Form 5500 · Employee benefit plan · KODAK, TN
KATOM RESTAURANT SUPPLY, INC.
The filing calls this plan KATOM RESTAURANT SUPPLY, INC. EMPLOYEE BENEFITS PLAN.
Public Form 5500 records show how KATOM RESTAURANT SUPPLY, INC. of KODAK, TN, a hospitality and food service employer, structures its employee benefits. Its broker of record is ATHENS INSURANCE. Coverage is written through THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA and 1 other carrier. The plan's most recent policy period ended in January.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 62-1506260 · plan 501 · plan year 2025, filed Sep 17, 2026
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How this plan is funded
Funding not settled by the filing
The filing does not report enough to settle how this plan pays for benefits.
Benefits declared on this filing
Also declared: other welfare.
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, vision, life and disability; the largest, with THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA, covers 210 people.
Reported premium across the insured contracts is $334,238, with $20,467 in disclosed broker commissions — about 6.1% of premium.
The health contract's policy period ended in January, while at least one ancillary line's policy period ended in December. The plan is on a split renewal cycle.
ATHENS INSURANCE is the broker of record on 1 of the 2 contracts; the rest name a different broker or none.
Two carriers split the book: THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA and UNITEDHEALTHCARE INSURANCE COMPANY.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | Dental, Vision, Life, Disability | 210 | Jan 1, 2026 | $177,859 | $20,467 |
| UNITEDHEALTHCARE INSURANCE COMPANY | Health | 343 | Feb 1, 2025 | $156,379 | $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.
Other plans filed by this employer
How this plan compares
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