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| Plan Name | DERMIRA, INC. LIFE/AD&D PLAN |
| Plan identification number | 504 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | DERMIRA, INC. |
| Employer identification number (EIN): | 273267680 |
| NAIC Classification: | 541700 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 504 | 2017-12-01 |
| Measure | Date | Value |
|---|---|---|
| 2017: DERMIRA, INC. LIFE/AD&D PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-12-01 | 152 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-12-01 | 0 |
| Number of retired or separated participants receiving benefits | 2017-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-12-01 | 0 |
| Total of all active and inactive participants | 2017-12-01 | 0 |
| 2017: DERMIRA, INC. LIFE/AD&D PLAN 2017 form 5500 responses | ||
|---|---|---|
| 2017-12-01 | Type of plan entity | Single employer plan |
| 2017-12-01 | First time form 5500 has been submitted | Yes |
| 2017-12-01 | This submission is the final filing | Yes |
| 2017-12-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2017-12-01 | Plan funding arrangement – Insurance | Yes |
| 2017-12-01 | Plan benefit arrangement – Insurance | Yes |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) | |||||||||||||||||||||||||||||||||||||||||
| Policy contract number | SGM608649 | ||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||
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