Form 5500 · Employee benefit plan · INDIAN SHORES, FL
BAY STAR RESTAURANT GROUP
The filing calls this plan BAY STAR RESTAURANT GROUP WELFARE BENEFIT PLAN.
BAY STAR RESTAURANT GROUP of INDIAN SHORES, FL insures health, dental and vision coverage for its employees, per Schedule A of its Form 5500. Its broker of record is THOMAS FINANCIAL GROUP, INC.. Coverage is written through CIGNA HEALTH AND LIFE INSURANCE COMPANY and 1 other carrier. The plan's most recent policy period ended in April.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 68-0669185 · plan 501 · plan year 2024, filed Sep 17, 2024
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 2 insured contracts covering health, dental and vision; the largest, with CIGNA HEALTH AND LIFE INSURANCE COMPANY, covers 79 people.
Reported premium across the insured contracts is $366,705, with $28,118 in disclosed broker commissions — about 7.7% of premium.
The most recent policy period ended in April, and the plan year ends April 30. Group contracts typically renew on that annual cycle.
THOMAS FINANCIAL GROUP, INC. is the broker of record on 1 of the 2 contracts; the rest name a different broker or none.
Two carriers split the book: CIGNA HEALTH AND LIFE INSURANCE COMPANY and METROPOLITAN LIFE INSURANCE COMPANY.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | Health | 79 | May 1, 2024 | $317,396 | $28,118 |
| METROPOLITAN LIFE INSURANCE COMPANY | Dental, Vision | 140 | May 1, 2024 | $49,309 | $0 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
How this plan compares
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