401k Plan data: JAE RESTAURANT GROUP 401(K) PLAN plan

JAE RESTAURANT GROUP 401(K) PLAN 401k Plan overview

Plan Name	JAE RESTAURANT GROUP 401(K) PLAN
Plan identification number	001

JAE RESTAURANT GROUP 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.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
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.

401k Sponsoring company profile

JAE RESTAURANT GROUP, LLC has sponsored the creation of one or more 401k plans.

Company Name: JAE RESTAURANT GROUP, LLC

Employer identification number (EIN): 205664841

NAIC Classification: 722511
NAIC Description: Full-Service Restaurants

Additional information about JAE RESTAURANT GROUP, LLC

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 2006-10-04

Company Identification Number: L06000097048

Legal Registered Office Address: C/O JAE RESTAURANT GROUP, LLC

POMPANO BEACH

33064

More information about JAE RESTAURANT GROUP, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JAE RESTAURANT GROUP 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01 ANTONETTE RODRIGUEZ
001 2016-11-01 ANTONETTE RODRIGUEZ

Plan Statistics for JAE RESTAURANT GROUP 401(K) PLAN

401k plan membership statisitcs for JAE RESTAURANT GROUP 401(K) PLAN

Measure Date Value
2022: JAE RESTAURANT GROUP 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 1,505
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 0
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 0
Number of participants with account balances 2022-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: JAE RESTAURANT GROUP 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 2,155
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 1,275
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 230
Total of all active and inactive participants 2021-01-01 1,505
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 1,505
Number of participants with account balances 2021-01-01 388
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 17
2020: JAE RESTAURANT GROUP 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 2,236
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 1,905
Number of retired or separated participants receiving benefits 2020-01-01 7
Number of other retired or separated participants entitled to future benefits 2020-01-01 91
Total of all active and inactive participants 2020-01-01 2,003
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 2,003
Number of participants with account balances 2020-01-01 426
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 7
2019: JAE RESTAURANT GROUP 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 2,392
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 1,973
Number of retired or separated participants receiving benefits 2019-01-01 1
Number of other retired or separated participants entitled to future benefits 2019-01-01 86
Total of all active and inactive participants 2019-01-01 2,060
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 2,060
Number of participants with account balances 2019-01-01 425
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 30
2018: JAE RESTAURANT GROUP 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 2,222
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 1,982
Number of retired or separated participants receiving benefits 2018-01-01 13
Number of other retired or separated participants entitled to future benefits 2018-01-01 88
Total of all active and inactive participants 2018-01-01 2,083
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 2,083
Number of participants with account balances 2018-01-01 455
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 35
2017: JAE RESTAURANT GROUP 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 1,948
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 1,778
Number of retired or separated participants receiving benefits 2017-01-01 2
Number of other retired or separated participants entitled to future benefits 2017-01-01 34
Total of all active and inactive participants 2017-01-01 1,814
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 1,814
Number of participants with account balances 2017-01-01 364
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 17
2016: JAE RESTAURANT GROUP 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-11-01 1,474
Total number of active participants reported on line 7a of the Form 5500 2016-11-01 1,416
Number of retired or separated participants receiving benefits 2016-11-01 0
Number of other retired or separated participants entitled to future benefits 2016-11-01 4
Total of all active and inactive participants 2016-11-01 1,420
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-11-01 0
Total participants 2016-11-01 1,420
Number of participants with account balances 2016-11-01 299
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-11-01 1

