401k Plan data: HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN plan

HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN
Plan identification number	501

HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness)

401k Sponsoring company profile

HUSA MANAGEMENT, INC. has sponsored the creation of one or more 401k plans.

Company Name: HUSA MANAGEMENT, INC.

Employer identification number (EIN): 760489736

NAIC Classification: 722410
NAIC Description: Drinking Places (Alcoholic Beverages)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2013-09-01 TAMMY ZEPEDA
501 2012-09-01 TAMMY ZEPEDA
501 2012-08-01 TAMMY ZEPEDA
501 2011-08-01 TAMMY ZEPEDA
501 2009-08-01 TAMMY ZEPEDA
501 2008-08-01 TAMMY ZEPEDA
501 2007-08-01 TAMMY ZEPEDA
501 2006-08-01 TAMMY ZEPEDA

Plan id#	Filing Submission Date	Name of Administrator
501	2013-09-01	TAMMY ZEPEDA
501	2012-09-01	TAMMY ZEPEDA
501	2012-08-01	TAMMY ZEPEDA
501	2011-08-01	TAMMY ZEPEDA
501	2009-08-01	TAMMY ZEPEDA
501	2008-08-01	TAMMY ZEPEDA
501	2007-08-01	TAMMY ZEPEDA
501	2006-08-01	TAMMY ZEPEDA

Plan Statistics for HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN

401k plan membership statisitcs for HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN

Measure Date Value
2013: HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-09-01 0
Total number of active participants reported on line 7a of the Form 5500 2013-09-01 0
Number of retired or separated participants receiving benefits 2013-09-01 0
Number of other retired or separated participants entitled to future benefits 2013-09-01 0
Total of all active and inactive participants 2013-09-01 0
2012: HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-09-01 141
Total number of active participants reported on line 7a of the Form 5500 2012-09-01 158
Number of retired or separated participants receiving benefits 2012-09-01 0
Number of other retired or separated participants entitled to future benefits 2012-09-01 0
Total of all active and inactive participants 2012-09-01 158
Total participants, beginning-of-year 2012-08-01 156
Total number of active participants reported on line 7a of the Form 5500 2012-08-01 154
Number of retired or separated participants receiving benefits 2012-08-01 0
Number of other retired or separated participants entitled to future benefits 2012-08-01 0
Total of all active and inactive participants 2012-08-01 154
2011: HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-08-01 175
Total number of active participants reported on line 7a of the Form 5500 2011-08-01 156
Number of retired or separated participants receiving benefits 2011-08-01 0
Number of other retired or separated participants entitled to future benefits 2011-08-01 0
Total of all active and inactive participants 2011-08-01 156
2009: HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-08-01 157
Total number of active participants reported on line 7a of the Form 5500 2009-08-01 163
Number of retired or separated participants receiving benefits 2009-08-01 0
Number of other retired or separated participants entitled to future benefits 2009-08-01 0
Total of all active and inactive participants 2009-08-01 163
2008: HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN 2008 401k membership
Total participants, beginning-of-year 2008-08-01 109
Total number of active participants reported on line 7a of the Form 5500 2008-08-01 157
Number of retired or separated participants receiving benefits 2008-08-01 0
Number of other retired or separated participants entitled to future benefits 2008-08-01 0
Total of all active and inactive participants 2008-08-01 157
2007: HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN 2007 401k membership
Total participants, beginning-of-year 2007-08-01 106
Total number of active participants reported on line 7a of the Form 5500 2007-08-01 109
Number of retired or separated participants receiving benefits 2007-08-01 0
Number of other retired or separated participants entitled to future benefits 2007-08-01 0
Total of all active and inactive participants 2007-08-01 109
2006: HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN 2006 401k membership
Total participants, beginning-of-year 2006-08-01 101
Total number of active participants reported on line 7a of the Form 5500 2006-08-01 106
Number of retired or separated participants receiving benefits 2006-08-01 0
Number of other retired or separated participants entitled to future benefits 2006-08-01 0
Total of all active and inactive participants 2006-08-01 106

