BURRIS RESTAURANTS, INC.

Company Details

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

BURRIS RESTAURANTS INC MEDOVA LIFESTYLE HEALTH PLAN

2021

020552513

2023-01-16

BURRIS RESTAURANTS INC

Plan administrator’s name and address

Administrator’s EIN	200200514
Plan administrator’s name	RECEIVERSHIP MANAGEMENT INC
Plan administrator’s address	510 HOSPITAL DR STE 490, MADISON, TN, 371155049
Administrator’s telephone number	6153700051

Signature of

Role	Plan administrator
Date	2023-01-15
Name of individual signing	ROBERT MOORE
Valid signature	Filed with authorized/valid electronic signature

BURRIS RESTAURANTS INC MEDOVA LIFESTYLE HEALTH PLAN

2020

020552513

2022-01-12

BURRIS RESTAURANTS INC

Plan administrator’s name and address

Administrator’s EIN	200200514
Plan administrator’s name	RECEIVERSHIP MANAGEMENT, INC
Plan administrator’s address	510 HOSPITAL DR STE 490, MADISON, TN, 371155049
Administrator’s telephone number	6153700051

Signature of

Role	Plan administrator
Date	2021-12-13
Name of individual signing	ROBERT MOORE
Valid signature	Filed with authorized/valid electronic signature

Name and Address	Role	Appointment Date
ALAN E STUMPF, 222 S MAIN ST, COLUMBIA, 62236, MONROE	Agent	2005-02-01

Name and Address	Role
WILLIAM E BURRIS 8054 LAKEWOOD PLACE WATERLOO IL 62298	President

Name and Address	Role
JAMIE S BURRIS	Secretary

Class	Series	Voting Rights	Authorized Shares	Issued Shares	Par Value
COMMON	No data	Voting Rights	1000	10000	100

Date of last update: 13 Jan 2025