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THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan NameTHE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN
Plan identification number 001

THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Plan covering Self-Employed individuals.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

THE HABIT RESTAURANTS, LLC has sponsored the creation of one or more 401k plans.

Company Name:THE HABIT RESTAURANTS, LLC
Employer identification number (EIN):260501524
NAIC Classification:722511
NAIC Description:Full-Service Restaurants

Additional information about THE HABIT RESTAURANTS, LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number: 4385059

More information about THE HABIT RESTAURANTS, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01
0012021-01-01TANYA CORNERS2022-08-03
0012020-01-01TANYA CORNERS2021-10-12 IRA FILS2021-10-12
0012019-01-01TANYA CORNERS2020-10-13 IRA FILS2020-10-13
0012018-01-01TANYA CORNERS2019-10-15 IRA FILS2019-10-15
0012017-01-01
0012016-01-01
0012016-01-01TANYA CORNERS2017-10-11
0012015-01-01
0012014-01-01TANYA CORNERS

Plan Statistics for THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN

Measure Date Value
2021: THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-011,364
Total number of active participants reported on line 7a of the Form 55002021-01-011,119
Number of retired or separated participants receiving benefits2021-01-0115
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-011,134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-011,134
Number of participants with account balances2021-01-0186
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-0119
2020: THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01949
Total number of active participants reported on line 7a of the Form 55002020-01-01942
Number of retired or separated participants receiving benefits2020-01-013
Number of other retired or separated participants entitled to future benefits2020-01-0153
Total of all active and inactive participants2020-01-01998
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01998
Number of participants with account balances2020-01-01308
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-0117
2019: THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01855
Total number of active participants reported on line 7a of the Form 55002019-01-01848
Number of retired or separated participants receiving benefits2019-01-011
Number of other retired or separated participants entitled to future benefits2019-01-0145
Total of all active and inactive participants2019-01-01894
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01894
Number of participants with account balances2019-01-01253
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-0119
2018: THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01764
Total number of active participants reported on line 7a of the Form 55002018-01-01756
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-0145
Total of all active and inactive participants2018-01-01801
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01801
Number of participants with account balances2018-01-01237
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-018
2017: THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01687
Total number of active participants reported on line 7a of the Form 55002017-01-01694
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-0139
Total of all active and inactive participants2017-01-01733
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-01733
Number of participants with account balances2017-01-01200
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-019
2016: THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01571
Total number of active participants reported on line 7a of the Form 55002016-01-01595
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-0145
Total of all active and inactive participants2016-01-01640
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-01640
Number of participants with account balances2016-01-01183
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-011
2015: THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01408
Total number of active participants reported on line 7a of the Form 55002015-01-01506
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0137
Total of all active and inactive participants2015-01-01543
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-01543
Number of participants with account balances2015-01-01163
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-013
2014: THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01398
Total number of active participants reported on line 7a of the Form 55002014-01-01413
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-0111
Total of all active and inactive participants2014-01-01424
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-01424
Number of participants with account balances2014-01-01137
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-012

