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| Plan Name | BERG HOSPITALITY GROUP, LLC HEALTH & WELFARE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | BERG HOSPITALITY GROUP, LLC |
| Employer identification number (EIN): | 824127444 |
| NAIC Classification: | 722300 |
| NAIC Description: | Special Food Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-07-01 | ||||
| 501 | 2023-07-01 | RACHEL SHOEMAKER | |||
| 501 | 2022-07-01 | ||||
| 501 | 2022-07-01 | RACHEL SHOEMAKER | |||
| 501 | 2021-07-01 | ||||
| 501 | 2021-07-01 | RACHEL SHOEMAKER |
| 2023: BERG HOSPITALITY GROUP, LLC HEALTH & WELFARE BENEFIT PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-07-01 | Type of plan entity | Single employer plan |
| 2023-07-01 | Submission has been amended | No |
| 2023-07-01 | This submission is the final filing | No |
| 2023-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2023-07-01 | Plan is a collectively bargained plan | No |
| 2023-07-01 | Plan funding arrangement – Insurance | Yes |
| 2023-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2022: BERG HOSPITALITY GROUP, LLC HEALTH & WELFARE BENEFIT PLAN 2022 form 5500 responses | ||
| 2022-07-01 | Type of plan entity | Single employer plan |
| 2022-07-01 | Submission has been amended | No |
| 2022-07-01 | This submission is the final filing | No |
| 2022-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-07-01 | Plan is a collectively bargained plan | No |
| 2022-07-01 | Plan funding arrangement – Insurance | Yes |
| 2022-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: BERG HOSPITALITY GROUP, LLC HEALTH & WELFARE BENEFIT PLAN 2021 form 5500 responses | ||
| 2021-07-01 | Type of plan entity | Single employer plan |
| 2021-07-01 | First time form 5500 has been submitted | Yes |
| 2021-07-01 | Submission has been amended | No |
| 2021-07-01 | This submission is the final filing | No |
| 2021-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-07-01 | Plan is a collectively bargained plan | No |
| 2021-07-01 | Plan funding arrangement – Insurance | Yes |
| 2021-07-01 | Plan benefit arrangement – Insurance | Yes |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 0186722 | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 4 | ||||||||||||||||||||||||||||||||||||||||||||||||||
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| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 0186722 | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||||||||||||||||||||
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| AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95490 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 0186722HNO | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||
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| TEXAS HEALTH AND AETNA HEALTH (National Association of Insurance Commissioners NAIC id number: 16121 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 0186722TH | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||
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| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 0186722 | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 4 | ||||||||||||||||||||||||||||||||||||||||||||||||||
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 0186722 | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||||||||||||||||||||
| AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95490 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 0186722HNO | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||
| TEXAS HEALTH AND AETNA HEALTH (National Association of Insurance Commissioners NAIC id number: 16121 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 0186722TH | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 165854 | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 010-048254 | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||
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