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| Plan Name | GROUP LIFE AD & D, ACCIDENT & SICKNESS |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | PAYLESS SHOE SOURCE |
| Employer identification number (EIN): | 480674097 |
| NAIC Classification: | 448210 |
| NAIC Description: | Shoe Stores |
Additional information about PAYLESS SHOE SOURCE
| Jurisdiction of Incorporation: | Texas Secretary of State |
| Incorporation Date: | 1962-03-16 |
| Company Identification Number: | 0002198106 |
| Legal Registered Office Address: |
3231 SE 6TH AVE TOPEKA United States of America (USA) 66607 |
More information about PAYLESS SHOE SOURCE
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2009-01-01 | BETTY CLICK, SVP OF HUMAN RESOURCES | BETTY CLICK, SVP OF HUMAN RESOURCES | 2010-08-02 | |
| 502 | 2009-01-01 | DONNA CUEVAS |
| Measure | Date | Value |
|---|---|---|
| 2009: GROUP LIFE AD & D, ACCIDENT & SICKNESS 2009 401k membership | ||
| Total participants, beginning-of-year | 2009-01-01 | 302 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 123 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 123 |
| 2009: GROUP LIFE AD & D, ACCIDENT & SICKNESS 2009 form 5500 responses | ||
|---|---|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | Yes |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2009-01-01 | Plan is a collectively bargained plan | Yes |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
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