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| Plan Name | LEGACY RESTAURANT GROUP EMPLOYEE BENEFITS PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | LEGACY RESTAURANT GROUP, L.L.C. |
| Employer identification number (EIN): | 431824787 |
| NAIC Classification: | 722513 |
| NAIC Description: | Limited-Service Restaurants |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2024-05-01 | FELIX TOLLINCHE | |||
| 501 | 2023-05-01 | FELIX TOLLINCHE | |||
| 501 | 2022-05-01 | ||||
| 501 | 2022-05-01 | FELIX TOLLINCHE |
| 2022: LEGACY RESTAURANT GROUP EMPLOYEE BENEFITS PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-05-01 | Type of plan entity | Single employer plan |
| 2022-05-01 | First time form 5500 has been submitted | Yes |
| 2022-05-01 | Plan funding arrangement – Insurance | Yes |
| 2022-05-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-05-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 ) | |
| Policy contract number | 45005000 |
| Policy instance | 1 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) | |
| Policy contract number | 10371971001, 02 |
| Policy instance | 2 |
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) | |
| Policy contract number | 170123 |
| Policy instance | 3 |
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) | |
| Policy contract number | 170123 |
| Policy instance | 4 |
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) | |
| Policy contract number | 170123 |
| Policy instance | 5 |
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