401k Plan data: SHRIMP BASKET BOTTLING, INC. plan

SHRIMP BASKET BOTTLING, INC. 401k Plan overview

Plan Name	SHRIMP BASKET BOTTLING, INC.
Plan identification number	999

SHRIMP BASKET BOTTLING, INC. Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

SHRIMP BASKET has sponsored the creation of one or more 401k plans.

Company Name: SHRIMP BASKET

Employer identification number (EIN): 262657180

NAIC Classification: 445291
NAIC Description: Baked Goods Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SHRIMP BASKET BOTTLING, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
999 2015-01-01 CHANTAL BRIER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
999	2015-01-01	CHANTAL BRIER

Plan Statistics for SHRIMP BASKET BOTTLING, INC.

401k plan membership statisitcs for SHRIMP BASKET BOTTLING, INC.

Measure Date Value
2015: SHRIMP BASKET BOTTLING, INC. 2015 401k membership
Total participants, beginning-of-year 2015-01-01 109
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 44
Total of all active and inactive participants 2015-01-01 44
Total participants 2015-01-01 44

Measure	Date	Value
2015: SHRIMP BASKET BOTTLING, INC. 2015 401k membership
Total participants, beginning-of-year	2015-01-01	109
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	44
Total of all active and inactive participants	2015-01-01	44
Total participants	2015-01-01	44

Form 5500 Responses for SHRIMP BASKET BOTTLING, INC.

2015: SHRIMP BASKET BOTTLING, INC. 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	First time form 5500 has been submitted	Yes
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	Yes
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF ALABAMA (National Association of Insurance Commissioners NAIC id number: 55433 )

Policy contract number

55433

Policy instance

Insurance contract or identification number	55433
Number of Individuals Covered	57
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $1,480
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

SHRIMP BASKET BOTTLING [EIN = 813248798]

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Company Name:	SHRIMP BASKET
Employer identification number (EIN):	262657180
NAIC Classification:	445291
NAIC Description:	Baked Goods Stores