Financial Data on THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN

Measure Date Value
2021 : THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total transfer of assets from this plan2021-12-31$7,523,965
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$2,150,664
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$1,201,405
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$1,010,399
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$1,291,662
Value of total assets at end of year2021-12-31$141,434
Value of total assets at beginning of year2021-12-31$6,716,140
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$191,006
Total interest from all sources2021-12-31$4,863
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$509,817
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$509,817
Administrative expenses professional fees incurred2021-12-31$159,115
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$954,240
Participant contributions at end of year2021-12-31$0
Participant contributions at beginning of year2021-12-31$71,656
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$107,446
Other income not declared elsewhere2021-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$949,259
Value of net assets at end of year (total assets less liabilities)2021-12-31$141,434
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$6,716,140
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Investment advisory and management fees2021-12-31$31,891
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$6,482,759
Interest on participant loans2021-12-31$4,863
Interest earned on other investments2021-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$141,434
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$161,725
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$344,322
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$229,976
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$1,010,399
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32021-12-31Yes
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31MCGOWAN GUNTERMAN
Accountancy firm EIN2021-12-31953680171
2020 : THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$1,978,402
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$517,807
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$394,035
Expenses. Certain deemed distributions of participant loans2020-12-31$1,997
Value of total corrective distributions2020-12-31$35,893
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$1,052,137
Value of total assets at end of year2020-12-31$6,716,140
Value of total assets at beginning of year2020-12-31$5,255,545
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$85,882
Total interest from all sources2020-12-31$3,994
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$138,853
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$138,853
Administrative expenses professional fees incurred2020-12-31$58,689
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$747,994
Participant contributions at end of year2020-12-31$71,656
Participant contributions at beginning of year2020-12-31$62,081
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$120,184
Other income not declared elsewhere2020-12-31$29,050
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$1,460,595
Value of net assets at end of year (total assets less liabilities)2020-12-31$6,716,140
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$5,255,545
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Investment advisory and management fees2020-12-31$27,193
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$6,482,759
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$5,093,787
Interest on participant loans2020-12-31$3,389
Interest earned on other investments2020-12-31$605
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$161,725
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$99,677
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$754,368
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$183,959
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$394,035
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31MCGOWAN GUNTERMAN
Accountancy firm EIN2020-12-31953680171
2019 : THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$1,822,098
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$437,847
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$363,452
Expenses. Certain deemed distributions of participant loans2019-12-31$2,530
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$848,179
Value of total assets at end of year2019-12-31$5,255,545
Value of total assets at beginning of year2019-12-31$3,871,294
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$71,865
Total interest from all sources2019-12-31$3,380
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$116,493
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2019-12-31$116,493
Administrative expenses professional fees incurred2019-12-31$54,061
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$387,130
If this is an individual account plan, was there a blackout period2019-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$649,494
Participant contributions at end of year2019-12-31$62,081
Participant contributions at beginning of year2019-12-31$46,830
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$37,724
Other income not declared elsewhere2019-12-31$43,131
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$1,384,251
Value of net assets at end of year (total assets less liabilities)2019-12-31$5,255,545
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$3,871,294
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Investment advisory and management fees2019-12-31$17,804
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$5,093,787
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$3,784,691
Interest on participant loans2019-12-31$3,041
Interest earned on other investments2019-12-31$339
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$99,677
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$39,773
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$810,915
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$160,961
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$363,452
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31MCGOWAN GUNTERMAN
Accountancy firm EIN2019-12-31953680171
2018 : THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total income from all sources (including contributions)2018-12-31$555,256
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$599,164
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$524,751
Expenses. Certain deemed distributions of participant loans2018-12-31$11,831
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$822,395
Value of total assets at end of year2018-12-31$3,871,294
Value of total assets at beginning of year2018-12-31$3,915,202
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$62,582
Total interest from all sources2018-12-31$2,796
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$107,052
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2018-12-31$107,052
Administrative expenses professional fees incurred2018-12-31$48,287
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$391,521
If this is an individual account plan, was there a blackout period2018-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$529,389
Participant contributions at end of year2018-12-31$46,830
Participant contributions at beginning of year2018-12-31$66,787
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$158,923
Other income not declared elsewhere2018-12-31$17,309
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-43,908
Value of net assets at end of year (total assets less liabilities)2018-12-31$3,871,294
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$3,915,202
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Investment advisory and management fees2018-12-31$14,295
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$3,784,691
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$3,824,328
Interest on participant loans2018-12-31$2,681
Interest earned on other investments2018-12-31$115
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$39,773
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$24,087
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-394,296
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$134,083
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$524,751
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31MCGOWAN GUNTERMAN
Accountancy firm EIN2018-12-31953680171
2017 : THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total income from all sources (including contributions)2017-12-31$1,304,800
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$102,174
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$69,918
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$739,779
Value of total assets at end of year2017-12-31$3,915,202
Value of total assets at beginning of year2017-12-31$2,712,576
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$32,256
Total interest from all sources2017-12-31$3,012
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$85,333
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2017-12-31$85,333
Administrative expenses professional fees incurred2017-12-31$32,256
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$271,258
If this is an individual account plan, was there a blackout period2017-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$464,624
Participant contributions at end of year2017-12-31$66,787
Participant contributions at beginning of year2017-12-31$58,835
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$147,336
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$1,202,626
Value of net assets at end of year (total assets less liabilities)2017-12-31$3,915,202
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$2,712,576
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$3,824,328
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$2,642,092
Interest on participant loans2017-12-31$2,918
Interest earned on other investments2017-12-31$94
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-12-31$24,087
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-12-31$11,649
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$476,676
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$127,819
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$69,918
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31Yes
Opinion of an independent qualified public accountant for this plan2017-12-31Disclaimer
Accountancy firm name2017-12-31MCGOWAN GUNTERMAN
Accountancy firm EIN2017-12-31953680171
2016 : THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total income from all sources (including contributions)2016-12-31$1,047,604
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$127,116
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$123,113
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$893,762
Value of total assets at end of year2016-12-31$2,712,576
Value of total assets at beginning of year2016-12-31$1,792,088
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$4,003
Total interest from all sources2016-12-31$3,133
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$62,386
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$62,386
Administrative expenses professional fees incurred2016-12-31$4,003
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$179,209
If this is an individual account plan, was there a blackout period2016-12-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$394,862
Participant contributions at end of year2016-12-31$58,835
Participant contributions at beginning of year2016-12-31$17,535
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$387,674
Total non interest bearing cash at end of year2016-12-31$0
Total non interest bearing cash at beginning of year2016-12-31$4,241
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$920,488
Value of net assets at end of year (total assets less liabilities)2016-12-31$2,712,576
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$1,792,088
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$2,642,092
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$1,770,312
Interest on participant loans2016-12-31$1,373
Interest earned on other investments2016-12-31$1,760
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$11,649
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$-10,861
Net investment gain/loss from pooled separate accounts2016-12-31$99,184
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$111,226
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$123,113
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-12-31Yes
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31MCGOWAN GUNTERMAN
Accountancy firm EIN2016-12-31953680171
2015 : THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total income from all sources (including contributions)2015-12-31$396,512
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$36,834
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$24,641
Value of total corrective distributions2015-12-31$11,501
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$427,483
Value of total assets at end of year2015-12-31$1,792,088
Value of total assets at beginning of year2015-12-31$1,432,410
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$692
Total interest from all sources2015-12-31$557
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Administrative expenses professional fees incurred2015-12-31$692
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$150,000
If this is an individual account plan, was there a blackout period2015-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$311,435
Participant contributions at end of year2015-12-31$17,535
Participant contributions at beginning of year2015-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$28,358
Total non interest bearing cash at end of year2015-12-31$4,241
Total non interest bearing cash at beginning of year2015-12-31$1,691
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$359,678
Value of net assets at end of year (total assets less liabilities)2015-12-31$1,792,088
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$1,432,410
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$1,770,312
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$1,430,719
Interest on participant loans2015-12-31$557
Net investment gain/loss from pooled separate accounts2015-12-31$-31,528
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$87,690
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$24,641
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31MCGOWAN GUNTERMAN
Accountancy firm EIN2015-12-31953680171
2014 : THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total income from all sources (including contributions)2014-12-31$394,051
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$59,011
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$58,584
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$331,475
Value of total assets at end of year2014-12-31$1,432,410
Value of total assets at beginning of year2014-12-31$1,097,370
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$427
Total interest from all sources2014-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Administrative expenses professional fees incurred2014-12-31$427
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$150,000
If this is an individual account plan, was there a blackout period2014-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$235,834
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$25,108
Assets. Loans (other than to participants) at end of year2014-12-31$0
Assets. Loans (other than to participants) at beginning of year2014-12-31$29
Total non interest bearing cash at end of year2014-12-31$1,691
Total non interest bearing cash at beginning of year2014-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$335,040
Value of net assets at end of year (total assets less liabilities)2014-12-31$1,432,410
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$1,097,370
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$1,430,719
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$1,097,341
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-12-31$0
Net investment gain/loss from pooled separate accounts2014-12-31$62,576
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$70,533
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$58,584
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31MCGOWAN GUNTERMAN
Accountancy firm EIN2014-12-31953680171

