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 8

Measure	Date	Value
2022: CAFE RIO, INC. 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	4,002
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	2,354
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	186
Total of all active and inactive participants	2022-01-01	2,540
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	2,540
Number of participants with account balances	2022-01-01	695
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	5
2021: CAFE RIO, INC. 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	2,849
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	1,729
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	512
Total of all active and inactive participants	2021-01-01	2,241
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	2,241
Number of participants with account balances	2021-01-01	967
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	5
2020: CAFE RIO, INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	2,826
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	1,914
Number of retired or separated participants receiving benefits	2020-01-01	34
Number of other retired or separated participants entitled to future benefits	2020-01-01	347
Total of all active and inactive participants	2020-01-01	2,295
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	2,295
Number of participants with account balances	2020-01-01	840
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	8
2019: CAFE RIO, INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	2,619
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	1,571
Number of retired or separated participants receiving benefits	2019-01-01	10
Number of other retired or separated participants entitled to future benefits	2019-01-01	239
Total of all active and inactive participants	2019-01-01	1,820
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	1,820
Number of participants with account balances	2019-01-01	592
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	12
2018: CAFE RIO, INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	2,320
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	1,451
Number of retired or separated participants receiving benefits	2018-01-01	14
Number of other retired or separated participants entitled to future benefits	2018-01-01	140
Total of all active and inactive participants	2018-01-01	1,605
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	1,605
Number of participants with account balances	2018-01-01	497
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	8
2017: CAFE RIO, INC. 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	2,208
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	1,620
Number of retired or separated participants receiving benefits	2017-01-01	9
Number of other retired or separated participants entitled to future benefits	2017-01-01	86
Total of all active and inactive participants	2017-01-01	1,715
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	1,715
Number of participants with account balances	2017-01-01	394
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	5
2016: CAFE RIO, INC. 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1,859
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	1,092
Number of retired or separated participants receiving benefits	2016-01-01	6
Number of other retired or separated participants entitled to future benefits	2016-01-01	56
Total of all active and inactive participants	2016-01-01	1,154
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	1,154
Number of participants with account balances	2016-01-01	256
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	56
2015: CAFE RIO, INC. 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	947
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	817
Number of retired or separated participants receiving benefits	2015-01-01	2
Number of other retired or separated participants entitled to future benefits	2015-01-01	25
Total of all active and inactive participants	2015-01-01	844
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	844
Number of participants with account balances	2015-01-01	75
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	13
2014: CAFE RIO, INC. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	865
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	702
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	19
Total of all active and inactive participants	2014-01-01	721
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	721
Number of participants with account balances	2014-01-01	63
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	8
2013: CAFE RIO, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	857
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	694
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	9
Total of all active and inactive participants	2013-01-01	703
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	703
Number of participants with account balances	2013-01-01	54
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	8
2012: CAFE RIO, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	652
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	634
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	7
Total of all active and inactive participants	2012-01-01	641
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	641
Number of participants with account balances	2012-01-01	53
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	8

