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FOURCROWN INC DBA WENDYS EMPLOYEE MEDICAL BENEFIT PLAN 401k Plan overview

Plan NameFOURCROWN INC DBA WENDYS EMPLOYEE MEDICAL BENEFIT PLAN
Plan identification number 502

FOURCROWN INC DBA WENDYS EMPLOYEE MEDICAL BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

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

Company Name:FOURCROWN, INC.
Employer identification number (EIN):411558163
NAIC Classification:531120
NAIC Description:Lessors of Nonresidential Buildings (except Miniwarehouses)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FOURCROWN INC DBA WENDYS EMPLOYEE MEDICAL BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022017-10-01DANIEL TURNQUIST DANIEL TURNQUIST2018-06-19
5022016-10-01DANIEL TURNQUIST DANIEL TURNQUIST2018-04-30
5022015-10-01DONALD JENSEN DONALD JENSEN2017-04-11
5022014-10-01DONALD JENSEN DONALD JENSEN2016-03-15
5022013-10-01DONALD JENSEN DONALD JENSEN2015-04-06
5022012-10-01DONALD JENSEN DONALD JENSEN2014-04-22
5022011-10-01DONALD JENSEN DONALD JENSEN2013-05-31
5022010-10-01DONALD P JENSEN
5022009-10-01DONALD P. JENSEN

Plan Statistics for FOURCROWN INC DBA WENDYS EMPLOYEE MEDICAL BENEFIT PLAN

401k plan membership statisitcs for FOURCROWN INC DBA WENDYS EMPLOYEE MEDICAL BENEFIT PLAN

Measure Date Value
2017: FOURCROWN INC DBA WENDYS EMPLOYEE MEDICAL BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-10-01262
Total number of active participants reported on line 7a of the Form 55002017-10-010
Total of all active and inactive participants2017-10-010
2016: FOURCROWN INC DBA WENDYS EMPLOYEE MEDICAL BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-10-01235
Total number of active participants reported on line 7a of the Form 55002016-10-01257
Number of retired or separated participants receiving benefits2016-10-015
Total of all active and inactive participants2016-10-01262
2015: FOURCROWN INC DBA WENDYS EMPLOYEE MEDICAL BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-10-01283
Total number of active participants reported on line 7a of the Form 55002015-10-01230
Number of retired or separated participants receiving benefits2015-10-015
Total of all active and inactive participants2015-10-01235
2014: FOURCROWN INC DBA WENDYS EMPLOYEE MEDICAL BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-10-01307
Total number of active participants reported on line 7a of the Form 55002014-10-01282
Number of retired or separated participants receiving benefits2014-10-011
Total of all active and inactive participants2014-10-01283
2013: FOURCROWN INC DBA WENDYS EMPLOYEE MEDICAL BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-10-01300
Total number of active participants reported on line 7a of the Form 55002013-10-01301
Total of all active and inactive participants2013-10-01301
2012: FOURCROWN INC DBA WENDYS EMPLOYEE MEDICAL BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-10-01224
Total number of active participants reported on line 7a of the Form 55002012-10-01275
Total of all active and inactive participants2012-10-01275
2011: FOURCROWN INC DBA WENDYS EMPLOYEE MEDICAL BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-10-01263
Total number of active participants reported on line 7a of the Form 55002011-10-01265
Total of all active and inactive participants2011-10-01265
2010: FOURCROWN INC DBA WENDYS EMPLOYEE MEDICAL BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-10-01167
Total number of active participants reported on line 7a of the Form 55002010-10-01147
Number of retired or separated participants receiving benefits2010-10-010
Number of other retired or separated participants entitled to future benefits2010-10-010
Total of all active and inactive participants2010-10-01147
2009: FOURCROWN INC DBA WENDYS EMPLOYEE MEDICAL BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-10-01265
Total number of active participants reported on line 7a of the Form 55002009-10-01264
Number of retired or separated participants receiving benefits2009-10-011
Number of other retired or separated participants entitled to future benefits2009-10-010
Total of all active and inactive participants2009-10-01265

