401k Plan data: CEO FOODS, INC. DBA EEGEES MEDICAL PLAN plan

CEO FOODS, INC. DBA EEGEES MEDICAL PLAN 401k Plan overview

Plan Name	CEO FOODS, INC. DBA EEGEES MEDICAL PLAN
Plan identification number	501

CEO FOODS, INC. DBA EEGEES MEDICAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20. 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

CEO FOODS, INC. DBA EEGEES has sponsored the creation of one or more 401k plans.

Company Name: CEO FOODS, INC. DBA EEGEES

Employer identification number (EIN): 953981762

NAIC Classification: 722511
NAIC Description: Full-Service Restaurants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CEO FOODS, INC. DBA EEGEES MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2016-11-01 MICHAEL HENNESSEY 2018-11-15
501 2016-11-01 MIKE HENNESSEY 2019-05-30
501 2015-11-01 MICHAEL HENNESSEY 2018-11-15
501 2015-05-01 MICHAEL HENNESSEY 2018-11-15
501 2014-05-01 MICHAEL HENNESSEY 2018-11-15
501 2013-05-01
501 2012-05-01 ROBERT JENSEN
501 2011-05-01 ROBERT JENSEN
501 2009-05-01 ROBERT JENSEN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2016-11-01	MICHAEL HENNESSEY	2018-11-15
501	2016-11-01	MIKE HENNESSEY	2019-05-30
501	2015-11-01	MICHAEL HENNESSEY	2018-11-15
501	2015-05-01	MICHAEL HENNESSEY	2018-11-15
501	2014-05-01	MICHAEL HENNESSEY	2018-11-15
501	2013-05-01
501	2012-05-01	ROBERT JENSEN
501	2011-05-01	ROBERT JENSEN
501	2009-05-01	ROBERT JENSEN

Plan Statistics for CEO FOODS, INC. DBA EEGEES MEDICAL PLAN

401k plan membership statisitcs for CEO FOODS, INC. DBA EEGEES MEDICAL PLAN

Measure Date Value
2016: CEO FOODS, INC. DBA EEGEES MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year 2016-11-01 117
Total number of active participants reported on line 7a of the Form 5500 2016-11-01 102
Number of retired or separated participants receiving benefits 2016-11-01 0
Number of other retired or separated participants entitled to future benefits 2016-11-01 0
Total of all active and inactive participants 2016-11-01 102
Number of employers contributing to the scheme 2016-11-01 0
2015: CEO FOODS, INC. DBA EEGEES MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year 2015-11-01 120
Total number of active participants reported on line 7a of the Form 5500 2015-11-01 117
Number of retired or separated participants receiving benefits 2015-11-01 0
Number of other retired or separated participants entitled to future benefits 2015-11-01 0
Total of all active and inactive participants 2015-11-01 117
Total participants, beginning-of-year 2015-05-01 113
Total number of active participants reported on line 7a of the Form 5500 2015-05-01 120
Number of retired or separated participants receiving benefits 2015-05-01 0
Number of other retired or separated participants entitled to future benefits 2015-05-01 0
Total of all active and inactive participants 2015-05-01 120
2014: CEO FOODS, INC. DBA EEGEES MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year 2014-05-01 101
Total number of active participants reported on line 7a of the Form 5500 2014-05-01 113
Number of retired or separated participants receiving benefits 2014-05-01 0
Number of other retired or separated participants entitled to future benefits 2014-05-01 0
Total of all active and inactive participants 2014-05-01 113
2013: CEO FOODS, INC. DBA EEGEES MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year 2013-05-01 100
Total number of active participants reported on line 7a of the Form 5500 2013-05-01 102
Number of retired or separated participants receiving benefits 2013-05-01 0
Number of other retired or separated participants entitled to future benefits 2013-05-01 0
Total of all active and inactive participants 2013-05-01 102
2012: CEO FOODS, INC. DBA EEGEES MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-05-01 97
Total number of active participants reported on line 7a of the Form 5500 2012-05-01 95
Number of retired or separated participants receiving benefits 2012-05-01 0
Number of other retired or separated participants entitled to future benefits 2012-05-01 0
Total of all active and inactive participants 2012-05-01 95
2011: CEO FOODS, INC. DBA EEGEES MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year 2011-05-01 100
Total number of active participants reported on line 7a of the Form 5500 2011-05-01 97
Number of retired or separated participants receiving benefits 2011-05-01 0
Number of other retired or separated participants entitled to future benefits 2011-05-01 0
Total of all active and inactive participants 2011-05-01 97
2009: CEO FOODS, INC. DBA EEGEES MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year 2009-05-01 100
Total number of active participants reported on line 7a of the Form 5500 2009-05-01 103
Number of retired or separated participants receiving benefits 2009-05-01 0
Number of other retired or separated participants entitled to future benefits 2009-05-01 0
Total of all active and inactive participants 2009-05-01 103

