401k Plan data: ROOKE, LLC DBA RIOT HOSPITALITY GROUP EMPLOYEE BENEFITS PLAN plan

ROOKE, LLC DBA RIOT HOSPITALITY GROUP EMPLOYEE BENEFITS PLAN 401k Plan overview

Plan Name	ROOKE, LLC DBA RIOT HOSPITALITY GROUP EMPLOYEE BENEFITS PLAN
Plan identification number	502

ROOKE, LLC DBA RIOT HOSPITALITY GROUP EMPLOYEE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

ROOKE, LLC DBA RIOT HOSPITALITY GROUP has sponsored the creation of one or more 401k plans.

Company Name: ROOKE, LLC DBA RIOT HOSPITALITY GROUP

Employer identification number (EIN): 272985462

NAIC Classification: 722511
NAIC Description: Full-Service Restaurants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ROOKE, LLC DBA RIOT HOSPITALITY GROUP EMPLOYEE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2023-06-01

Plan Statistics for ROOKE, LLC DBA RIOT HOSPITALITY GROUP EMPLOYEE BENEFITS PLAN

401k plan membership statisitcs for ROOKE, LLC DBA RIOT HOSPITALITY GROUP EMPLOYEE BENEFITS PLAN

Measure Date Value
2023: ROOKE, LLC DBA RIOT HOSPITALITY GROUP EMPLOYEE BENEFITS PLAN 2023 401k membership
Total participants, beginning-of-year 2023-06-01 303
Total number of active participants reported on line 7a of the Form 5500 2023-06-01 284
Number of retired or separated participants receiving benefits 2023-06-01 1
Number of other retired or separated participants entitled to future benefits 2023-06-01 0
Total of all active and inactive participants 2023-06-01 285

Measure	Date	Value
2023: ROOKE, LLC DBA RIOT HOSPITALITY GROUP EMPLOYEE BENEFITS PLAN 2023 401k membership
Total participants, beginning-of-year	2023-06-01	303
Total number of active participants reported on line 7a of the Form 5500	2023-06-01	284
Number of retired or separated participants receiving benefits	2023-06-01	1
Number of other retired or separated participants entitled to future benefits	2023-06-01	0
Total of all active and inactive participants	2023-06-01	285

Form 5500 Responses for ROOKE, LLC DBA RIOT HOSPITALITY GROUP EMPLOYEE BENEFITS PLAN

2023: ROOKE, LLC DBA RIOT HOSPITALITY GROUP EMPLOYEE BENEFITS PLAN 2023 form 5500 responses
2023-06-01	Type of plan entity	Single employer plan
2023-06-01	First time form 5500 has been submitted	Yes
2023-06-01	Submission has been amended	No
2023-06-01	This submission is the final filing	No
2023-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2023-06-01	Plan is a collectively bargained plan	No
2023-06-01	Plan funding arrangement – Insurance	Yes
2023-06-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00632899

Policy instance

Insurance contract or identification number	00632899
Number of Individuals Covered	95
Insurance policy start date	2023-06-01
Insurance policy end date	2024-05-31
Total amount of commissions paid to insurance broker	USD $5,774
Total amount of fees paid to insurance company	USD $28,601
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	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $629,668
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CURALINC HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

02631

Policy instance

Insurance contract or identification number	02631
Number of Individuals Covered	217
Insurance policy start date	2022-10-15
Insurance policy end date	2023-10-14
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
Other welfare benefits provided	EAP
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 $4,297
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

00053955

Policy instance

Insurance contract or identification number	00053955
Number of Individuals Covered	179
Insurance policy start date	2023-06-01
Insurance policy end date	2024-05-31
Total amount of commissions paid to insurance broker	USD $5,342
Total amount of fees paid to insurance company	USD $685
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	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D, SUPPLEMENTAL LIFE, SUPPLEMENTAL AD&D, ACCIDENT, CRITICAL ILLNESS, HOSPITAL INDEMNITY
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 $26,710
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HEALTHIEST YOU (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

HY12198

Policy instance

Insurance contract or identification number	HY12198
Number of Individuals Covered	70
Insurance policy start date	2023-06-01
Insurance policy end date	2024-05-31
Total amount of commissions paid to insurance broker	USD $1,195
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?	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
Other welfare benefits provided	TELEPHONE HEALTH CONSULTATION
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 $7,961
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	ROOKE, LLC DBA RIOT HOSPITALITY GROUP
Employer identification number (EIN):	272985462
NAIC Classification:	722511
NAIC Description:	Full-Service Restaurants