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| Plan Name | BASIC LIFE AND AD&D |
| Plan identification number | 504 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | DAN'S HAMBURGERS |
| Employer identification number (EIN): | 742029231 |
| NAIC Classification: | 722511 |
| NAIC Description: | Full-Service Restaurants |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 504 | 2019-04-01 | KATIE CONGDON | 2020-09-29 |
| Measure | Date | Value |
|---|---|---|
| 2019: BASIC LIFE AND AD&D 2019 401k membership | ||
| Total participants, beginning-of-year | 2019-04-01 | 110 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-04-01 | 117 |
| Number of retired or separated participants receiving benefits | 2019-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-04-01 | 0 |
| Total of all active and inactive participants | 2019-04-01 | 117 |
| Number of employers contributing to the scheme | 2019-04-01 | 0 |
| 2019: BASIC LIFE AND AD&D 2019 form 5500 responses | ||
|---|---|---|
| 2019-04-01 | Type of plan entity | Single employer plan |
| 2019-04-01 | First time form 5500 has been submitted | Yes |
| 2019-04-01 | Plan funding arrangement – Insurance | Yes |
| 2019-04-01 | Plan benefit arrangement – Insurance | Yes |
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) | |||||||||||||||||||||||||||||||
| Policy contract number | F022519 | ||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||
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