Measure	Date	Value
2016: CEO FOODS, INC. DBA EEGEES MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year	2016-11-01	117
Total number of active participants reported on line 7a of the Form 5500	2016-11-01	102
Number of retired or separated participants receiving benefits	2016-11-01	0
Number of other retired or separated participants entitled to future benefits	2016-11-01	0
Total of all active and inactive participants	2016-11-01	102
Number of employers contributing to the scheme	2016-11-01	0
2015: CEO FOODS, INC. DBA EEGEES MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year	2015-11-01	120
Total number of active participants reported on line 7a of the Form 5500	2015-11-01	117
Number of retired or separated participants receiving benefits	2015-11-01	0
Number of other retired or separated participants entitled to future benefits	2015-11-01	0
Total of all active and inactive participants	2015-11-01	117
Total participants, beginning-of-year	2015-05-01	113
Total number of active participants reported on line 7a of the Form 5500	2015-05-01	120
Number of retired or separated participants receiving benefits	2015-05-01	0
Number of other retired or separated participants entitled to future benefits	2015-05-01	0
Total of all active and inactive participants	2015-05-01	120
2014: CEO FOODS, INC. DBA EEGEES MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year	2014-05-01	101
Total number of active participants reported on line 7a of the Form 5500	2014-05-01	113
Number of retired or separated participants receiving benefits	2014-05-01	0
Number of other retired or separated participants entitled to future benefits	2014-05-01	0
Total of all active and inactive participants	2014-05-01	113
2013: CEO FOODS, INC. DBA EEGEES MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year	2013-05-01	100
Total number of active participants reported on line 7a of the Form 5500	2013-05-01	102
Number of retired or separated participants receiving benefits	2013-05-01	0
Number of other retired or separated participants entitled to future benefits	2013-05-01	0
Total of all active and inactive participants	2013-05-01	102
2012: CEO FOODS, INC. DBA EEGEES MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-05-01	97
Total number of active participants reported on line 7a of the Form 5500	2012-05-01	95
Number of retired or separated participants receiving benefits	2012-05-01	0
Number of other retired or separated participants entitled to future benefits	2012-05-01	0
Total of all active and inactive participants	2012-05-01	95
2011: CEO FOODS, INC. DBA EEGEES MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year	2011-05-01	100
Total number of active participants reported on line 7a of the Form 5500	2011-05-01	97
Number of retired or separated participants receiving benefits	2011-05-01	0
Number of other retired or separated participants entitled to future benefits	2011-05-01	0
Total of all active and inactive participants	2011-05-01	97
2009: CEO FOODS, INC. DBA EEGEES MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year	2009-05-01	100
Total number of active participants reported on line 7a of the Form 5500	2009-05-01	103
Number of retired or separated participants receiving benefits	2009-05-01	0
Number of other retired or separated participants entitled to future benefits	2009-05-01	0
Total of all active and inactive participants	2009-05-01	103

