401k Plan data: COASTAL RESTAURANT GROUP, INC. 401(K) PLAN plan

COASTAL RESTAURANT GROUP, INC. 401(K) PLAN 401k Plan overview

Plan Name	COASTAL RESTAURANT GROUP, INC. 401(K) PLAN
Plan identification number	001

COASTAL RESTAURANT GROUP, INC. 401(K) PLAN Benefits

401k Plan Type

Defined 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.
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

COASTAL RESTAURANT GROUP, INC. has sponsored the creation of one or more 401k plans.

Company Name: COASTAL RESTAURANT GROUP, INC.

Employer identification number (EIN): 203771369

NAIC Classification: 722513
NAIC Description: Limited-Service Restaurants

Additional information about COASTAL RESTAURANT GROUP, INC.

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 2005-11-10

Company Identification Number: 3279948

Legal Registered Office Address: JEFFREY F PARKER
403 W BROAD ST
HORSEHEADS
United States of America (USA)
14845

More information about COASTAL RESTAURANT GROUP, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COASTAL RESTAURANT GROUP, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 ALISON PARKER 2017-10-12 ALISON PARKER 2017-10-12
001 2015-01-01 ALISON PARKER 2016-07-20
001 2014-01-01 ALISON PARKER 2015-10-13 ALISON PARKER 2015-10-13
001 2013-01-01 JACKIE GREENAWALT
001 2012-01-01 JACKIE GREENAWALT
001 2011-01-01 JACKIE GREENAWALT
001 2010-01-01 JACKIE GREENAWALT 2011-10-17

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2016-01-01	ALISON PARKER	2017-10-12	ALISON PARKER	2017-10-12
001	2015-01-01	ALISON PARKER	2016-07-20
001	2014-01-01	ALISON PARKER	2015-10-13	ALISON PARKER	2015-10-13
001	2013-01-01	JACKIE GREENAWALT
001	2012-01-01	JACKIE GREENAWALT
001	2011-01-01	JACKIE GREENAWALT
001	2010-01-01	JACKIE GREENAWALT	2011-10-17

Plan Statistics for COASTAL RESTAURANT GROUP, INC. 401(K) PLAN

401k plan membership statisitcs for COASTAL RESTAURANT GROUP, INC. 401(K) PLAN

Measure Date Value
2013: COASTAL RESTAURANT GROUP, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 107
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 79
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 12
Total of all active and inactive participants 2013-01-01 91
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 91
Number of participants with account balances 2013-01-01 60
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 7
2012: COASTAL RESTAURANT GROUP, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 149
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 81
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 17
Total of all active and inactive participants 2012-01-01 98
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 98
Number of participants with account balances 2012-01-01 58
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 18
2011: COASTAL RESTAURANT GROUP, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 142
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 116
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 21
Total of all active and inactive participants 2011-01-01 137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 137
Number of participants with account balances 2011-01-01 72
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 10

Measure	Date	Value
2013: COASTAL RESTAURANT GROUP, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	107
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	79
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	12
Total of all active and inactive participants	2013-01-01	91
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	91
Number of participants with account balances	2013-01-01	60
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	7
2012: COASTAL RESTAURANT GROUP, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	149
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	81
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	17
Total of all active and inactive participants	2012-01-01	98
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	98
Number of participants with account balances	2012-01-01	58
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	18
2011: COASTAL RESTAURANT GROUP, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	142
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	116
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	21
Total of all active and inactive participants	2011-01-01	137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	137
Number of participants with account balances	2011-01-01	72
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	10