Measure	Date	Value
2022: JAE RESTAURANT GROUP 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	1,505
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	0
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	0
Number of participants with account balances	2022-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: JAE RESTAURANT GROUP 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	2,155
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	1,275
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	230
Total of all active and inactive participants	2021-01-01	1,505
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	1,505
Number of participants with account balances	2021-01-01	388
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	17
2020: JAE RESTAURANT GROUP 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	2,236
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	1,905
Number of retired or separated participants receiving benefits	2020-01-01	7
Number of other retired or separated participants entitled to future benefits	2020-01-01	91
Total of all active and inactive participants	2020-01-01	2,003
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	2,003
Number of participants with account balances	2020-01-01	426
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	7
2019: JAE RESTAURANT GROUP 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	2,392
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	1,973
Number of retired or separated participants receiving benefits	2019-01-01	1
Number of other retired or separated participants entitled to future benefits	2019-01-01	86
Total of all active and inactive participants	2019-01-01	2,060
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	2,060
Number of participants with account balances	2019-01-01	425
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	30
2018: JAE RESTAURANT GROUP 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	2,222
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	1,982
Number of retired or separated participants receiving benefits	2018-01-01	13
Number of other retired or separated participants entitled to future benefits	2018-01-01	88
Total of all active and inactive participants	2018-01-01	2,083
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	2,083
Number of participants with account balances	2018-01-01	455
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	35
2017: JAE RESTAURANT GROUP 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	1,948
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	1,778
Number of retired or separated participants receiving benefits	2017-01-01	2
Number of other retired or separated participants entitled to future benefits	2017-01-01	34
Total of all active and inactive participants	2017-01-01	1,814
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	1,814
Number of participants with account balances	2017-01-01	364
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	17
2016: JAE RESTAURANT GROUP 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-11-01	1,474
Total number of active participants reported on line 7a of the Form 5500	2016-11-01	1,416
Number of retired or separated participants receiving benefits	2016-11-01	0
Number of other retired or separated participants entitled to future benefits	2016-11-01	4
Total of all active and inactive participants	2016-11-01	1,420
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-11-01	0
Total participants	2016-11-01	1,420
Number of participants with account balances	2016-11-01	299
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-11-01	1