Financial Data on CAFE RIO, INC. 401(K) PLAN

Measure	Date	Value
2022 : CAFE RIO, INC. 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$3,335
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$1,077,316
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$2,163,617
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$2,057,790
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$2,869,545
Value of total assets at end of year	2022-12-31	$10,492,415
Value of total assets at beginning of year	2022-12-31	$11,575,381
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$105,827
Total interest from all sources	2022-12-31	$15,054
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$183,325
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$183,325
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$1,710,220
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$71,871
Total non interest bearing cash at end of year	2022-12-31	$3,338
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-1,086,301
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$10,489,080
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$11,575,381
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$9,185,955
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$10,469,866
Interest earned on other investments	2022-12-31	$15,054
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$1,303,122
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$1,105,515
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-1,990,608
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$1,087,454
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$2,057,790
Contract administrator fees	2022-12-31	$105,827
Liabilities. Value of benefit claims payable at end of year	2022-12-31	$3,335
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	LARSON & COMPANY, PC
Accountancy firm EIN	2022-12-31	870516083
2021 : CAFE RIO, INC. 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$8,539
Total income from all sources (including contributions)	2021-12-31	$3,831,886
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$1,318,358
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$1,089,204
Value of total corrective distributions	2021-12-31	$192,077
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$2,289,096
Value of total assets at end of year	2021-12-31	$11,575,381
Value of total assets at beginning of year	2021-12-31	$9,070,392
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$37,077
Total interest from all sources	2021-12-31	$3,822
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2021-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$1,380,514
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$3,446
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2021-12-31	$8,539
Total non interest bearing cash at beginning of year	2021-12-31	$29,298
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$2,513,528
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$11,575,381
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$9,061,853
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$10,469,866
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$9,027,820
Interest earned on other investments	2021-12-31	$3,822
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$1,105,515
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$1,538,968
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$905,136
Employer contributions (assets) at beginning of year	2021-12-31	$13,274
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$1,089,204
Contract administrator fees	2021-12-31	$37,077
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2021-12-31	Yes
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	LARSON & COMPANY, PC
Accountancy firm EIN	2021-12-31	870516083
2020 : CAFE RIO, INC. 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$8,539
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$3,180,269
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$820,011
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$820,011
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$1,886,143
Value of total assets at end of year	2020-12-31	$9,070,392
Value of total assets at beginning of year	2020-12-31	$6,701,595
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$0
Total interest from all sources	2020-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$1,228,922
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2020-12-31	$8,539
Total non interest bearing cash at end of year	2020-12-31	$29,298
Total non interest bearing cash at beginning of year	2020-12-31	$28,157
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$2,360,258
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$9,061,853
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$6,701,595
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$9,027,820
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$6,673,438
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$1,294,126
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$657,221
Employer contributions (assets) at end of year	2020-12-31	$13,274
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$820,011
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	LARSON & COMPANY, PC
Accountancy firm EIN	2020-12-31	870516083
2019 : CAFE RIO, INC. 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$6,799
Total income from all sources (including contributions)	2019-12-31	$3,078,058
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$217,923
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$217,923
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$1,996,134
Value of total assets at end of year	2019-12-31	$6,701,595
Value of total assets at beginning of year	2019-12-31	$3,848,259
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$0
Total interest from all sources	2019-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$1,156,191
Assets. Other investments not covered elsewhere at beginning of year	2019-12-31	$122,197
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$90,409
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$6,799
Total non interest bearing cash at end of year	2019-12-31	$28,157
Total non interest bearing cash at beginning of year	2019-12-31	$9,984
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$2,860,135
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$6,701,595
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$3,841,460
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$6,673,438
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$3,716,078
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$1,081,924
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$749,534
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$217,923
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	LARSON & COMPANY, PC
Accountancy firm EIN	2019-12-31	870516083
2018 : CAFE RIO, INC. 401(K) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$6,799
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$91,660
Total income from all sources (including contributions)	2018-12-31	$1,224,545
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$250,463
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$250,463
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$1,556,132
Value of total assets at end of year	2018-12-31	$3,848,259
Value of total assets at beginning of year	2018-12-31	$2,959,038
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$0
Total interest from all sources	2018-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$968,771
Assets. Other investments not covered elsewhere at end of year	2018-12-31	$122,197
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2018-12-31	$6,799
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2018-12-31	$91,660
Total non interest bearing cash at end of year	2018-12-31	$9,984
Total non interest bearing cash at beginning of year	2018-12-31	$110
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$974,082
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$3,841,460
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$2,867,378
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$3,716,078
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$2,958,928
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-331,587
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$587,361
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$250,463
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	TANNER, LLC
Accountancy firm EIN	2018-12-31	202253063
2017 : CAFE RIO, INC. 401(K) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$91,660
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$106
Total income from all sources (including contributions)	2017-12-31	$1,497,149
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$227,945
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$214,198
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$1,177,359
Value of total assets at end of year	2017-12-31	$2,959,038
Value of total assets at beginning of year	2017-12-31	$1,598,280
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$13,747
Total interest from all sources	2017-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Administrative expenses professional fees incurred	2017-12-31	$2,475
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$764,461
