401k Plan data: OXFORD FOODS, INC. HEALTH & WELFARE PLAN plan

OXFORD FOODS, INC. HEALTH & WELFARE PLAN 401k Plan overview

Plan Name	OXFORD FOODS, INC. HEALTH & WELFARE PLAN
Plan identification number	501

OXFORD FOODS, INC. HEALTH & WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision Temporary disability (accident and sickness)

401k Sponsoring company profile

OXFORD FOODS, INC. has sponsored the creation of one or more 401k plans.

Company Name: OXFORD FOODS, INC.

Employer identification number (EIN): 200253474

NAIC Classification: 722513
NAIC Description: Limited-Service Restaurants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OXFORD FOODS, INC. HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-03-01 THOMAS W. SCOTT III 2024-08-20
501 2022-03-01 THOMAS SCOTT, PRESIDENT 2023-09-11
501 2021-03-01 THOMAS SCOTT, PRESIDENT 2023-09-11

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-03-01	THOMAS W. SCOTT III	2024-08-20
501	2022-03-01	THOMAS SCOTT, PRESIDENT	2023-09-11
501	2021-03-01	THOMAS SCOTT, PRESIDENT	2023-09-11

Plan Statistics for OXFORD FOODS, INC. HEALTH & WELFARE PLAN

401k plan membership statisitcs for OXFORD FOODS, INC. HEALTH & WELFARE PLAN

Measure Date Value
2023: OXFORD FOODS, INC. HEALTH & WELFARE PLAN 2023 401k membership
Total participants, beginning-of-year 2023-03-01 142
Total number of active participants reported on line 7a of the Form 5500 2023-03-01 195
Number of retired or separated participants receiving benefits 2023-03-01 0
Number of other retired or separated participants entitled to future benefits 2023-03-01 0
Total of all active and inactive participants 2023-03-01 195
Number of employers contributing to the scheme 2023-03-01 0
2022: OXFORD FOODS, INC. HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-03-01 116
Total number of active participants reported on line 7a of the Form 5500 2022-03-01 132
Number of retired or separated participants receiving benefits 2022-03-01 0
Number of other retired or separated participants entitled to future benefits 2022-03-01 0
Total of all active and inactive participants 2022-03-01 132
2021: OXFORD FOODS, INC. HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-03-01 141
Total number of active participants reported on line 7a of the Form 5500 2021-03-01 98
Number of retired or separated participants receiving benefits 2021-03-01 0
Number of other retired or separated participants entitled to future benefits 2021-03-01 0
Total of all active and inactive participants 2021-03-01 98

Measure	Date	Value
2023: OXFORD FOODS, INC. HEALTH & WELFARE PLAN 2023 401k membership
Total participants, beginning-of-year	2023-03-01	142
Total number of active participants reported on line 7a of the Form 5500	2023-03-01	195
Number of retired or separated participants receiving benefits	2023-03-01	0
Number of other retired or separated participants entitled to future benefits	2023-03-01	0
Total of all active and inactive participants	2023-03-01	195
Number of employers contributing to the scheme	2023-03-01	0
2022: OXFORD FOODS, INC. HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-03-01	116
Total number of active participants reported on line 7a of the Form 5500	2022-03-01	132
Number of retired or separated participants receiving benefits	2022-03-01	0
Number of other retired or separated participants entitled to future benefits	2022-03-01	0
Total of all active and inactive participants	2022-03-01	132
2021: OXFORD FOODS, INC. HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-03-01	141
Total number of active participants reported on line 7a of the Form 5500	2021-03-01	98
Number of retired or separated participants receiving benefits	2021-03-01	0
Number of other retired or separated participants entitled to future benefits	2021-03-01	0
Total of all active and inactive participants	2021-03-01	98

Form 5500 Responses for OXFORD FOODS, INC. HEALTH & WELFARE PLAN

2023: OXFORD FOODS, INC. HEALTH & WELFARE PLAN 2023 form 5500 responses
2023-03-01	Type of plan entity	Single employer plan
2023-03-01	Plan funding arrangement – Insurance	Yes
2023-03-01	Plan benefit arrangement – Insurance	Yes
2022: OXFORD FOODS, INC. HEALTH & WELFARE PLAN 2022 form 5500 responses
2022-03-01	Type of plan entity	Single employer plan
2022-03-01	Submission has been amended	No
2022-03-01	This submission is the final filing	No
2022-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-03-01	Plan is a collectively bargained plan	No
2022-03-01	Plan funding arrangement – Insurance	Yes
2022-03-01	Plan benefit arrangement – Insurance	Yes
2021: OXFORD FOODS, INC. HEALTH & WELFARE PLAN 2021 form 5500 responses
2021-03-01	Type of plan entity	Single employer plan
2021-03-01	Submission has been amended	No
2021-03-01	This submission is the final filing	No
2021-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-03-01	Plan is a collectively bargained plan	No
2021-03-01	Plan funding arrangement – Insurance	Yes
2021-03-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

852732

Policy instance

Insurance contract or identification number	852732
Number of Individuals Covered	108
Insurance policy start date	2023-03-01
Insurance policy end date	2024-02-29
Total amount of commissions paid to insurance broker	USD $40,599
Total amount of fees paid to insurance company	USD $2,542
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $846,398
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

549045

Policy instance

Insurance contract or identification number	549045
Number of Individuals Covered	214
Insurance policy start date	2023-03-01
Insurance policy end date	2024-02-29
Total amount of commissions paid to insurance broker	USD $10,378
Total amount of fees paid to insurance company	USD $3,235
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $97,828
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

AXIS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 37273 )

Policy contract number

8369206

Policy instance

Insurance contract or identification number	8369206
Number of Individuals Covered	48
Insurance policy start date	2023-03-01
Insurance policy end date	2024-02-29
Total amount of commissions paid to insurance broker	USD $1,173
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,534
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00549045

Policy instance

Insurance contract or identification number	00549045
Number of Individuals Covered	132
Insurance policy start date	2022-03-01
Insurance policy end date	2023-02-28
Total amount of commissions paid to insurance broker	USD $7,879
Total amount of fees paid to insurance company	USD $2,257
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	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $73,437
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,879
Amount paid for insurance broker fees	2257
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00549045

Policy instance

Insurance contract or identification number	00549045
Number of Individuals Covered	111
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Total amount of commissions paid to insurance broker	USD $6,801
Total amount of fees paid to insurance company	USD $4,426
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	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $63,622
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,801
Amount paid for insurance broker fees	4426
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

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Company Name:	OXFORD FOODS, INC.
Employer identification number (EIN):	200253474
NAIC Classification:	722513
NAIC Description:	Limited-Service Restaurants