401k Plan data: PERKINS LLC WELFARE BENEFIT PLAN plan

PERKINS LLC WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	PERKINS LLC WELFARE BENEFIT PLAN
Plan identification number	505

PERKINS LLC WELFARE BENEFIT 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 Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

PERKINS & MARIE CALLENDER'S, LLC has sponsored the creation of one or more 401k plans.

Company Name: PERKINS & MARIE CALLENDER'S, LLC

Employer identification number (EIN): 453942435

NAIC Classification: 722511
NAIC Description: Full-Service Restaurants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PERKINS LLC WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2019-10-22

Plan Statistics for PERKINS LLC WELFARE BENEFIT PLAN

401k plan membership statisitcs for PERKINS LLC WELFARE BENEFIT PLAN

Measure Date Value
2019: PERKINS LLC WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-10-22 885
Total number of active participants reported on line 7a of the Form 5500 2019-10-22 607
Number of retired or separated participants receiving benefits 2019-10-22 7
Number of other retired or separated participants entitled to future benefits 2019-10-22 0
Total of all active and inactive participants 2019-10-22 614

Measure	Date	Value
2019: PERKINS LLC WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-10-22	885
Total number of active participants reported on line 7a of the Form 5500	2019-10-22	607
Number of retired or separated participants receiving benefits	2019-10-22	7
Number of other retired or separated participants entitled to future benefits	2019-10-22	0
Total of all active and inactive participants	2019-10-22	614

Form 5500 Responses for PERKINS LLC WELFARE BENEFIT PLAN

2019: PERKINS LLC WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-10-22	Type of plan entity	Single employer plan
2019-10-22	First time form 5500 has been submitted	Yes
2019-10-22	Submission has been amended	No
2019-10-22	This submission is the final filing	No
2019-10-22	This return/report is a short plan year return/report (less than 12 months)	Yes
2019-10-22	Plan is a collectively bargained plan	No
2019-10-22	Plan funding arrangement – Insurance	Yes
2019-10-22	Plan funding arrangement – General assets of the sponsor	Yes
2019-10-22	Plan benefit arrangement – Insurance	Yes
2019-10-22	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000023845

Policy instance

Insurance contract or identification number	0000023845
Number of Individuals Covered	0
Insurance policy start date	2019-10-22
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
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	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 $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )

Policy contract number

BTA-2299

Policy instance

Insurance contract or identification number	BTA-2299
Number of Individuals Covered	511
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $965
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	BUSINESS TRAVEL ACCIDENT (ACCIDENTAL DEATH & DISMEM BERMENT)
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 $3,858
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $965
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

166863

Policy instance

Insurance contract or identification number	166863
Number of Individuals Covered	922
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
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	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

00032083

Policy instance

Insurance contract or identification number	00032083
Number of Individuals Covered	287
Insurance policy start date	2019-10-22
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,331
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	ACCIDENT, CRITICAL ILLNESS
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 $9,320
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $681
Insurance broker organization code?	3

Potentially related plans

PERKINS LLC HEALTH & WELFARE PLAN [EIN = 371955460]

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Company Name:	PERKINS & MARIE CALLENDER'S, LLC
Employer identification number (EIN):	453942435
NAIC Classification:	722511
NAIC Description:	Full-Service Restaurants