401k Plan data: 5 SIRENS BLAZIN RETIREMENT PLAN plan

5 SIRENS BLAZIN RETIREMENT PLAN 401k Plan overview

Plan Name	5 SIRENS BLAZIN RETIREMENT PLAN
Plan identification number	001

5 SIRENS BLAZIN RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
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.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
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

5 SIRENS BLAZIN, INC. has sponsored the creation of one or more 401k plans.

Company Name: 5 SIRENS BLAZIN, INC.

Employer identification number (EIN): 823088818

NAIC Classification: 722513
NAIC Description: Limited-Service Restaurants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan 5 SIRENS BLAZIN RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2019-01-01
001 2018-01-01 ELIZABETH STRACK

Plan Statistics for 5 SIRENS BLAZIN RETIREMENT PLAN

401k plan membership statisitcs for 5 SIRENS BLAZIN RETIREMENT PLAN

Measure Date Value
2019: 5 SIRENS BLAZIN RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 2
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 2
Number of participants with account balances 2019-01-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: 5 SIRENS BLAZIN RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 2
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 2
Number of participants with account balances 2018-01-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0

Measure	Date	Value
2019: 5 SIRENS BLAZIN RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	2
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	2
Number of participants with account balances	2019-01-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: 5 SIRENS BLAZIN RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	2
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	2
Number of participants with account balances	2018-01-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0

Financial Data on 5 SIRENS BLAZIN RETIREMENT PLAN

Measure	Date	Value
2019 : 5 SIRENS BLAZIN RETIREMENT PLAN 2019 401k financial data
Total plan liabilities at end of year	2019-12-31	$10
Total income from all sources	2019-12-31	$-17,850
Expenses. Total of all expenses incurred	2019-12-31	$0
Total plan assets at end of year	2019-12-31	$85,500
Total plan assets at beginning of year	2019-12-31	$103,340
Other income received	2019-12-31	$-17,850
Net income (gross income less expenses)	2019-12-31	$-17,850
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$85,490
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$103,340
Assets. Value of employer securities	2019-12-31	$84,000
2018 : 5 SIRENS BLAZIN RETIREMENT PLAN 2018 401k financial data
Total income from all sources	2018-12-31	$103,350
Expenses. Total of all expenses incurred	2018-12-31	$10
Total plan assets at end of year	2018-12-31	$103,340
Contributions received from other sources (not participants or employers)	2018-12-31	$83,417
Other income received	2018-12-31	$19,933
Net income (gross income less expenses)	2018-12-31	$103,340
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$103,340
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$0
Assets. Value of employer securities	2018-12-31	$101,850
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$10

Form 5500 Responses for 5 SIRENS BLAZIN RETIREMENT PLAN

2019: 5 SIRENS BLAZIN RETIREMENT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: 5 SIRENS BLAZIN RETIREMENT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	First time form 5500 has been submitted	Yes
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	5 SIRENS BLAZIN, INC.
Employer identification number (EIN):	823088818
NAIC Classification:	722513
NAIC Description:	Limited-Service Restaurants