Financial Data on JAE RESTAURANT GROUP 401(K) PLAN

Measure	Date	Value
2022 : JAE RESTAURANT GROUP 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-11-11	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-11-11	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-11-11	$0
Total income from all sources (including contributions)	2022-11-11	$-233,370
Total loss/gain on sale of assets	2022-11-11	$0
Total of all expenses incurred	2022-11-11	$3,643,552
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-11-11	$3,617,153
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-11-11	$7,474
Value of total assets at end of year	2022-11-11	$0
Value of total assets at beginning of year	2022-11-11	$3,876,922
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-11-11	$26,399
Total interest from all sources	2022-11-11	$22
Total dividends received (eg from common stock, registered investment company shares)	2022-11-11	$134
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-11-11	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2022-11-11	$0
Total dividends received from registered investment company shares (eg mutual funds)	2022-11-11	$134
Administrative expenses professional fees incurred	2022-11-11	$11,149
Was this plan covered by a fidelity bond	2022-11-11	Yes
Value of fidelity bond cover	2022-11-11	$500,000
If this is an individual account plan, was there a blackout period	2022-11-11	No
Were there any nonexempt tranactions with any party-in-interest	2022-11-11	No
Contributions received from participants	2022-11-11	$6,450
Participant contributions at end of year	2022-11-11	$0
Participant contributions at beginning of year	2022-11-11	$14,444
Administrative expenses (other) incurred	2022-11-11	$385
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-11-11	No
Value of net income/loss	2022-11-11	$-3,876,922
Value of net assets at end of year (total assets less liabilities)	2022-11-11	$0
Value of net assets at beginning of year (total assets less liabilities)	2022-11-11	$3,876,922
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-11-11	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-11-11	No
Were any leases to which the plan was party in default or uncollectible	2022-11-11	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-11-11	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-11-11	$3,848,542
Interest earned on other investments	2022-11-11	$22
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-11-11	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-11-11	$11,355
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-11-11	$-241,000
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-11-11	No
Was there a failure to transmit to the plan any participant contributions	2022-11-11	Yes
Has the plan failed to provide any benefit when due under the plan	2022-11-11	No
Contributions received in cash from employer	2022-11-11	$1,024
Employer contributions (assets) at end of year	2022-11-11	$0
Employer contributions (assets) at beginning of year	2022-11-11	$2,581
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-11-11	$3,617,153
Contract administrator fees	2022-11-11	$14,865
Did the plan have assets held for investment	2022-11-11	No
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	2022-11-11	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-11-11	Yes
Opinion of an independent qualified public accountant for this plan	2022-11-11	Unqualified
Accountancy firm name	2022-11-11	GRANT THORNTON, LLP
Accountancy firm EIN	2022-11-11	036605558
2021 : JAE RESTAURANT GROUP 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
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	$1,200,424
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$459,699
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$396,411
Value of total corrective distributions	2021-12-31	$46,178
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$774,131
Value of total assets at end of year	2021-12-31	$3,859,897
Value of total assets at beginning of year	2021-12-31	$3,119,172
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$17,110
Total interest from all sources	2021-12-31	$104
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$210,836
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$210,836
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	Yes
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$529,006
Participant contributions at end of year	2021-12-31	$14,444
Participant contributions at beginning of year	2021-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$154,344
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$740,725
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$3,859,897
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$3,119,172
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$3,848,542
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$0
Value of interest in pooled separate accounts at end of year	2021-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$3,119,172
Interest earned on other investments	2021-12-31	$104
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$11,355
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$153,342
Net investment gain/loss from pooled separate accounts	2021-12-31	$62,011
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$90,781
Employer contributions (assets) at end of year	2021-12-31	$2,581
Employer contributions (assets) at beginning of year	2021-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$396,411
Contract administrator fees	2021-12-31	$17,110
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2021-12-31	Yes
Did the plan have assets held for investment	2021-12-31	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	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	GRANT THORNTON, LLP
Accountancy firm EIN	2021-12-31	036605558
2020 : JAE RESTAURANT GROUP 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$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	$1,054,925
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$488,792
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$365,493
Value of total corrective distributions	2020-12-31	$108,726
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$669,012
Value of total assets at end of year	2020-12-31	$3,119,172
Value of total assets at beginning of year	2020-12-31	$2,553,039
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$14,573
Total interest from all sources	2020-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$535,174
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$38,648
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$566,133
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$3,119,172
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$2,553,039
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Investment advisory and management fees	2020-12-31	$14,573
Value of interest in pooled separate accounts at end of year	2020-12-31	$3,119,172
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$2,553,039
Net investment gain/loss from pooled separate accounts	2020-12-31	$385,913
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$95,190
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$365,493
Did the plan have assets held for investment	2020-12-31	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	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	GRANT THORNTON, LLP
Accountancy firm EIN	2020-12-31	036605558
2019 : JAE RESTAURANT GROUP 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$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	$1,149,747
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$462,882
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$384,500
Value of total corrective distributions	2019-12-31	$63,955
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$750,474
Value of total assets at end of year	2019-12-31	$2,557,136
Value of total assets at beginning of year	2019-12-31	$1,870,271
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$14,427
Total interest from all sources	2019-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$641,424
Participant contributions at end of year	2019-12-31	$3,742
Participant contributions at beginning of year	2019-12-31	$0
Other income not declared elsewhere	2019-12-31	$1,259
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$686,865
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$2,557,136
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$1,870,271
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Investment advisory and management fees	2019-12-31	$14,427
Value of interest in pooled separate accounts at end of year	2019-12-31	$2,553,039
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$1,870,271
Net investment gain/loss from pooled separate accounts	2019-12-31	$398,014
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$109,050
Employer contributions (assets) at end of year	2019-12-31	$355
Employer contributions (assets) at beginning of year	2019-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$384,500
Did the plan have assets held for investment	2019-12-31	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	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	GRANT THORNTON, LLP
Accountancy firm EIN	2019-12-31	036605558
2018 : JAE RESTAURANT GROUP 401(K) PLAN 2018 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
2017 : JAE RESTAURANT GROUP 401(K) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$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	$794,482
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$41,802
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$34,516
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$730,007
Value of total assets at end of year	2017-12-31	$852,236
Value of total assets at beginning of year	2017-12-31	$99,556
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$7,286
Total interest from all sources	2017-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	No
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$581,614
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$48,209
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$752,680
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$852,236
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$99,556
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in pooled separate accounts at end of year	2017-12-31	$852,236
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$99,556
Net investment gain/loss from pooled separate accounts	2017-12-31	$64,475
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$100,184
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$34,516
Contract administrator fees	2017-12-31	$7,286
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2017-12-31	No
Did the plan have assets held for investment	2017-12-31	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	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	MILLER CPA, PLLC
Accountancy firm EIN	2017-12-31	821430242
2016 : JAE RESTAURANT GROUP 401(K) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$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	$101,056
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$1,500
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$100,622
Value of total assets at end of year	2016-12-31	$99,556
Value of total assets at beginning of year	2016-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$1,500
Total interest from all sources	2016-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	No
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$13,661
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$8,585
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$99,556
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$99,556
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$99,556
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$434
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$78,376
Contract administrator fees	2016-12-31	$1,500
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2016-12-31	No
Did the plan have assets held for investment	2016-12-31	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	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No