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$27,480
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2017-12-31	$91,660
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2017-12-31	$106
Total non interest bearing cash at end of year	2017-12-31	$110
Total non interest bearing cash at beginning of year	2017-12-31	$5,941
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$1,269,204
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$2,867,378
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$1,598,174
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in pooled separate accounts at end of year	2017-12-31	$2,958,928
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$1,592,339
Net investment gain/loss from pooled separate accounts	2017-12-31	$319,790
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$385,418
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$214,198
Contract administrator fees	2017-12-31	$11,272
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	TANNER, LLC
Accountancy firm EIN	2017-12-31	202253063
2016 : CAFE RIO, INC. 401(K) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$106
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$858,147
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$130,066
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$117,931
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$740,437
Value of total assets at end of year	2016-12-31	$1,598,280
Value of total assets at beginning of year	2016-12-31	$870,093
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$12,135
Total interest from all sources	2016-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Administrative expenses professional fees incurred	2016-12-31	$2,025
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$50,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$493,940
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$49,999
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2016-12-31	$106
Total non interest bearing cash at end of year	2016-12-31	$5,941
Total non interest bearing cash at beginning of year	2016-12-31	$3,652
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$728,081
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$1,598,174
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$870,093
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in pooled separate accounts at end of year	2016-12-31	$1,592,339
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$866,441
Net investment gain/loss from pooled separate accounts	2016-12-31	$117,710
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$196,498
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$117,931
Contract administrator fees	2016-12-31	$10,110
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	TANNER, LLC
Accountancy firm EIN	2016-12-31	202253063
2015 : CAFE RIO, INC. 401(K) PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$10,891
Total income from all sources (including contributions)	2015-12-31	$246,048
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$117,663
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$111,511
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$274,604
Value of total assets at end of year	2015-12-31	$870,093
Value of total assets at beginning of year	2015-12-31	$752,599
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$6,152
Total interest from all sources	2015-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Administrative expenses professional fees incurred	2015-12-31	$975
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$50,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$159,968
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$44,293
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$10,891
Total non interest bearing cash at end of year	2015-12-31	$3,652
Total non interest bearing cash at beginning of year	2015-12-31	$9,339
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$128,385
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$870,093
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$741,708
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in pooled separate accounts at end of year	2015-12-31	$866,441
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$743,260
Net investment gain/loss from pooled separate accounts	2015-12-31	$-28,556
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$70,343
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$111,511
Contract administrator fees	2015-12-31	$5,177
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	TANNER, LLC
Accountancy firm EIN	2015-12-31	202253063
2014 : CAFE RIO, INC. 401(K) PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$10,891
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$254,019
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$27,067
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$22,459
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$222,948
Value of total assets at end of year	2014-12-31	$752,599
Value of total assets at beginning of year	2014-12-31	$514,756
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$4,608
Total interest from all sources	2014-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Administrative expenses professional fees incurred	2014-12-31	$300
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$50,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$154,192
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-12-31	$10,891
Total non interest bearing cash at end of year	2014-12-31	$9,339
Total non interest bearing cash at beginning of year	2014-12-31	$6,404
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$226,952
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$741,708
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$514,756
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in pooled separate accounts at end of year	2014-12-31	$743,260
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$508,352
Net investment gain/loss from pooled separate accounts	2014-12-31	$31,071
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$68,756
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$22,459
Contract administrator fees	2014-12-31	$4,308
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	TANNER, LLC
Accountancy firm EIN	2014-12-31	202253063
2013 : CAFE RIO, INC. 401(K) PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$307,874
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$28,690
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$25,030
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$242,779
Value of total assets at end of year	2013-12-31	$514,756
Value of total assets at beginning of year	2013-12-31	$235,572
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$3,660
Total interest from all sources	2013-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Administrative expenses professional fees incurred	2013-12-31	$525
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$50,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$124,242
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$59,323
Total non interest bearing cash at end of year	2013-12-31	$6,404
Total non interest bearing cash at beginning of year	2013-12-31	$1,340
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$279,184
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$514,756
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$235,572
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in pooled separate accounts at end of year	2013-12-31	$508,352
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$234,232
Net investment gain/loss from pooled separate accounts	2013-12-31	$65,095
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$59,214
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$25,030
Contract administrator fees	2013-12-31	$3,135
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	TANNER, LLC
Accountancy firm EIN	2013-12-31	202253063
2012 : CAFE RIO, INC. 401(K) PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$243,687
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$8,115
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$5,268
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$233,157
Value of total assets at end of year	2012-12-31	$235,572
Value of total assets at beginning of year	2012-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$2,847
Total interest from all sources	2012-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Administrative expenses professional fees incurred	2012-12-31	$150
Was this plan covered by a fidelity bond	2012-12-31	No
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$148,754
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$16,371
Total non interest bearing cash at end of year	2012-12-31	$1,340
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$235,572
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$235,572
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in pooled separate accounts at end of year	2012-12-31	$234,232
Net investment gain/loss from pooled separate accounts	2012-12-31	$10,530
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$68,032
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$5,268
Contract administrator fees	2012-12-31	$2,697
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	TANNER, LLC
Accountancy firm EIN	2012-12-31	202253063