Measure	Date	Value
2013: HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-09-01	0
Total number of active participants reported on line 7a of the Form 5500	2013-09-01	0
Number of retired or separated participants receiving benefits	2013-09-01	0
Number of other retired or separated participants entitled to future benefits	2013-09-01	0
Total of all active and inactive participants	2013-09-01	0
2012: HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-09-01	141
Total number of active participants reported on line 7a of the Form 5500	2012-09-01	158
Number of retired or separated participants receiving benefits	2012-09-01	0
Number of other retired or separated participants entitled to future benefits	2012-09-01	0
Total of all active and inactive participants	2012-09-01	158
Total participants, beginning-of-year	2012-08-01	156
Total number of active participants reported on line 7a of the Form 5500	2012-08-01	154
Number of retired or separated participants receiving benefits	2012-08-01	0
Number of other retired or separated participants entitled to future benefits	2012-08-01	0
Total of all active and inactive participants	2012-08-01	154
2011: HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-08-01	175
Total number of active participants reported on line 7a of the Form 5500	2011-08-01	156
Number of retired or separated participants receiving benefits	2011-08-01	0
Number of other retired or separated participants entitled to future benefits	2011-08-01	0
Total of all active and inactive participants	2011-08-01	156
2009: HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-08-01	157
Total number of active participants reported on line 7a of the Form 5500	2009-08-01	163
Number of retired or separated participants receiving benefits	2009-08-01	0
Number of other retired or separated participants entitled to future benefits	2009-08-01	0
Total of all active and inactive participants	2009-08-01	163
2008: HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN 2008 401k membership
Total participants, beginning-of-year	2008-08-01	109
Total number of active participants reported on line 7a of the Form 5500	2008-08-01	157
Number of retired or separated participants receiving benefits	2008-08-01	0
Number of other retired or separated participants entitled to future benefits	2008-08-01	0
Total of all active and inactive participants	2008-08-01	157
2007: HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN 2007 401k membership
Total participants, beginning-of-year	2007-08-01	106
Total number of active participants reported on line 7a of the Form 5500	2007-08-01	109
Number of retired or separated participants receiving benefits	2007-08-01	0
Number of other retired or separated participants entitled to future benefits	2007-08-01	0
Total of all active and inactive participants	2007-08-01	109
2006: HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN 2006 401k membership
Total participants, beginning-of-year	2006-08-01	101
Total number of active participants reported on line 7a of the Form 5500	2006-08-01	106
Number of retired or separated participants receiving benefits	2006-08-01	0
Number of other retired or separated participants entitled to future benefits	2006-08-01	0
Total of all active and inactive participants	2006-08-01	106

Form 5500 Responses for HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN

2013: HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN 2013 form 5500 responses
2013-09-01	Type of plan entity	Single employer plan
2013-09-01	Submission has been amended	No
2013-09-01	This submission is the final filing	Yes
2013-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-09-01	Plan is a collectively bargained plan	No
2013-09-01	Plan funding arrangement – Insurance	Yes
2013-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-09-01	Plan benefit arrangement – Insurance	Yes
2013-09-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN 2012 form 5500 responses
2012-09-01	Type of plan entity	Single employer plan
2012-09-01	Submission has been amended	No
2012-09-01	This submission is the final filing	No
2012-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-09-01	Plan is a collectively bargained plan	No
2012-09-01	Plan funding arrangement – Insurance	Yes
2012-09-01	Plan benefit arrangement – Insurance	Yes
2012-08-01	Type of plan entity	Single employer plan
2012-08-01	Submission has been amended	No
2012-08-01	This submission is the final filing	No
2012-08-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2012-08-01	Plan is a collectively bargained plan	No
2012-08-01	Plan funding arrangement – Insurance	Yes
2012-08-01	Plan benefit arrangement – Insurance	Yes
2011: HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN 2011 form 5500 responses
2011-08-01	Type of plan entity	Single employer plan
2011-08-01	Submission has been amended	No
2011-08-01	This submission is the final filing	No
2011-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-08-01	Plan is a collectively bargained plan	No
2011-08-01	Plan funding arrangement – Insurance	Yes
2011-08-01	Plan benefit arrangement – Insurance	Yes
2009: HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN 2009 form 5500 responses
2009-08-01	Type of plan entity	Single employer plan
2009-08-01	Submission has been amended	No
2009-08-01	This submission is the final filing	No
2009-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-08-01	Plan is a collectively bargained plan	No
2009-08-01	Plan funding arrangement – Insurance	Yes
2009-08-01	Plan benefit arrangement – Insurance	Yes
2008: HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN 2008 form 5500 responses
2008-08-01	Type of plan entity	Single employer plan
2008-08-01	Submission has been amended	No
2008-08-01	This submission is the final filing	No
2008-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-08-01	Plan is a collectively bargained plan	No
2008-08-01	Plan funding arrangement – Insurance	Yes
2008-08-01	Plan benefit arrangement – Insurance	Yes
2007: HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN 2007 form 5500 responses
2007-08-01	Type of plan entity	Single employer plan
2007-08-01	Submission has been amended	No
2007-08-01	This submission is the final filing	No
2007-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2007-08-01	Plan is a collectively bargained plan	No
2007-08-01	Plan funding arrangement – Insurance	Yes
2007-08-01	Plan benefit arrangement – Insurance	Yes
2006: HOSPITALITY USA INVESTMENT GROUP, INC. HEALTH AND WELFARE PLAN 2006 form 5500 responses
2006-08-01	Type of plan entity	Single employer plan
2006-08-01	First time form 5500 has been submitted	Yes
2006-08-01	Submission has been amended	No
2006-08-01	This submission is the final filing	No
2006-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2006-08-01	Plan is a collectively bargained plan	No
2006-08-01	Plan funding arrangement – Insurance	Yes
2006-08-01	Plan benefit arrangement – Insurance	Yes

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Company Name:	HUSA MANAGEMENT, INC.
Employer identification number (EIN):	760489736
NAIC Classification:	722410
NAIC Description:	Drinking Places (Alcoholic Beverages)