Form 5500 Responses for JAE RESTAURANT GROUP 401(K) PLAN

2022: JAE RESTAURANT GROUP 401(K) PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	Yes
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: JAE RESTAURANT GROUP 401(K) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	Yes
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: JAE RESTAURANT GROUP 401(K) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: JAE RESTAURANT GROUP 401(K) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: JAE RESTAURANT GROUP 401(K) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: JAE RESTAURANT GROUP 401(K) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: JAE RESTAURANT GROUP 401(K) PLAN 2016 form 5500 responses
2016-11-01	Type of plan entity	Single employer plan
2016-11-01	First time form 5500 has been submitted	Yes
2016-11-01	Submission has been amended	No
2016-11-01	This submission is the final filing	No
2016-11-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2016-11-01	Plan is a collectively bargained plan	No
2016-11-01	Plan funding arrangement – Insurance	Yes
2016-11-01	Plan funding arrangement – Trust	Yes
2016-11-01	Plan benefit arrangement – Insurance	Yes
2016-11-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

896675-087

Policy instance

Insurance contract or identification number	896675-087
Number of Individuals Covered	0
Insurance policy start date	2022-01-01
Insurance policy end date	2022-11-11
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	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

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

670161

Policy instance

Insurance contract or identification number	670161
Number of Individuals Covered	0
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	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

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

896675-087

Policy instance

Insurance contract or identification number	896675-087
Number of Individuals Covered	2
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
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 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

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

670161

Policy instance

Insurance contract or identification number	670161
Number of Individuals Covered	421
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	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

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

670161

Policy instance

Insurance contract or identification number	670161
Number of Individuals Covered	424
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	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

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 78778 )

Policy contract number

633212

Policy instance

Insurance contract or identification number	633212
Number of Individuals Covered	444
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,393
Total amount of fees paid to insurance company	USD $93
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	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 $2,393
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	0
Insurance broker organization code?	4

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 78778 )

Policy contract number

633212

Policy instance

Insurance contract or identification number	633212
Number of Individuals Covered	363
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,046
Total amount of fees paid to insurance company	USD $283
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	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 $2,046
Insurance broker organization code?	4
Amount paid for insurance broker fees	156
Additional information about fees paid to insurance broker	MARKETING ALLOWANCE AND/OR SERVICE FEES
Insurance broker name	SWBC INVESTMENT ADVISORY

Potentially related plans

JAE RESTAURANT GROUP, LLC WELFARE BENEFITS PLAN [EIN = 205854958]

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See full terms and conditions

Company Name:	JAE RESTAURANT GROUP, LLC
Employer identification number (EIN):	205664841
NAIC Classification:	722511
NAIC Description:	Full-Service Restaurants

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	2006-10-04
Company Identification Number:	L06000097048
Legal Registered Office Address:	C/O JAE RESTAURANT GROUP, LLC POMPANO BEACH 33064