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LEMONADE RESTAURANT GROUP, LLC HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameLEMONADE RESTAURANT GROUP, LLC HEALTH AND WELFARE PLAN
Plan identification number 501

LEMONADE RESTAURANT GROUP, LLC HEALTH AND WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover
  • 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

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

Company Name:LEMONADE RESTAURANT GROUP, LLC
Employer identification number (EIN):270247767
NAIC Classification:722513
NAIC Description:Limited-Service Restaurants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LEMONADE RESTAURANT GROUP, LLC HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012020-09-01RYANNE MARTEL2022-06-16
5012020-09-01RYANNE MARTEL2022-06-02
5012019-09-01RYANNE MARTEL2021-06-07
5012018-09-01RYANNE MARTEL2020-06-09
5012017-09-01
5012016-09-01MICHAEL NISHI
5012015-09-01

Plan Statistics for LEMONADE RESTAURANT GROUP, LLC HEALTH AND WELFARE PLAN

401k plan membership statisitcs for LEMONADE RESTAURANT GROUP, LLC HEALTH AND WELFARE PLAN

Measure Date Value
2020: LEMONADE RESTAURANT GROUP, LLC HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-09-0166
Total number of active participants reported on line 7a of the Form 55002020-09-0139
Number of retired or separated participants receiving benefits2020-09-012
Number of other retired or separated participants entitled to future benefits2020-09-010
Total of all active and inactive participants2020-09-0141
Number of employers contributing to the scheme2020-09-010
2019: LEMONADE RESTAURANT GROUP, LLC HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-09-01229
Total number of active participants reported on line 7a of the Form 55002019-09-01223
Number of retired or separated participants receiving benefits2019-09-010
Number of other retired or separated participants entitled to future benefits2019-09-010
Total of all active and inactive participants2019-09-01223
Number of employers contributing to the scheme2019-09-010
2018: LEMONADE RESTAURANT GROUP, LLC HEALTH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-09-01206
Total number of active participants reported on line 7a of the Form 55002018-09-01223
Number of retired or separated participants receiving benefits2018-09-016
Number of other retired or separated participants entitled to future benefits2018-09-010
Total of all active and inactive participants2018-09-01229
Number of employers contributing to the scheme2018-09-010
2017: LEMONADE RESTAURANT GROUP, LLC HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-09-01216
Total number of active participants reported on line 7a of the Form 55002017-09-01206
Number of retired or separated participants receiving benefits2017-09-0110
Number of other retired or separated participants entitled to future benefits2017-09-010
Total of all active and inactive participants2017-09-01216
2016: LEMONADE RESTAURANT GROUP, LLC HEALTH AND WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-09-01242
Total number of active participants reported on line 7a of the Form 55002016-09-01213
Number of retired or separated participants receiving benefits2016-09-013
Total of all active and inactive participants2016-09-01216
2015: LEMONADE RESTAURANT GROUP, LLC HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-09-01121
Total number of active participants reported on line 7a of the Form 55002015-09-01241
Number of retired or separated participants receiving benefits2015-09-011
Number of other retired or separated participants entitled to future benefits2015-09-0185
Total of all active and inactive participants2015-09-01327