Form 5500 Responses for FOURCROWN INC DBA WENDYS EMPLOYEE MEDICAL BENEFIT PLAN

2017: FOURCROWN INC DBA WENDYS EMPLOYEE MEDICAL BENEFIT PLAN 2017 form 5500 responses
2017-10-01Type of plan entitySingle employer plan
2017-10-01This submission is the final filingYes
2017-10-01This return/report is a short plan year return/report (less than 12 months)Yes
2017-10-01Plan funding arrangement – InsuranceYes
2017-10-01Plan funding arrangement – General assets of the sponsorYes
2017-10-01Plan benefit arrangement – InsuranceYes
2017-10-01Plan benefit arrangement – General assets of the sponsorYes
2016: FOURCROWN INC DBA WENDYS EMPLOYEE MEDICAL BENEFIT PLAN 2016 form 5500 responses
2016-10-01Type of plan entitySingle employer plan
2016-10-01Plan funding arrangement – InsuranceYes
2016-10-01Plan funding arrangement – General assets of the sponsorYes
2016-10-01Plan benefit arrangement – InsuranceYes
2016-10-01Plan benefit arrangement – General assets of the sponsorYes
2015: FOURCROWN INC DBA WENDYS EMPLOYEE MEDICAL BENEFIT PLAN 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01Plan funding arrangement – InsuranceYes
2015-10-01Plan funding arrangement – General assets of the sponsorYes
2015-10-01Plan benefit arrangement – InsuranceYes
2015-10-01Plan benefit arrangement – General assets of the sponsorYes
2014: FOURCROWN INC DBA WENDYS EMPLOYEE MEDICAL BENEFIT PLAN 2014 form 5500 responses
2014-10-01Type of plan entitySingle employer plan
2014-10-01Plan funding arrangement – InsuranceYes
2014-10-01Plan funding arrangement – General assets of the sponsorYes
2014-10-01Plan benefit arrangement – InsuranceYes
2014-10-01Plan benefit arrangement – General assets of the sponsorYes
2013: FOURCROWN INC DBA WENDYS EMPLOYEE MEDICAL BENEFIT PLAN 2013 form 5500 responses
2013-10-01Type of plan entitySingle employer plan
2013-10-01Plan funding arrangement – InsuranceYes
2013-10-01Plan funding arrangement – General assets of the sponsorYes
2013-10-01Plan benefit arrangement – InsuranceYes
2013-10-01Plan benefit arrangement – General assets of the sponsorYes
2012: FOURCROWN INC DBA WENDYS EMPLOYEE MEDICAL BENEFIT PLAN 2012 form 5500 responses
2012-10-01Type of plan entitySingle employer plan
2012-10-01Plan funding arrangement – InsuranceYes
2012-10-01Plan funding arrangement – General assets of the sponsorYes
2012-10-01Plan benefit arrangement – InsuranceYes
2012-10-01Plan benefit arrangement – General assets of the sponsorYes
2011: FOURCROWN INC DBA WENDYS EMPLOYEE MEDICAL BENEFIT PLAN 2011 form 5500 responses
2011-10-01Type of plan entitySingle employer plan
2011-10-01Plan funding arrangement – InsuranceYes
2011-10-01Plan funding arrangement – General assets of the sponsorYes
2011-10-01Plan benefit arrangement – InsuranceYes
2011-10-01Plan benefit arrangement – General assets of the sponsorYes
2010: FOURCROWN INC DBA WENDYS EMPLOYEE MEDICAL BENEFIT PLAN 2010 form 5500 responses
2010-10-01Type of plan entitySingle employer plan
2010-10-01Submission has been amendedNo
2010-10-01This submission is the final filingNo
2010-10-01This return/report is a short plan year return/report (less than 12 months)No
2010-10-01Plan is a collectively bargained planNo
2010-10-01Plan funding arrangement – InsuranceYes
2010-10-01Plan funding arrangement – General assets of the sponsorYes
2010-10-01Plan benefit arrangement – InsuranceYes
2010-10-01Plan benefit arrangement – General assets of the sponsorYes
2009: FOURCROWN INC DBA WENDYS EMPLOYEE MEDICAL BENEFIT PLAN 2009 form 5500 responses
2009-10-01Type of plan entitySingle employer plan
2009-10-01Submission has been amendedNo
2009-10-01This submission is the final filingNo
2009-10-01This return/report is a short plan year return/report (less than 12 months)No
2009-10-01Plan is a collectively bargained planNo
2009-10-01Plan funding arrangement – InsuranceYes
2009-10-01Plan funding arrangement – General assets of the sponsorYes
2009-10-01Plan benefit arrangement – InsuranceYes
2009-10-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number10718294
Policy instance 1
Insurance contract or identification number10718294
Number of Individuals Covered64
Insurance policy start date2017-10-01
Insurance policy end date2017-11-30
Total amount of commissions paid to insurance brokerUSD $53
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,027
