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| Plan Name | WAITR, INC. HEALTH AND WELFARE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | WAITR, INC. |
| Employer identification number (EIN): | 832249871 |
| NAIC Classification: | 454110 |
| NAIC Description: | Electronic Shopping and Mail-Order Houses |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-01-01 | MICHELLE ODENBACH | 2023-04-20 | ||
| 501 | 2021-07-01 | AMY BEHNE | 2022-05-17 |
| Measure | Date | Value |
|---|---|---|
| 2022: WAITR, INC. HEALTH AND WELFARE PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-01-01 | 433 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 227 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 227 |
| Number of employers contributing to the scheme | 2022-01-01 | 0 |
| 2021: WAITR, INC. HEALTH AND WELFARE PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-07-01 | 623 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-07-01 | 435 |
| Number of retired or separated participants receiving benefits | 2021-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-07-01 | 0 |
| Total of all active and inactive participants | 2021-07-01 | 435 |
| Number of employers contributing to the scheme | 2021-07-01 | 0 |
| 2022: WAITR, INC. HEALTH AND WELFARE PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: WAITR, INC. HEALTH AND WELFARE PLAN 2021 form 5500 responses | ||
| 2021-07-01 | Type of plan entity | Single employer plan |
| 2021-07-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2021-07-01 | Plan funding arrangement – Insurance | Yes |
| 2021-07-01 | Plan benefit arrangement – Insurance | Yes |
| BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 ) | |||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 78K52ERC | ||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 221545 | ||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||
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| BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 ) | |||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 78K52ERC | ||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 221545 | ||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||
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