Form 5500 Responses for CEO FOODS, INC. DBA EEGEES MEDICAL PLAN

2016: CEO FOODS, INC. DBA EEGEES MEDICAL PLAN 2016 form 5500 responses
2016-11-01	Type of plan entity	Single employer plan
2016-11-01	Submission has been amended	No
2016-11-01	This submission is the final filing	No
2016-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-11-01	Plan is a collectively bargained plan	No
2016-11-01	Plan funding arrangement – Insurance	Yes
2016-11-01	Plan benefit arrangement – Insurance	Yes
2015: CEO FOODS, INC. DBA EEGEES MEDICAL PLAN 2015 form 5500 responses
2015-11-01	Type of plan entity	Single employer plan
2015-11-01	Submission has been amended	No
2015-11-01	This submission is the final filing	No
2015-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-11-01	Plan is a collectively bargained plan	No
2015-11-01	Plan funding arrangement – Insurance	Yes
2015-11-01	Plan benefit arrangement – Insurance	Yes
2015-05-01	Type of plan entity	Single employer plan
2015-05-01	Submission has been amended	No
2015-05-01	This submission is the final filing	No
2015-05-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2015-05-01	Plan is a collectively bargained plan	No
2015-05-01	Plan funding arrangement – Insurance	Yes
2015-05-01	Plan benefit arrangement – Insurance	Yes
2014: CEO FOODS, INC. DBA EEGEES MEDICAL PLAN 2014 form 5500 responses
2014-05-01	Type of plan entity	Single employer plan
2014-05-01	Submission has been amended	No
2014-05-01	This submission is the final filing	No
2014-05-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-05-01	Plan is a collectively bargained plan	No
2014-05-01	Plan funding arrangement – Insurance	Yes
2014-05-01	Plan benefit arrangement – Insurance	Yes
2013: CEO FOODS, INC. DBA EEGEES MEDICAL PLAN 2013 form 5500 responses
2013-05-01	Type of plan entity	Single employer plan
2013-05-01	Submission has been amended	No
2013-05-01	This submission is the final filing	No
2013-05-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-05-01	Plan is a collectively bargained plan	No
2013-05-01	Plan funding arrangement – Insurance	Yes
2013-05-01	Plan benefit arrangement – Insurance	Yes
2012: CEO FOODS, INC. DBA EEGEES MEDICAL PLAN 2012 form 5500 responses
2012-05-01	Type of plan entity	Single employer plan
2012-05-01	Submission has been amended	No
2012-05-01	This submission is the final filing	No
2012-05-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-05-01	Plan is a collectively bargained plan	No
2012-05-01	Plan funding arrangement – Insurance	Yes
2012-05-01	Plan benefit arrangement – Insurance	Yes
2011: CEO FOODS, INC. DBA EEGEES MEDICAL PLAN 2011 form 5500 responses
2011-05-01	Type of plan entity	Single employer plan
2011-05-01	Submission has been amended	No
2011-05-01	This submission is the final filing	No
2011-05-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-05-01	Plan is a collectively bargained plan	No
2011-05-01	Plan funding arrangement – Insurance	Yes
2011-05-01	Plan benefit arrangement – Insurance	Yes
2009: CEO FOODS, INC. DBA EEGEES MEDICAL PLAN 2009 form 5500 responses
2009-05-01	Type of plan entity	Single employer plan
2009-05-01	First time form 5500 has been submitted	Yes
2009-05-01	Submission has been amended	No
2009-05-01	This submission is the final filing	No
2009-05-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-05-01	Plan is a collectively bargained plan	No
2009-05-01	Plan funding arrangement – Insurance	Yes
2009-05-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )

Policy contract number

27053

Policy instance

Insurance contract or identification number	27053
Number of Individuals Covered	102
Insurance policy start date	2013-05-01
Insurance policy end date	2014-04-30
Total amount of commissions paid to insurance broker	USD $26,189
Total amount of fees paid to insurance company	USD $581
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	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 $558,871
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,189
Amount paid for insurance broker fees	581
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BLACK GOULD AND ASSOCIATES

Potentially related plans

CEO FOODS, INC. DBA EEGEE'S HEALTH & WELFARE BENEFIT PLAN [EIN = 364898087]

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Company Name:	CEO FOODS, INC. DBA EEGEES
Employer identification number (EIN):	953981762
NAIC Classification:	722511
NAIC Description:	Full-Service Restaurants