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| Plan Name | GROUP VOLUNTARY LIFE/ADD AND LTD |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | DAFFYS, INC. |
| Employer identification number (EIN): | 221671723 |
| NAIC Classification: | 448140 |
| NAIC Description: | Family Clothing Stores |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2012-05-01 | JOHN KRZYWDA | |||
| 502 | 2011-05-01 | RICHARD KRAMER | |||
| 502 | 2009-05-01 | ALLEN GROSS |
| Measure | Date | Value |
|---|---|---|
| 2012: GROUP VOLUNTARY LIFE/ADD AND LTD 2012 401k membership | ||
| Total participants, beginning-of-year | 2012-05-01 | 771 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-05-01 | 49 |
| Number of retired or separated participants receiving benefits | 2012-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-05-01 | 0 |
| Total of all active and inactive participants | 2012-05-01 | 49 |
| 2011: GROUP VOLUNTARY LIFE/ADD AND LTD 2011 401k membership | ||
| Total participants, beginning-of-year | 2011-05-01 | 710 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-05-01 | 771 |
| Number of retired or separated participants receiving benefits | 2011-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-05-01 | 0 |
| Total of all active and inactive participants | 2011-05-01 | 771 |
| 2009: GROUP VOLUNTARY LIFE/ADD AND LTD 2009 401k membership | ||
| Total participants, beginning-of-year | 2009-05-01 | 721 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-05-01 | 672 |
| Number of retired or separated participants receiving benefits | 2009-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-05-01 | 0 |
| Total of all active and inactive participants | 2009-05-01 | 672 |
| 2012: GROUP VOLUNTARY LIFE/ADD AND LTD 2012 form 5500 responses | ||
|---|---|---|
| 2012-05-01 | Type of plan entity | Single employer plan |
| 2012-05-01 | Submission has been amended | No |
| 2012-05-01 | This submission is the final filing | No |
| 2012-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-05-01 | Plan is a collectively bargained plan | No |
| 2012-05-01 | Plan funding arrangement – Insurance | Yes |
| 2012-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: GROUP VOLUNTARY LIFE/ADD AND LTD 2011 form 5500 responses | ||
| 2011-05-01 | Type of plan entity | Single employer plan |
| 2011-05-01 | Submission has been amended | No |
| 2011-05-01 | This submission is the final filing | No |
| 2011-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-05-01 | Plan is a collectively bargained plan | No |
| 2011-05-01 | Plan funding arrangement – Insurance | Yes |
| 2011-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: GROUP VOLUNTARY LIFE/ADD AND LTD 2009 form 5500 responses | ||
| 2009-05-01 | Type of plan entity | Single employer plan |
| 2009-05-01 | Submission has been amended | No |
| 2009-05-01 | This submission is the final filing | No |
| 2009-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-05-01 | Plan is a collectively bargained plan | No |
| 2009-05-01 | Plan funding arrangement – Insurance | Yes |
| 2009-05-01 | Plan benefit arrangement – Insurance | Yes |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | GLUG0945E | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | GLUG0945E | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | GLUG0945E | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | GLTD0945E | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | GUPR0945E | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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