Financial Data on COASTAL RESTAURANT GROUP, INC. 401(K) PLAN

Measure	Date	Value
2013 : COASTAL RESTAURANT GROUP, INC. 401(K) PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$123,203
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$84,549
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$66,401
Value of total corrective distributions	2013-12-31	$9,861
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$70,412
Value of total assets at end of year	2013-12-31	$348,481
Value of total assets at beginning of year	2013-12-31	$309,827
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$8,287
Total interest from all sources	2013-12-31	$94
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Administrative expenses professional fees incurred	2013-12-31	$5,000
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$20,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$59,876
Participant contributions at end of year	2013-12-31	$1,534
Participant contributions at beginning of year	2013-12-31	$2,582
Participant contributions at end of year	2013-12-31	$591
Participant contributions at beginning of year	2013-12-31	$0
Other income not declared elsewhere	2013-12-31	$88
Total non interest bearing cash at end of year	2013-12-31	$116
Total non interest bearing cash at beginning of year	2013-12-31	$3,156
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$38,654
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$348,481
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$309,827
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$346,092
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$304,089
Interest on participant loans	2013-12-31	$94
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$52,609
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$10,536
Employer contributions (assets) at end of year	2013-12-31	$148
Employer contributions (assets) at beginning of year	2013-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$66,401
Contract administrator fees	2013-12-31	$3,287
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	GRAY, GRAY & GRAY, LLP
Accountancy firm EIN	2013-12-31	042088368
2012 : COASTAL RESTAURANT GROUP, INC. 401(K) PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$106,044
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$79,899
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$71,182
Value of total corrective distributions	2012-12-31	$5,196
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$69,500
Value of total assets at end of year	2012-12-31	$309,827
Value of total assets at beginning of year	2012-12-31	$283,682
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$3,521
Total interest from all sources	2012-12-31	$148
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Administrative expenses professional fees incurred	2012-12-31	$50
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$20,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$60,389
Participant contributions at end of year	2012-12-31	$2,582
Participant contributions at beginning of year	2012-12-31	$2,960
Total non interest bearing cash at end of year	2012-12-31	$3,156
Total non interest bearing cash at beginning of year	2012-12-31	$1,190
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$26,145
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$309,827
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$283,682
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$304,089
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$279,532
Interest on participant loans	2012-12-31	$148
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$36,396
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$9,111
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$71,182
Contract administrator fees	2012-12-31	$3,471
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	GRAY, GRAY & GRAY LLP
Accountancy firm EIN	2012-12-31	042088368
2011 : COASTAL RESTAURANT GROUP, INC. 401(K) PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$75,193
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$30,856
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$10,767
Value of total corrective distributions	2011-12-31	$15,812
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$87,048
Value of total assets at end of year	2011-12-31	$283,682
Value of total assets at beginning of year	2011-12-31	$239,345
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$4,277
Total interest from all sources	2011-12-31	$173
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$20,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$72,188
Participant contributions at end of year	2011-12-31	$2,960
Participant contributions at beginning of year	2011-12-31	$2,694
Total non interest bearing cash at end of year	2011-12-31	$1,190
Total non interest bearing cash at beginning of year	2011-12-31	$1,011
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$44,337
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$283,682
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$239,345
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$279,532
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$235,640
Interest on participant loans	2011-12-31	$173
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-12,028
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$14,860
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$10,767
Contract administrator fees	2011-12-31	$4,277
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	UNKNOWN
Accountancy firm EIN	2011-12-31	111111111

Form 5500 Responses for COASTAL RESTAURANT GROUP, INC. 401(K) PLAN

2013: COASTAL RESTAURANT GROUP, INC. 401(K) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: COASTAL RESTAURANT GROUP, INC. 401(K) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: COASTAL RESTAURANT GROUP, INC. 401(K) PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	Yes
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 86375 )

Policy contract number

82095

Policy instance

Insurance contract or identification number	82095
Number of Individuals Covered	62
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,151
Total amount of fees paid to insurance company	USD $142
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,151
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMISSION
Insurance broker organization code?	7
Insurance broker name	PENNSYLVANIA PENSION PLANNERS

JOHN HANCOCK LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 86375 )

Policy contract number

82095

Policy instance

Insurance contract or identification number	82095
Number of Individuals Covered	66
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $982
Total amount of fees paid to insurance company	USD $50
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
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
Commission paid to Insurance Broker	USD $982
Additional information about fees paid to insurance broker	BROKER COMISSION
Insurance broker organization code?	7
Amount paid for insurance broker fees	50
Insurance broker name	PENNSYLVANIA PENSION PLANNERS

JOHN HANCOCK LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 86375 )

Policy contract number

82095

Policy instance

Insurance contract or identification number	82095
Number of Individuals Covered	80
Insurance policy start date	2011-01-01
Total amount of commissions paid to insurance broker	USD $1,172
Total amount of fees paid to insurance company	USD $0
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
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

Potentially related plans

COASTAL RESTAURANT GROUP, INC. 401(K) PLAN [EIN = 201824614]

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Company Name:	COASTAL RESTAURANT GROUP, INC.
Employer identification number (EIN):	203771369
NAIC Classification:	722513
NAIC Description:	Limited-Service Restaurants

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	2005-11-10
Company Identification Number:	3279948
Legal Registered Office Address:	JEFFREY F PARKER 403 W BROAD ST HORSEHEADS United States of America (USA) 14845