401k Plan data: NE TIMEAS RESTAURANT GROUP HEALTH AND WELFARE BENEFIT PLAN plan

NE TIMEAS RESTAURANT GROUP HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	NE TIMEAS RESTAURANT GROUP HEALTH AND WELFARE BENEFIT PLAN
Plan identification number	501

NE TIMEAS RESTAURANT GROUP HEALTH AND WELFARE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

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

Company Name: NE TIMEAS RESTAURANT GROUP, INC.

Employer identification number (EIN): 262650938

NAIC Classification: 722511
NAIC Description: Full-Service Restaurants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NE TIMEAS RESTAURANT GROUP HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-01-01

Plan Statistics for NE TIMEAS RESTAURANT GROUP HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for NE TIMEAS RESTAURANT GROUP HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2017: NE TIMEAS RESTAURANT GROUP HEALTH AND WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 121
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 90
Number of retired or separated participants receiving benefits 2017-01-01 3
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 93

Measure	Date	Value
2017: NE TIMEAS RESTAURANT GROUP HEALTH AND WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	121
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	90
Number of retired or separated participants receiving benefits	2017-01-01	3
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	93

Form 5500 Responses for NE TIMEAS RESTAURANT GROUP HEALTH AND WELFARE BENEFIT PLAN

2017: NE TIMEAS RESTAURANT GROUP HEALTH AND WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	First time form 5500 has been submitted	Yes
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

663505

Policy instance

Insurance contract or identification number	663505
Number of Individuals Covered	102
Insurance policy start date	2016-12-01
Insurance policy end date	2017-11-30
Total amount of commissions paid to insurance broker	USD $23,990
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $495,215
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,469
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	INTERNATIONAL PROINSURANCE SERVICES

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Company Name:	NE TIMEAS RESTAURANT GROUP, INC.
Employer identification number (EIN):	262650938
NAIC Classification:	722511
NAIC Description:	Full-Service Restaurants