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MEDICAL INSURANCE PLAN 401k Plan overview

Plan NameMEDICAL INSURANCE PLAN
Plan identification number 501

MEDICAL INSURANCE PLAN Benefits

401k Plan TypeWelfare 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.
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

CKA MANAGEMENT, LLC has sponsored the creation of one or more 401k plans.

Company Name:CKA MANAGEMENT, LLC
Employer identification number (EIN):464108030
NAIC Classification:722513
NAIC Description:Limited-Service Restaurants

Additional information about CKA MANAGEMENT, LLC

Jurisdiction of Incorporation: New York Department of State
Incorporation Date: 2016-09-22
Company Identification Number: 5012423
Legal Registered Office Address: 2028 BELLMORE AVENUE
Nassau
BELLMORE
United States of America (USA)
11710

More information about CKA MANAGEMENT, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDICAL INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01MARITZA RIZZI2023-09-11
5012021-01-01MARITZA RIZZI2022-10-04
5012019-01-01MARITZA RIZZI2020-07-10
5012018-01-01MARITZA RIZZI2019-08-30
5012017-01-01
5012016-01-01MARITZA RIZZI2019-09-06

Plan Statistics for MEDICAL INSURANCE PLAN

401k plan membership statisitcs for MEDICAL INSURANCE PLAN

Measure Date Value
2022: MEDICAL INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01112
Total number of active participants reported on line 7a of the Form 55002022-01-0192
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-0192
Number of employers contributing to the scheme2022-01-010
2021: MEDICAL INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01100
Total number of active participants reported on line 7a of the Form 55002021-01-01112
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01112
Number of employers contributing to the scheme2021-01-010
2019: MEDICAL INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0198
Total number of active participants reported on line 7a of the Form 55002019-01-01112
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01112
Number of employers contributing to the scheme2019-01-010
2018: MEDICAL INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01109
Total number of active participants reported on line 7a of the Form 55002018-01-0198
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-0198
Number of employers contributing to the scheme2018-01-010
2017: MEDICAL INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01125
Total number of active participants reported on line 7a of the Form 55002017-01-01109
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01109
2016: MEDICAL INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01105
Total number of active participants reported on line 7a of the Form 55002016-01-01123
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01123

Form 5500 Responses for MEDICAL INSURANCE PLAN

2022: MEDICAL INSURANCE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: MEDICAL INSURANCE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2019: MEDICAL INSURANCE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: MEDICAL INSURANCE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: MEDICAL INSURANCE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: MEDICAL INSURANCE PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01First time form 5500 has been submittedYes
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number618175
Policy instance 1
Insurance contract or identification number618175
Number of Individuals Covered105
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $47,673
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,001,103
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees47673
Additional information about fees paid to insurance brokerBENEFIT ADVISOR FEES
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number618175
Policy instance 1
Insurance contract or identification number618175
Number of Individuals Covered127
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $55,866
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,066,628
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees55713
Additional information about fees paid to insurance brokerBENEFIT ADVISOR FEES, INCENTIVE COMPENSATION
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number618175
Policy instance 1
Insurance contract or identification number618175
Number of Individuals Covered131
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $93,835
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,247,906
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees62926
Additional information about fees paid to insurance brokerBENEFIT ADVISOR FEES
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number00618175
Policy instance 1
Insurance contract or identification number00618175
Number of Individuals Covered109
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $54,133
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $788,117
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees38370
Additional information about fees paid to insurance brokerBENEFIT ADVISOR FEE INCENTIVE COMPENSATION
Insurance broker organization code?3
Insurance broker nameGREATER METRO AGENCY, INC.

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