401k Plan data: CHARTER FOODS, INCORPORATED plan

CHARTER FOODS, INCORPORATED 401k Plan overview

Plan Name	CHARTER FOODS, INCORPORATED
Plan identification number	501

CHARTER FOODS, INCORPORATED Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Long-term disability cover

401k Sponsoring company profile

CHARTER FOODS, INCORPORATED has sponsored the creation of one or more 401k plans.

Company Name: CHARTER FOODS, INCORPORATED

Employer identification number (EIN): 621742741

NAIC Classification: 722513
NAIC Description: Limited-Service Restaurants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHARTER FOODS, INCORPORATED

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-07-01 JUDITH MUNCY
501 2014-07-01 JUDITH MUNCY JUDITH MUNCY 2016-01-19
501 2012-07-15 KATY POTTS

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2015-07-01	JUDITH MUNCY
501	2014-07-01	JUDITH MUNCY	JUDITH MUNCY	2016-01-19
501	2012-07-15	KATY POTTS

Plan Statistics for CHARTER FOODS, INCORPORATED

401k plan membership statisitcs for CHARTER FOODS, INCORPORATED

Measure Date Value
2015: CHARTER FOODS, INCORPORATED 2015 401k membership
Total participants, beginning-of-year 2015-07-01 0
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 0
Total of all active and inactive participants 2015-07-01 0
Total participants 2015-07-01 0
2014: CHARTER FOODS, INCORPORATED 2014 401k membership
Total participants, beginning-of-year 2014-07-01 185
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 275
Number of retired or separated participants receiving benefits 2014-07-01 0
Number of other retired or separated participants entitled to future benefits 2014-07-01 0
Total of all active and inactive participants 2014-07-01 275
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-07-01 0
Total participants 2014-07-01 275
Number of participants with account balances 2014-07-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-07-01 0
2012: CHARTER FOODS, INCORPORATED 2012 401k membership
Total participants, beginning-of-year 2012-07-15 401
Total number of active participants reported on line 7a of the Form 5500 2012-07-15 435
Number of retired or separated participants receiving benefits 2012-07-15 0
Number of other retired or separated participants entitled to future benefits 2012-07-15 0
Total of all active and inactive participants 2012-07-15 435
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-07-15 0
Total participants 2012-07-15 435
Number of participants with account balances 2012-07-15 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-07-15 0

Measure	Date	Value
2015: CHARTER FOODS, INCORPORATED 2015 401k membership
Total participants, beginning-of-year	2015-07-01	0
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	0
Total of all active and inactive participants	2015-07-01	0
Total participants	2015-07-01	0
2014: CHARTER FOODS, INCORPORATED 2014 401k membership
Total participants, beginning-of-year	2014-07-01	185
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	275
Number of retired or separated participants receiving benefits	2014-07-01	0
Number of other retired or separated participants entitled to future benefits	2014-07-01	0
Total of all active and inactive participants	2014-07-01	275
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-07-01	0
Total participants	2014-07-01	275
Number of participants with account balances	2014-07-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-07-01	0
2012: CHARTER FOODS, INCORPORATED 2012 401k membership
Total participants, beginning-of-year	2012-07-15	401
Total number of active participants reported on line 7a of the Form 5500	2012-07-15	435
Number of retired or separated participants receiving benefits	2012-07-15	0
Number of other retired or separated participants entitled to future benefits	2012-07-15	0
Total of all active and inactive participants	2012-07-15	435
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-07-15	0
Total participants	2012-07-15	435
Number of participants with account balances	2012-07-15	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-07-15	0

Form 5500 Responses for CHARTER FOODS, INCORPORATED

2015: CHARTER FOODS, INCORPORATED 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Submission has been amended	No
2015-07-01	This submission is the final filing	Yes
2015-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-07-01	Plan is a collectively bargained plan	No
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2014: CHARTER FOODS, INCORPORATED 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	First time form 5500 has been submitted	Yes
2014-07-01	Submission has been amended	No
2014-07-01	This submission is the final filing	No
2014-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-07-01	Plan is a collectively bargained plan	No
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2012: CHARTER FOODS, INCORPORATED 2012 form 5500 responses
2012-07-15	Type of plan entity	Single employer plan
2012-07-15	First time form 5500 has been submitted	Yes
2012-07-15	Submission has been amended	No
2012-07-15	This submission is the final filing	No
2012-07-15	This return/report is a short plan year return/report (less than 12 months)	No
2012-07-15	Plan is a collectively bargained plan	No
2012-07-15	Plan funding arrangement – Insurance	Yes
2012-07-15	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )

Policy contract number

120161

Policy instance

Insurance contract or identification number	120161
Number of Individuals Covered	134
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $62,095
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 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	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 $1,774,169
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $62,095
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	SAMUEL BROWN-PRICE & RAMEY INSURANC

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50000605

Policy instance

Insurance contract or identification number	50000605
Number of Individuals Covered	275
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $33,608
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 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
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 $189,402
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,389
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	GROUP INSURANCE SERVICES

BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )

Policy contract number

120161

Policy instance

Insurance contract or identification number	120161
Number of Individuals Covered	474
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $7,034
Total amount of fees paid to insurance company	USD $0
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 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	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 $96,739
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,034
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	PRICE & RAMEY INSURANCE AGENCY

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

Policy contract number

0730084

Policy instance

Insurance contract or identification number	0730084
Insurance policy start date	2012-07-15
Insurance policy end date	2013-07-14
Total amount of commissions paid to insurance broker	USD $55,228
Total amount of fees paid to insurance company	USD $0
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 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 $1,380,709
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55,228
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	PRICE & RAMEY INSURANCE AGENCY

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50000605

Policy instance

Insurance contract or identification number	50000605
Number of Individuals Covered	384
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $18,718
Total amount of fees paid to insurance company	USD $1,621
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 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	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 $124,785
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,604
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker name	GROUP INSURANCE SERVICES, INC

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Company Name:	CHARTER FOODS, INCORPORATED
Employer identification number (EIN):	621742741
NAIC Classification:	722513
NAIC Description:	Limited-Service Restaurants