401k Plan data: THE KLAMATH GRILL, INC. 401(K) PROFIT-SHARING PLA plan

THE KLAMATH GRILL, INC. 401(K) PROFIT-SHARING PLA 401k Plan overview

Plan Name	THE KLAMATH GRILL, INC. 401(K) PROFIT-SHARING PLA
Plan identification number	001

THE KLAMATH GRILL, INC. 401(K) PROFIT-SHARING PLA Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Participant-directed brokerage accounts provided as an investment option under the plan.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

KLAMATH GRILL, INC. has sponsored the creation of one or more 401k plans.

Company Name: KLAMATH GRILL, INC.

Employer identification number (EIN): 201059630

NAIC Classification: 311900
NAIC Description: Other Food Manufacturing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE KLAMATH GRILL, INC. 401(K) PROFIT-SHARING PLA

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2012-01-01 PATRICK TARBELL 2013-08-20 PATRICK TARBELL 2013-08-20
001 2011-01-01 PATRICK TARBELL PATRICK TARBELL 2012-06-30
001 2010-01-01 PATRICK TARBELL PATRICK TARBELL 2011-08-31
001 2009-01-01 PATRICK TARBELL PATRICK TARBELL 2010-07-18

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2012-01-01	PATRICK TARBELL	2013-08-20	PATRICK TARBELL	2013-08-20
001	2011-01-01	PATRICK TARBELL		PATRICK TARBELL	2012-06-30
001	2010-01-01	PATRICK TARBELL		PATRICK TARBELL	2011-08-31
001	2009-01-01	PATRICK TARBELL		PATRICK TARBELL	2010-07-18

Plan Statistics for THE KLAMATH GRILL, INC. 401(K) PROFIT-SHARING PLA

401k plan membership statisitcs for THE KLAMATH GRILL, INC. 401(K) PROFIT-SHARING PLA

Measure Date Value
2011: THE KLAMATH GRILL, INC. 401(K) PROFIT-SHARING PLA 2011 401k membership
Total participants, beginning-of-year 2011-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 9
Total of all active and inactive participants 2011-01-01 9
Total participants 2011-01-01 9
Number of participants with account balances 2011-01-01 7
2010: THE KLAMATH GRILL, INC. 401(K) PROFIT-SHARING PLA 2010 401k membership
Total participants, beginning-of-year 2010-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 10
Total of all active and inactive participants 2010-01-01 10
Total participants 2010-01-01 10
Number of participants with account balances 2010-01-01 10
2009: THE KLAMATH GRILL, INC. 401(K) PROFIT-SHARING PLA 2009 401k membership
Total participants, beginning-of-year 2009-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 9
Total of all active and inactive participants 2009-01-01 9
Total participants 2009-01-01 9
Number of participants with account balances 2009-01-01 9

Measure	Date	Value
2011: THE KLAMATH GRILL, INC. 401(K) PROFIT-SHARING PLA 2011 401k membership
Total participants, beginning-of-year	2011-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	9
Total of all active and inactive participants	2011-01-01	9
Total participants	2011-01-01	9
Number of participants with account balances	2011-01-01	7
2010: THE KLAMATH GRILL, INC. 401(K) PROFIT-SHARING PLA 2010 401k membership
Total participants, beginning-of-year	2010-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	10
Total of all active and inactive participants	2010-01-01	10
Total participants	2010-01-01	10
Number of participants with account balances	2010-01-01	10
2009: THE KLAMATH GRILL, INC. 401(K) PROFIT-SHARING PLA 2009 401k membership
Total participants, beginning-of-year	2009-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	9
Total of all active and inactive participants	2009-01-01	9
Total participants	2009-01-01	9
Number of participants with account balances	2009-01-01	9

Financial Data on THE KLAMATH GRILL, INC. 401(K) PROFIT-SHARING PLA

Measure	Date	Value
2011 : THE KLAMATH GRILL, INC. 401(K) PROFIT-SHARING PLA 2011 401k financial data
Total income from all sources	2011-12-31	$-3,792
Expenses. Total of all expenses incurred	2011-12-31	$19,378
Benefits paid (including direct rollovers)	2011-12-31	$18,069
Total plan assets at end of year	2011-12-31	$98,491
Total plan assets at beginning of year	2011-12-31	$121,661
Value of fidelity bond covering the plan	2011-12-31	$9,500
Other income received	2011-12-31	$-3,792
Net income (gross income less expenses)	2011-12-31	$-23,170
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$98,491
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$121,661
Assets. Value of participant loans	2011-12-31	$14,736
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$1,309
2010 : THE KLAMATH GRILL, INC. 401(K) PROFIT-SHARING PLA 2010 401k financial data
Total income from all sources	2010-12-31	$14,556
Expenses. Total of all expenses incurred	2010-12-31	$4,547
Benefits paid (including direct rollovers)	2010-12-31	$3,453
Total plan assets at end of year	2010-12-31	$121,661
Total plan assets at beginning of year	2010-12-31	$111,652
Value of fidelity bond covering the plan	2010-12-31	$9,500
Other income received	2010-12-31	$12,309
Net income (gross income less expenses)	2010-12-31	$10,009
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$121,661
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$111,652
Assets. Value of participant loans	2010-12-31	$31,347
Total contributions received or receivable from employer(s)	2010-12-31	$2,247
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$1,094

Form 5500 Responses for THE KLAMATH GRILL, INC. 401(K) PROFIT-SHARING PLA

2011: THE KLAMATH GRILL, INC. 401(K) PROFIT-SHARING PLA 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: THE KLAMATH GRILL, INC. 401(K) PROFIT-SHARING PLA 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: THE KLAMATH GRILL, INC. 401(K) PROFIT-SHARING PLA 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Potentially related plans

THE KLAMATH TRIBES PS PLAN [EIN = 930801543]

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Company Name:	KLAMATH GRILL, INC.
Employer identification number (EIN):	201059630
NAIC Classification:	311900
NAIC Description:	Other Food Manufacturing