401k Plan data: SCHMIDT FAMILY RESTUARANT GROUP plan

SCHMIDT FAMILY RESTUARANT GROUP 401k Plan overview

Plan Name	SCHMIDT FAMILY RESTUARANT GROUP
Plan identification number	501

SCHMIDT FAMILY RESTUARANT GROUP 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

SCHMIDT FAMILY RESTAURANT GROUP, INC. has sponsored the creation of one or more 401k plans.

Company Name: SCHMIDT FAMILY RESTAURANT GROUP, INC.

Employer identification number (EIN): 475190200

NAIC Classification: 722511
NAIC Description: Full-Service Restaurants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SCHMIDT FAMILY RESTUARANT GROUP

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-02-01 SUARRA SPARKS 2024-05-13
501 2022-02-01 SUARRA SPARKS 2023-08-28
501 2021-02-01 SUARRA SPARKS 2022-09-28

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-02-01	SUARRA SPARKS	2024-05-13
501	2022-02-01	SUARRA SPARKS	2023-08-28
501	2021-02-01	SUARRA SPARKS	2022-09-28

Form 5500 Responses for SCHMIDT FAMILY RESTUARANT GROUP

2023: SCHMIDT FAMILY RESTUARANT GROUP 2023 form 5500 responses
2023-02-01	Type of plan entity	Single employer plan
2023-02-01	Submission has been amended	No
2023-02-01	This submission is the final filing	No
2023-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2023-02-01	Plan is a collectively bargained plan	No
2023-02-01	Plan funding arrangement – Insurance	Yes
2023-02-01	Plan benefit arrangement – Insurance	Yes
2022: SCHMIDT FAMILY RESTUARANT GROUP 2022 form 5500 responses
2022-02-01	Type of plan entity	Single employer plan
2022-02-01	Plan funding arrangement – Insurance	Yes
2022-02-01	Plan benefit arrangement – Insurance	Yes
2021: SCHMIDT FAMILY RESTUARANT GROUP 2021 form 5500 responses
2021-02-01	Type of plan entity	Single employer plan
2021-02-01	First time form 5500 has been submitted	Yes
2021-02-01	Plan funding arrangement – Insurance	Yes
2021-02-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0931004

Policy instance

Insurance contract or identification number	0931004
Number of Individuals Covered	140
Insurance policy start date	2023-02-01
Insurance policy end date	2024-01-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $23,080
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	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
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 $1,208,904
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

618256

Policy instance

Insurance contract or identification number	618256
Number of Individuals Covered	227
Insurance policy start date	2023-02-01
Insurance policy end date	2024-01-31
Total amount of commissions paid to insurance broker	USD $5,378
Total amount of fees paid to insurance company	USD $166
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 $53,782
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

00047986

Policy instance

Insurance contract or identification number	00047986
Number of Individuals Covered	190
Insurance policy start date	2023-02-01
Insurance policy end date	2024-01-31
Total amount of commissions paid to insurance broker	USD $3,632
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	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 $59,382
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

W43204

Policy instance

Insurance contract or identification number	W43204
Number of Individuals Covered	210
Insurance policy start date	2022-02-01
Insurance policy end date	2023-01-31
Total amount of commissions paid to insurance broker	USD $36,039
Total amount of fees paid to insurance company	USD $4,434
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,192,364
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

618256

Policy instance

Insurance contract or identification number	618256
Number of Individuals Covered	318
Insurance policy start date	2022-02-01
Insurance policy end date	2023-01-31
Total amount of commissions paid to insurance broker	USD $7,313
Total amount of fees paid to insurance company	USD $3,101
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $73,131
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

W43204

Policy instance

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

618256

Policy instance

Potentially related plans

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Company Name:	SCHMIDT FAMILY RESTAURANT GROUP, INC.
Employer identification number (EIN):	475190200
NAIC Classification:	722511
NAIC Description:	Full-Service Restaurants