401k Plan data: JERSEY MIKE'S FRANCHISE SYSTEMS GROUP PLAN plan

JERSEY MIKE'S FRANCHISE SYSTEMS GROUP PLAN 401k Plan overview

Plan Name	JERSEY MIKE'S FRANCHISE SYSTEMS GROUP PLAN
Plan identification number	501

JERSEY MIKE'S FRANCHISE SYSTEMS GROUP PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

JERSEY MIKE'S FRANCHISE SYSTEMS, INC. has sponsored the creation of one or more 401k plans.

Company Name: JERSEY MIKE'S FRANCHISE SYSTEMS, INC.

Employer identification number (EIN): 222815245

NAIC Classification: 533110
NAIC Description: Lessors of Nonfinancial Intangible Assets (except Copyrighted Works)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JERSEY MIKE'S FRANCHISE SYSTEMS GROUP PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-04-01 PATRICIA GILLMANN, CPA 2024-10-21
501 2022-04-01 PATRICIA GILLMANN, CPA 2023-10-31
501 2021-04-01 PATRICIA GILLMANN, CPA 2022-10-14
501 2020-04-01 PATRICIA GILLMANN, CPA 2021-10-14
501 2019-04-01 PATRICIA GILLMANN, CPA 2020-10-28
501 2018-04-01 PATRICIA GILLMANN, CPA 2019-12-05
501 2017-04-01
501 2016-04-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-04-01	PATRICIA GILLMANN, CPA	2024-10-21
501	2022-04-01	PATRICIA GILLMANN, CPA	2023-10-31
501	2021-04-01	PATRICIA GILLMANN, CPA	2022-10-14
501	2020-04-01	PATRICIA GILLMANN, CPA	2021-10-14
501	2019-04-01	PATRICIA GILLMANN, CPA	2020-10-28
501	2018-04-01	PATRICIA GILLMANN, CPA	2019-12-05
501	2017-04-01
501	2016-04-01

Form 5500 Responses for JERSEY MIKE'S FRANCHISE SYSTEMS GROUP PLAN

2023: JERSEY MIKE'S FRANCHISE SYSTEMS GROUP PLAN 2023 form 5500 responses
2023-04-01	Type of plan entity	Single employer plan
2023-04-01	Plan funding arrangement – Insurance	Yes
2023-04-01	Plan benefit arrangement – Insurance	Yes
2022: JERSEY MIKE'S FRANCHISE SYSTEMS GROUP PLAN 2022 form 5500 responses
2022-04-01	Type of plan entity	Single employer plan
2022-04-01	Plan funding arrangement – Insurance	Yes
2022-04-01	Plan benefit arrangement – Insurance	Yes
2021: JERSEY MIKE'S FRANCHISE SYSTEMS GROUP PLAN 2021 form 5500 responses
2021-04-01	Type of plan entity	Single employer plan
2021-04-01	Plan funding arrangement – Insurance	Yes
2021-04-01	Plan benefit arrangement – Insurance	Yes
2020: JERSEY MIKE'S FRANCHISE SYSTEMS GROUP PLAN 2020 form 5500 responses
2020-04-01	Type of plan entity	Single employer plan
2020-04-01	Plan funding arrangement – Insurance	Yes
2020-04-01	Plan benefit arrangement – Insurance	Yes
2019: JERSEY MIKE'S FRANCHISE SYSTEMS GROUP PLAN 2019 form 5500 responses
2019-04-01	Type of plan entity	Single employer plan
2019-04-01	Plan funding arrangement – Insurance	Yes
2019-04-01	Plan benefit arrangement – Insurance	Yes
2018: JERSEY MIKE'S FRANCHISE SYSTEMS GROUP PLAN 2018 form 5500 responses
2018-04-01	Type of plan entity	Single employer plan
2018-04-01	Plan funding arrangement – Insurance	Yes
2018-04-01	Plan benefit arrangement – Insurance	Yes
2017: JERSEY MIKE'S FRANCHISE SYSTEMS GROUP PLAN 2017 form 5500 responses
2017-04-01	Type of plan entity	Single employer plan
2017-04-01	Plan funding arrangement – Insurance	Yes
2017-04-01	Plan benefit arrangement – Insurance	Yes
2016: JERSEY MIKE'S FRANCHISE SYSTEMS GROUP PLAN 2016 form 5500 responses
2016-04-01	Type of plan entity	Single employer plan
2016-04-01	First time form 5500 has been submitted	Yes
2016-04-01	Plan funding arrangement – Insurance	Yes
2016-04-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00636107

Policy instance

Insurance contract or identification number	00636107
Number of Individuals Covered	289
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $149,330
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $958,702
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

0636107

Policy instance

Insurance contract or identification number	0636107
Number of Individuals Covered	246
Insurance policy start date	2022-05-01
Insurance policy end date	2023-04-30
Total amount of commissions paid to insurance broker	USD $9,380
Total amount of fees paid to insurance company	USD $6,484
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $164,044
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50010632

Policy instance

Insurance contract or identification number	50010632
Number of Individuals Covered	306
Insurance policy start date	2023-04-01
Insurance policy end date	2024-03-31
Total amount of commissions paid to insurance broker	USD $2,906
Total amount of fees paid to insurance company	USD $1,381
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $24,882
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50010632

Policy instance

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

80431

Policy instance

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

80431

Policy instance

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

80431

Policy instance

HORIZON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14690 )

Policy contract number

80431

Policy instance

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50010632

Policy instance

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

80431

Policy instance

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

80431

Policy instance

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

80431

Policy instance

HORIZON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14690 )

Policy contract number

80431

Policy instance

HORIZON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14690 )

Policy contract number

80431

Policy instance

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

80431

Policy instance

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

80431

Policy instance

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

80431

Policy instance

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50010632

Policy instance

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50010632

Policy instance

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

80431

Policy instance

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

80431

Policy instance

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

80431

Policy instance

HORIZON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14690 )

Policy contract number

80431

Policy instance

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

80431

Policy instance

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50010632

Policy instance

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

80431

Policy instance

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

80431

Policy instance

HORIZON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14690 )

Policy contract number

80431

Policy instance

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

80431

Policy instance

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

80431

Policy instance

HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )

Policy contract number

80431

Policy instance

HORIZON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14690 )

Policy contract number

80431

Policy instance

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50010632

Policy instance

Potentially related plans

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Company Name:	JERSEY MIKE'S FRANCHISE SYSTEMS, INC.
Employer identification number (EIN):	222815245
NAIC Classification:	533110
NAIC Description:	Lessors of Nonfinancial Intangible Assets (except Copyrighted Works)