Form 5500 Responses for CAFE RIO, INC. 401(K) PLAN

2022: CAFE RIO, INC. 401(K) PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: CAFE RIO, INC. 401(K) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: CAFE RIO, INC. 401(K) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: CAFE RIO, INC. 401(K) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: CAFE RIO, INC. 401(K) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: CAFE RIO, INC. 401(K) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: CAFE RIO, INC. 401(K) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: CAFE RIO, INC. 401(K) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: CAFE RIO, INC. 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: CAFE RIO, INC. 401(K) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: CAFE RIO, INC. 401(K) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	First time form 5500 has been submitted	Yes
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

815347

Policy instance

Insurance contract or identification number	815347
Number of Individuals Covered	2540
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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 plan	No
Contracts With Unallocated Funds Deposit Administration	1
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

815347

Policy instance

Insurance contract or identification number	815347
Number of Individuals Covered	2241
Insurance policy start date	2021-09-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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 plan	No
Contracts With Unallocated Funds Deposit Administration	1
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G38928

Policy instance

Insurance contract or identification number	G38928
Number of Individuals Covered	0
Insurance policy start date	2021-01-01
Insurance policy end date	2021-11-22
Are there contracts with allocated funds for individual policies?	0
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G38928

Policy instance

Insurance contract or identification number	G38928
Number of Individuals Covered	837
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G38928

Policy instance

Insurance contract or identification number	G38928
Number of Individuals Covered	590
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G38928

Policy instance

Insurance contract or identification number	G38928
Number of Individuals Covered	498
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

104198

Policy instance

Insurance contract or identification number	104198
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,575
Are there contracts with allocated funds for individual policies?	0
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Amount paid for insurance broker fees	1575
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker organization code?	5

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

104198

Policy instance

Insurance contract or identification number	104198
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $8,578
Total amount of fees paid to insurance company	USD $3,577
Are there contracts with allocated funds for individual policies?	0
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $8,578
Insurance broker organization code?	3
Amount paid for insurance broker fees	3577
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker name	NATIONAL BENEFIT SERVICES, LLC

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

104198

Policy instance

Insurance contract or identification number	104198
Number of Individuals Covered	79
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,698
Total amount of fees paid to insurance company	USD $975
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $3,269
Insurance broker organization code?	3
Amount paid for insurance broker fees	975
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker name	NATIONAL BENEFIT SERVICES, LLC

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

104198

Policy instance

Insurance contract or identification number	104198
Number of Individuals Covered	70
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,846
Total amount of fees paid to insurance company	USD $300
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $2,504
Insurance broker organization code?	3
Amount paid for insurance broker fees	300
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker name	NATIONAL BENEFIT SERVICES, LLC

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

104198

Policy instance

Insurance contract or identification number	104198
Number of Individuals Covered	60
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,899
Total amount of fees paid to insurance company	USD $525
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $1,527
Insurance broker organization code?	3
Amount paid for insurance broker fees	525
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker name	NATIONAL BENEFIT SERVICES, LLC

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

104198

Policy instance

Insurance contract or identification number	104198
Number of Individuals Covered	56
Insurance policy start date	2012-01-23
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,843
Total amount of fees paid to insurance company	USD $150
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $2,168
Insurance broker organization code?	3
Amount paid for insurance broker fees	150
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker name	NATIONAL BENEFIT SERVICES, LLC

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Company Name:	CAFE RIO, INC.
Employer identification number (EIN):	841417768
NAIC Classification:	722511
NAIC Description:	Full-Service Restaurants

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	2004-04-05
Company Identification Number:	3036056
Legal Registered Office Address:	44 SHAGWONG DRIVE Suffolk SOUND BEACH United States of America (USA) 11789