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| Plan Name | JEM RESTAURANT GROUP INC FLEXIBLE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | JEM RESTAURANT GROUP INC |
| Employer identification number (EIN): | 815005787 |
| NAIC Classification: | 722511 |
| NAIC Description: | Full-Service Restaurants |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2021-11-01 | ALLEN WOOD | 2023-02-28 | ||
| 501 | 2020-11-01 | ALLEN WOOD | 2023-02-28 |
| Measure | Date | Value |
|---|---|---|
| 2021: JEM RESTAURANT GROUP INC FLEXIBLE BENEFIT PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-11-01 | 215 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-11-01 | 195 |
| Total of all active and inactive participants | 2021-11-01 | 195 |
| 2020: JEM RESTAURANT GROUP INC FLEXIBLE BENEFIT PLAN 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-11-01 | 168 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-11-01 | 215 |
| Total of all active and inactive participants | 2020-11-01 | 215 |
| 2021: JEM RESTAURANT GROUP INC FLEXIBLE BENEFIT PLAN 2021 form 5500 responses | ||
|---|---|---|
| 2021-11-01 | Type of plan entity | Single employer plan |
| 2021-11-01 | Plan funding arrangement – Insurance | Yes |
| 2021-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: JEM RESTAURANT GROUP INC FLEXIBLE BENEFIT PLAN 2020 form 5500 responses | ||
| 2020-11-01 | Type of plan entity | Single employer plan |
| 2020-11-01 | Plan funding arrangement – Insurance | Yes |
| 2020-11-01 | Plan benefit arrangement – Insurance | Yes |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |||||||||||||||||||||||||||||||
| Policy contract number | 5774837 | ||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||
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| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) | |||||||||||||||||||||||||||||||
| Policy contract number | 66-16984-00 | ||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |||||||||||||||||||||||||||||||
| Policy contract number | G000AHHS | ||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||
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