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| Plan Name | SFR X HOLDINGS LLC DBA BLUEGRASS PIZZA WELFARE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | SFR X HOLDINGS LLC DBA BLUEGRASS PIZZA |
| Employer identification number (EIN): | 861494250 |
| NAIC Classification: | 541600 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-01-01 | HOLLEY LANE | 2023-07-26 |
| Measure | Date | Value |
|---|---|---|
| 2022: SFR X HOLDINGS LLC DBA BLUEGRASS PIZZA WELFARE BENEFIT PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-01-01 | 198 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 269 |
| Total of all active and inactive participants | 2022-01-01 | 269 |
| 2022: SFR X HOLDINGS LLC DBA BLUEGRASS PIZZA WELFARE BENEFIT PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |||||||||||||||||||||||||||||||
| Policy contract number | 926695 | ||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||
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| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) | |||||||||||||||||||||||||||||||
| Policy contract number | 17767 | ||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||
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| UNITED BEHAVIORAL HEALTH DBA OPTUM (National Association of Insurance Commissioners NAIC id number: 79413 ) | |||||||||||||||||||||||||||||||
| Policy contract number | 15416 | ||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||
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