401k Plan data: BELL AMERICAN GROUP, LLC EMPLOYEE LIFE AND DISABILITY PLANS plan

BELL AMERICAN GROUP, LLC EMPLOYEE LIFE AND DISABILITY PLANS 401k Plan overview

Plan Name	BELL AMERICAN GROUP, LLC EMPLOYEE LIFE AND DISABILITY PLANS
Plan identification number	504

BELL AMERICAN GROUP, LLC EMPLOYEE LIFE AND DISABILITY PLANS Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

BELL AMERICAN GROUP, LLC has sponsored the creation of one or more 401k plans.

Company Name: BELL AMERICAN GROUP, LLC

Employer identification number (EIN): 900903491

NAIC Classification: 722513
NAIC Description: Limited-Service Restaurants

Additional information about BELL AMERICAN GROUP, LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 5217060

More information about BELL AMERICAN GROUP, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BELL AMERICAN GROUP, LLC EMPLOYEE LIFE AND DISABILITY PLANS

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2015-01-01 CYNTHIA TERRY
504 2015-01-01 CYNTHIA TERRY
504 2014-01-01 REBECCA JACKSON

Plan id#	Filing Submission Date	Name of Administrator
504	2015-01-01	CYNTHIA TERRY
504	2015-01-01	CYNTHIA TERRY
504	2014-01-01	REBECCA JACKSON

Plan Statistics for BELL AMERICAN GROUP, LLC EMPLOYEE LIFE AND DISABILITY PLANS

401k plan membership statisitcs for BELL AMERICAN GROUP, LLC EMPLOYEE LIFE AND DISABILITY PLANS

Measure Date Value
2015: BELL AMERICAN GROUP, LLC EMPLOYEE LIFE AND DISABILITY PLANS 2015 401k membership
Total participants, beginning-of-year 2015-01-01 356
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 404
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 404
2014: BELL AMERICAN GROUP, LLC EMPLOYEE LIFE AND DISABILITY PLANS 2014 401k membership
Total participants, beginning-of-year 2014-01-01 308
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 337
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 337

Measure	Date	Value
2015: BELL AMERICAN GROUP, LLC EMPLOYEE LIFE AND DISABILITY PLANS 2015 401k membership
Total participants, beginning-of-year	2015-01-01	356
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	404
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	404
2014: BELL AMERICAN GROUP, LLC EMPLOYEE LIFE AND DISABILITY PLANS 2014 401k membership
Total participants, beginning-of-year	2014-01-01	308
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	337
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	337

Form 5500 Responses for BELL AMERICAN GROUP, LLC EMPLOYEE LIFE AND DISABILITY PLANS

2015: BELL AMERICAN GROUP, LLC EMPLOYEE LIFE AND DISABILITY PLANS 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: BELL AMERICAN GROUP, LLC EMPLOYEE LIFE AND DISABILITY PLANS 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	First time form 5500 has been submitted	Yes
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10022016*

Policy instance

Insurance contract or identification number	10022016*
Number of Individuals Covered	375
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $16,182
Total amount of fees paid to insurance company	USD $1,570
Are there contracts with allocated funds for individual policies?	No
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL 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 Carrier	USD $123,892
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,182
Insurance broker organization code?	3
Amount paid for insurance broker fees	1570
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker name	WILLIS OF ARIZONA INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10022016*

Policy instance

Insurance contract or identification number	10022016*
Number of Individuals Covered	326
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,901
Total amount of fees paid to insurance company	USD $499
Are there contracts with allocated funds for individual policies?	No
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL 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 Carrier	USD $39,340
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	499
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $5,901
Insurance broker name	WILLIS OF WI INC

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Company Name:	BELL AMERICAN GROUP, LLC
Employer identification number (EIN):	900903491
NAIC Classification:	722513
NAIC Description:	Limited-Service Restaurants

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	5217060