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JEM RESTAURANT GROUP INC FLEXIBLE BENEFIT PLAN 401k Plan overview

Plan NameJEM RESTAURANT GROUP INC FLEXIBLE BENEFIT PLAN
Plan identification number 501

JEM RESTAURANT GROUP INC FLEXIBLE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

JEM RESTAURANT GROUP INC has sponsored the creation of one or more 401k plans.

Company Name:JEM RESTAURANT GROUP INC
Employer identification number (EIN):020642004
NAIC Classification:722511
NAIC Description:Full-Service Restaurants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JEM RESTAURANT GROUP INC FLEXIBLE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-11-01ALLEN WOOD2023-02-28
5012020-11-01ALLEN WOOD2023-02-28
5012019-11-01ALLEN WOOD2023-02-28
5012018-11-01
5012017-11-01
5012016-11-01CLAYTON PATTON
5012009-11-01THOMAS V. TAYLOR, CPA

Plan Statistics for JEM RESTAURANT GROUP INC FLEXIBLE BENEFIT PLAN

401k plan membership statisitcs for JEM RESTAURANT GROUP INC FLEXIBLE BENEFIT PLAN

Measure Date Value
2021: JEM RESTAURANT GROUP INC FLEXIBLE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-11-01215
Total number of active participants reported on line 7a of the Form 55002021-11-01195
Total of all active and inactive participants2021-11-01195
2020: JEM RESTAURANT GROUP INC FLEXIBLE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-11-01168
Total number of active participants reported on line 7a of the Form 55002020-11-01215
Total of all active and inactive participants2020-11-01215
2019: JEM RESTAURANT GROUP INC FLEXIBLE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-11-01183
Total number of active participants reported on line 7a of the Form 55002019-11-01168
Total of all active and inactive participants2019-11-01168
2018: JEM RESTAURANT GROUP INC FLEXIBLE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-11-01167
Total number of active participants reported on line 7a of the Form 55002018-11-01183
Number of retired or separated participants receiving benefits2018-11-010
Number of other retired or separated participants entitled to future benefits2018-11-010
Total of all active and inactive participants2018-11-01183
2017: JEM RESTAURANT GROUP INC FLEXIBLE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-11-01167
Total number of active participants reported on line 7a of the Form 55002017-11-01167
Number of retired or separated participants receiving benefits2017-11-010
Number of other retired or separated participants entitled to future benefits2017-11-010
Total of all active and inactive participants2017-11-01167
2016: JEM RESTAURANT GROUP INC FLEXIBLE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-11-01192
Total number of active participants reported on line 7a of the Form 55002016-11-01167
Number of retired or separated participants receiving benefits2016-11-010
Number of other retired or separated participants entitled to future benefits2016-11-010
Total of all active and inactive participants2016-11-01167
2009: JEM RESTAURANT GROUP INC FLEXIBLE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-11-01118
Total number of active participants reported on line 7a of the Form 55002009-11-0194
Number of retired or separated participants receiving benefits2009-11-014
Number of other retired or separated participants entitled to future benefits2009-11-010
Total of all active and inactive participants2009-11-0198
Total participants2009-11-0198

