401k Plan data: CRACKER BARREL STORES HEALTH BENEFIT PLAN plan

CRACKER BARREL STORES HEALTH BENEFIT PLAN 401k Plan overview

Plan Name	CRACKER BARREL STORES HEALTH BENEFIT PLAN
Plan identification number	501

CRACKER BARREL STORES HEALTH BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Death benefits (include travel accident but not life insurance) Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

AMERICAN GENERAL INVESTMENTS, LLC has sponsored the creation of one or more 401k plans.

Company Name: AMERICAN GENERAL INVESTMENTS, LLC

Employer identification number (EIN): 720645812

NAIC Classification: 525100
NAIC Description: Insurance and Employee Benefit Funds

Additional information about AMERICAN GENERAL INVESTMENTS, LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 3570455

More information about AMERICAN GENERAL INVESTMENTS, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CRACKER BARREL STORES HEALTH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2016-01-01
501 2015-01-01 JANICE CHIASSON JANICE CHIASSON 2016-10-10

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2016-01-01
501	2015-01-01	JANICE CHIASSON		JANICE CHIASSON	2016-10-10

Plan Statistics for CRACKER BARREL STORES HEALTH BENEFIT PLAN

401k plan membership statisitcs for CRACKER BARREL STORES HEALTH BENEFIT PLAN

Measure Date Value
2016: CRACKER BARREL STORES HEALTH BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 139
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 131
Number of retired or separated participants receiving benefits 2016-01-01 1
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 132
2015: CRACKER BARREL STORES HEALTH BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 189
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 139
Number of retired or separated participants receiving benefits 2015-01-01 1
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 140

Measure	Date	Value
2016: CRACKER BARREL STORES HEALTH BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	139
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	131
Number of retired or separated participants receiving benefits	2016-01-01	1
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	132
2015: CRACKER BARREL STORES HEALTH BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	189
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	139
Number of retired or separated participants receiving benefits	2015-01-01	1
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	140

Form 5500 Responses for CRACKER BARREL STORES HEALTH BENEFIT PLAN

2016: CRACKER BARREL STORES HEALTH BENEFIT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: CRACKER BARREL STORES HEALTH BENEFIT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )

Policy contract number

79484FF2

Policy instance

Insurance contract or identification number	79484FF2
Number of Individuals Covered	161
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $621
Total amount of fees paid to insurance company	USD $141
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	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL 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 Carrier	USD $722,696
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $621
Insurance broker organization code?	3
Amount paid for insurance broker fees	141
Additional information about fees paid to insurance broker	INDIRECT COMPENSATION
Insurance broker name	GALLAGHER BENEFIT SERVICES, INC.

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Company Name:	AMERICAN GENERAL INVESTMENTS, LLC
Employer identification number (EIN):	720645812
NAIC Classification:	525100
NAIC Description:	Insurance and Employee Benefit Funds

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	3570455