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $37
Insurance broker organization code?3
Insurance broker nameTHE KNW GROUP LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number420298
Policy instance 2
Insurance contract or identification number420298
Number of Individuals Covered276
Insurance policy start date2017-10-01
Insurance policy end date2017-11-30
Total amount of commissions paid to insurance brokerUSD $889
Total amount of fees paid to insurance companyUSD $51
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $6,389
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $819
Amount paid for insurance broker fees51
Additional information about fees paid to insurance brokerMARKETING ALLOWANCE
Insurance broker organization code?3
Insurance broker nameCARUTH JENNON
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number10718294
Policy instance 1
Insurance contract or identification number10718294
Number of Individuals Covered135
Insurance policy start date2015-10-01
Insurance policy end date2016-10-01
Total amount of commissions paid to insurance brokerUSD $18,898
Total amount of fees paid to insurance companyUSD $719
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,860
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,228
Amount paid for insurance broker fees120
Additional information about fees paid to insurance brokerMARKETING ALLOWANCE
Insurance broker organization code?3
Insurance broker nameTHE KNW GROUP LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number420298
Policy instance 2
Insurance contract or identification number420298
Number of Individuals Covered293
Insurance policy start date2015-10-01
Insurance policy end date2016-10-01
Total amount of commissions paid to insurance brokerUSD $26,113
Total amount of fees paid to insurance companyUSD $1,344
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $85,873
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,687
Amount paid for insurance broker fees1344
Additional information about fees paid to insurance brokerMARKETING ALLOWANCE
Insurance broker organization code?3
Insurance broker nameCARUTH JENNON
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number041444
Policy instance 1
Insurance contract or identification number041444
Number of Individuals Covered250
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $5,675
Total amount of fees paid to insurance companyUSD $332
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $56,670
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,675
Amount paid for insurance broker fees332
Additional information about fees paid to insurance brokerMARKETING ALLOWANCE
Insurance broker organization code?3
Insurance broker nameTHE KNW GROUP LLC
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number041444
Policy instance 1
Insurance contract or identification number041444
Number of Individuals Covered253
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $5,310
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $52,945
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,310
Insurance broker organization code?3
Insurance broker nameTHE KNW GROUP LLC
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number041444
Policy instance 1
Insurance contract or identification number041444
Number of Individuals Covered275
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $5,300
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $52,497
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,300
Insurance broker organization code?3
Insurance broker nameTHE KNW GROUP LLC
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number041444
Policy instance 1
Insurance contract or identification number041444
Number of Individuals Covered254
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $4,686
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $45,580
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number41444
Policy instance 1
Insurance contract or identification number41444
Number of Individuals Covered243
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $2,761
Total amount of fees paid to insurance companyUSD $62
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 CarrierUSD $26,507
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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