Form 5500 Responses for JEM RESTAURANT GROUP INC FLEXIBLE BENEFIT PLAN

2021: JEM RESTAURANT GROUP INC FLEXIBLE BENEFIT PLAN 2021 form 5500 responses
2021-11-01Type of plan entitySingle employer plan
2021-11-01Plan funding arrangement – InsuranceYes
2021-11-01Plan benefit arrangement – InsuranceYes
2020: JEM RESTAURANT GROUP INC FLEXIBLE BENEFIT PLAN 2020 form 5500 responses
2020-11-01Type of plan entitySingle employer plan
2020-11-01Plan funding arrangement – InsuranceYes
2020-11-01Plan benefit arrangement – InsuranceYes
2019: JEM RESTAURANT GROUP INC FLEXIBLE BENEFIT PLAN 2019 form 5500 responses
2019-11-01Type of plan entitySingle employer plan
2019-11-01Plan funding arrangement – InsuranceYes
2019-11-01Plan benefit arrangement – InsuranceYes
2018: JEM RESTAURANT GROUP INC FLEXIBLE BENEFIT PLAN 2018 form 5500 responses
2018-11-01Type of plan entitySingle employer plan
2018-11-01Plan funding arrangement – InsuranceYes
2018-11-01Plan benefit arrangement – InsuranceYes
2017: JEM RESTAURANT GROUP INC FLEXIBLE BENEFIT PLAN 2017 form 5500 responses
2017-11-01Type of plan entitySingle employer plan
2017-11-01Plan funding arrangement – InsuranceYes
2017-11-01Plan benefit arrangement – InsuranceYes
2016: JEM RESTAURANT GROUP INC FLEXIBLE BENEFIT PLAN 2016 form 5500 responses
2016-11-01Type of plan entitySingle employer plan
2016-11-01Plan funding arrangement – InsuranceYes
2016-11-01Plan benefit arrangement – InsuranceYes
2009: JEM RESTAURANT GROUP INC FLEXIBLE BENEFIT PLAN 2009 form 5500 responses
2009-11-01Type of plan entitySingle employer plan
2009-11-01First time form 5500 has been submittedYes
2009-11-01This submission is the final filingNo
2009-11-01Plan funding arrangement – InsuranceYes
2009-11-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AHHS
Policy instance 3
Insurance contract or identification numberG000AHHS
Number of Individuals Covered73
Insurance policy start date2021-11-01
Insurance policy end date2022-11-01
Total amount of commissions paid to insurance brokerUSD $12,496
Total amount of fees paid to insurance companyUSD $6,570
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $83,311
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,496
Amount paid for insurance broker fees3942
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 )
Policy contract number66-16984-00
Policy instance 2
Insurance contract or identification number66-16984-00
Number of Individuals Covered195
Insurance policy start date2021-11-01
Insurance policy end date2022-11-01
Total amount of commissions paid to insurance brokerUSD $101,835
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $101,835
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5774837
Policy instance 1
Insurance contract or identification number5774837
Number of Individuals Covered381
Insurance policy start date2021-11-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $13,250
Total amount of fees paid to insurance companyUSD $189
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $143,652
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,625
Insurance broker organization code?3
Amount paid for insurance broker fees189
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AHHS
Policy instance 3
Insurance contract or identification numberG000AHHS
Number of Individuals Covered69
Insurance policy start date2019-11-01
Insurance policy end date2020-11-01
Total amount of commissions paid to insurance brokerUSD $12,412
Total amount of fees paid to insurance companyUSD $7,543
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $82,746
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,412
Insurance broker organization code?3
Amount paid for insurance broker fees5029
Additional information about fees paid to insurance brokerOTHER COMPENSATION
BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 )
Policy contract number66-16984-00
Policy instance 2
Insurance contract or identification number66-16984-00
Number of Individuals Covered168
Insurance policy start date2019-11-01
Insurance policy end date2020-11-01
Total amount of commissions paid to insurance brokerUSD $80,786
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $80,786
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5774837
Policy instance 1
Insurance contract or identification number5774837
Number of Individuals Covered340
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
Total amount of commissions paid to insurance brokerUSD $10,950
Total amount of fees paid to insurance companyUSD $31
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $109,072
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,475
Insurance broker organization code?3
Amount paid for insurance broker fees31
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AHHS
Policy instance 3
Insurance contract or identification numberG000AHHS
Number of Individuals Covered71
Insurance policy start date2018-11-01
Insurance policy end date2019-11-01
Total amount of commissions paid to insurance brokerUSD $12,431
Total amount of fees paid to insurance companyUSD $4,452
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $82,873
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,431
Amount paid for insurance broker fees4452
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5774837
Policy instance 1
Insurance contract or identification number5774837
Number of Individuals Covered354
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $12,468
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $123,144
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,372
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 )
Policy contract number66-16984-00
Policy instance 2
Insurance contract or identification number66-16984-00
Number of Individuals Covered183
Insurance policy start date2018-11-01
Insurance policy end date2019-11-01
Total amount of commissions paid to insurance brokerUSD $89,048
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $89,048
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AHHS
Policy instance 3
Insurance contract or identification numberG000AHHS
Number of Individuals Covered73
Insurance policy start date2017-11-01
Insurance policy end date2018-11-01
Total amount of commissions paid to insurance brokerUSD $10,939
Total amount of fees paid to insurance companyUSD $5,799
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $72,930
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5774837
Policy instance 1
Insurance contract or identification number5774837
Number of Individuals Covered420
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
Total amount of commissions paid to insurance brokerUSD $16,302
Total amount of fees paid to insurance companyUSD $38
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $123,409
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 )
Policy contract number66-16984-00
Policy instance 2
Insurance contract or identification number66-16984-00
Number of Individuals Covered191
Insurance policy start date2017-11-01
Insurance policy end date2018-11-01
Total amount of commissions paid to insurance brokerUSD $95,403
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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