Form 5500 Responses for LEMONADE RESTAURANT GROUP, LLC HEALTH AND WELFARE PLAN

2020: LEMONADE RESTAURANT GROUP, LLC HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-09-01Type of plan entitySingle employer plan
2020-09-01Submission has been amendedYes
2020-09-01Plan funding arrangement – InsuranceYes
2020-09-01Plan funding arrangement – General assets of the sponsorYes
2020-09-01Plan benefit arrangement – InsuranceYes
2020-09-01Plan benefit arrangement – General assets of the sponsorYes
2019: LEMONADE RESTAURANT GROUP, LLC HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-09-01Type of plan entitySingle employer plan
2019-09-01Plan funding arrangement – InsuranceYes
2019-09-01Plan funding arrangement – General assets of the sponsorYes
2019-09-01Plan benefit arrangement – InsuranceYes
2019-09-01Plan benefit arrangement – General assets of the sponsorYes
2018: LEMONADE RESTAURANT GROUP, LLC HEALTH AND WELFARE PLAN 2018 form 5500 responses
2018-09-01Type of plan entitySingle employer plan
2018-09-01Plan funding arrangement – InsuranceYes
2018-09-01Plan funding arrangement – General assets of the sponsorYes
2018-09-01Plan benefit arrangement – InsuranceYes
2018-09-01Plan benefit arrangement – General assets of the sponsorYes
2017: LEMONADE RESTAURANT GROUP, LLC HEALTH AND WELFARE PLAN 2017 form 5500 responses
2017-09-01Type of plan entitySingle employer plan
2017-09-01Submission has been amendedNo
2017-09-01This submission is the final filingNo
2017-09-01This return/report is a short plan year return/report (less than 12 months)No
2017-09-01Plan is a collectively bargained planNo
2017-09-01Plan funding arrangement – InsuranceYes
2017-09-01Plan funding arrangement – General assets of the sponsorYes
2017-09-01Plan benefit arrangement – InsuranceYes
2017-09-01Plan benefit arrangement – General assets of the sponsorYes
2016: LEMONADE RESTAURANT GROUP, LLC HEALTH AND WELFARE PLAN 2016 form 5500 responses
2016-09-01Type of plan entitySingle employer plan
2016-09-01Submission has been amendedNo
2016-09-01This submission is the final filingNo
2016-09-01This return/report is a short plan year return/report (less than 12 months)No
2016-09-01Plan is a collectively bargained planNo
2016-09-01Plan funding arrangement – InsuranceYes
2016-09-01Plan benefit arrangement – InsuranceYes
2015: LEMONADE RESTAURANT GROUP, LLC HEALTH AND WELFARE PLAN 2015 form 5500 responses
2015-09-01Type of plan entitySingle employer plan
2015-09-01First time form 5500 has been submittedYes
2015-09-01Submission has been amendedNo
2015-09-01This submission is the final filingNo
2015-09-01This return/report is a short plan year return/report (less than 12 months)No
2015-09-01Plan is a collectively bargained planNo
2015-09-01Plan funding arrangement – InsuranceYes
2015-09-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberUNKNOWN
Policy instance 1
Insurance contract or identification numberUNKNOWN
Number of Individuals Covered39
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number217438
Policy instance 2
Insurance contract or identification number217438
Number of Individuals Covered39
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $681
Total amount of fees paid to insurance companyUSD $4
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedCRITICAL ILLNESS,HOSPITAL,ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $4,452
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $476
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerSUPP COMPENSATION
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0922031
Policy instance 1
Insurance contract or identification number0922031
Number of Individuals Covered40
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $17,406
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $384,127
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,406
Amount paid for insurance broker fees0
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0217440
Policy instance 4
Insurance contract or identification number0217440
Number of Individuals Covered20
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $2,150
Total amount of fees paid to insurance companyUSD $43
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $5,871
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,320
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number217439
Policy instance 3
Insurance contract or identification number217439
Number of Individuals Covered34
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $1,855
Total amount of fees paid to insurance companyUSD $43
Other welfare benefits providedHOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $5,194
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,178
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number217438
Policy instance 2
Insurance contract or identification number217438
Number of Individuals Covered8
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $873
Total amount of fees paid to insurance companyUSD $41
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $2,954
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $996
Amount paid for insurance broker fees9
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )
Policy contract numberW0067169
Policy instance 1
Insurance contract or identification numberW0067169
Number of Individuals Covered138
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $8,521
Total amount of fees paid to insurance companyUSD $37,298
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $784,747
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,521
Amount paid for insurance broker fees37298
Additional information about fees paid to insurance brokerPRODUCER SERVICE FEES
Insurance broker organization code?3
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberJLW59
Policy instance 3
Insurance contract or identification numberJLW59
Insurance policy start date2018-09-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedVOL. BENEFITS
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61557 )
Policy contract numberW0067169
Policy instance 1
Insurance contract or identification numberW0067169
Number of Individuals Covered223
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $2,580
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $17,199
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,874
Amount paid for insurance broker fees0
Insurance broker organization code?3
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )
Policy contract numberW0067169
Policy instance 2
Insurance contract or identification numberW0067169
Number of Individuals Covered180
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $48,135
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $871,323
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,573
Amount paid for insurance broker fees0
Insurance broker organization code?3
AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number804225HNO
Policy instance 3
Insurance contract or identification number804225HNO
Number of Individuals Covered109
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $26,964
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $553,183
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberJLW59
Policy instance 2
Insurance contract or identification numberJLW59
Number of Individuals Covered17
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $1,885
Total amount of fees paid to insurance companyUSD $94
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedWORKSITE BENEFITS
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $12,673
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number804225
Policy instance 1
Insurance contract or identification number804225
Number of Individuals Covered181
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $35,620
Total amount of fees paid to insurance companyUSD $293
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $662,377
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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