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| Plan Name | SHRIMP BASKET BOTTLING |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | SHRIMP BASKET INTERMEDIATE HOLDINGS,LLC |
| Employer identification number (EIN): | 813248798 |
| NAIC Classification: | 445291 |
| NAIC Description: | Baked Goods Stores |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2017-01-01 | CHANTAL BRIER |
| Measure | Date | Value |
|---|---|---|
| 2017: SHRIMP BASKET BOTTLING 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-01-01 | 59 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 66 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 66 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2017-01-01 | 0 |
| Total participants | 2017-01-01 | 66 |
| Number of participants with account balances | 2017-01-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2017-01-01 | 0 |
| 2017: SHRIMP BASKET BOTTLING 2017 form 5500 responses | ||
|---|---|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | First time form 5500 has been submitted | Yes |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) | |
| Policy contract number | 30072895 |
| Policy instance | 1 |
| BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 ) | |
| Policy contract number | 0037366 |
| Policy instance | 2 |
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) | |
| Policy contract number | F020419 |
| Policy instance | 3 |
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