Form 5500 Responses for THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN

2021: THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement - TrustYes
2020: THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement - TrustYes
2019: THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement - TrustYes
2018: THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement - TrustYes
2017: THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement - TrustYes
2016: THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedYes
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement - TrustYes
2015: THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement - TrustYes
2014: THE HABIT RESTAURANTS, LLC 401(K) PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number500681-01
Policy instance 1
Insurance contract or identification number500681-01
Number of Individuals Covered86
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number500681-01
Policy instance 1
Insurance contract or identification number500681-01
Number of Individuals Covered74
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number500681-01
Policy instance 1
Insurance contract or identification number500681-01
Number of Individuals Covered53
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number500681-01
Policy instance 1
Insurance contract or identification number500681-01
Number of Individuals Covered38
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number500681-01
Policy instance 1
Insurance contract or identification number500681-01
Number of Individuals Covered24
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number89247
Policy instance 1
Insurance contract or identification number89247
Number of Individuals Covered246
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $13,070
Total amount of fees paid to insurance companyUSD $1,441
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,070
Insurance broker organization code?3
Amount paid for insurance broker fees1441
Additional information about fees paid to insurance brokerADMINISTRATIVE REIMBURSEMENT
Insurance broker nameKRAVITZ, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number89247
Policy instance 1
Insurance contract or identification number89247
Number of Individuals Covered220
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $10,043
Total amount of fees paid to insurance companyUSD $1,046
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,043
Insurance broker organization code?3
Amount paid for insurance broker fees1046
Additional information about fees paid to insurance brokerADMINISTRATIVE REIMBURSEMENT
Insurance broker nameKRAVITZ, INC.

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