401k Plan data: TRUDY'S TEXAS STAR, INC. HEALTH AND WELFARE BENEFIT PLAN plan

TRUDY'S TEXAS STAR, INC. HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	TRUDY'S TEXAS STAR, INC. HEALTH AND WELFARE BENEFIT PLAN
Plan identification number	501

TRUDY'S TEXAS STAR, INC. HEALTH AND WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

TRUDYS TEXAS STAR has sponsored the creation of one or more 401k plans.

Company Name: TRUDYS TEXAS STAR

Employer identification number (EIN): 742234050

NAIC Classification: 722110
NAIC Description: Full-Service Restaurants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TRUDY'S TEXAS STAR, INC. HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-01-01
501 2016-01-01 ALIX DEAN

Plan Statistics for TRUDY'S TEXAS STAR, INC. HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for TRUDY'S TEXAS STAR, INC. HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2017: TRUDY'S TEXAS STAR, INC. HEALTH AND WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 181
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 181
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 181
2016: TRUDY'S TEXAS STAR, INC. HEALTH AND WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 175
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 175
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 175

Measure	Date	Value
2017: TRUDY'S TEXAS STAR, INC. HEALTH AND WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	181
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	181
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	181
2016: TRUDY'S TEXAS STAR, INC. HEALTH AND WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	175
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	175
Number of retired or separated participants receiving benefits	2016-01-01	0
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	175

Form 5500 Responses for TRUDY'S TEXAS STAR, INC. HEALTH AND WELFARE BENEFIT PLAN

2017: TRUDY'S TEXAS STAR, INC. HEALTH AND WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: TRUDY'S TEXAS STAR, INC. HEALTH AND WELFARE 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

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05997396

Policy instance

Insurance contract or identification number	KM05997396
Number of Individuals Covered	148
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $9,074
Total amount of fees paid to insurance company	USD $453
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,753
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,932
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker name	USI INSURANCE SERVICES LLC

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F014858

Policy instance

Insurance contract or identification number	F014858
Number of Individuals Covered	160
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,500
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $10,539
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,500
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES LLC

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

15348

Policy instance

Insurance contract or identification number	15348
Number of Individuals Covered	134
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $14,911
Total amount of fees paid to insurance company	USD $3,410
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $364,411
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $14,911
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	OTHER COMMISSIONS
Insurance broker name	BALL PEOPLES

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Company Name:	TRUDYS TEXAS STAR
Employer identification number (EIN):	742234050
NAIC Classification:	722110
NAIC Description:	Full-Service Restaurants