BACKLOT HOSPITALITY, LLC

Company Details

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

BACKLOT COFFEE 401(K) PLAN

2023

824110571

2024-05-03

BACKLOT HOSPITALITY LLC

Plan administrator’s name and address

Administrator’s EIN	474474775
Plan administrator’s name	GUIDELINE, INC.
Plan administrator’s address	1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number	8882283491

Signature of

Role	Plan administrator
Date	2024-05-03
Name of individual signing	QIAN LIU
Valid signature	Filed with authorized/valid electronic signature

BACKLOT COFFEE 401(K) PLAN

2022

824110571

2023-05-28

BACKLOT HOSPITALITY LLC

Plan administrator’s name and address

Administrator’s EIN	474474775
Plan administrator’s name	GUIDELINE, INC.
Plan administrator’s address	1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number	8882283491

Signature of

Role	Plan administrator
Date	2023-05-27
Name of individual signing	CHRISTINE RIMER
Valid signature	Filed with authorized/valid electronic signature

Name and Address	Role	Appointment Date
JUSTIN SHLENSKY, 436 N FULTON AVE, VILLA PARK, 60181	Agent	2021-11-30

Name and Address	Role	Appointment Date
KIM, JOHN J., 2615 PARK PLACE, EVANSTON, IL, 60201	Manager	2024-12-12
BLOOM, ISAAC F., 4436 N WESTERN AVE, UNIT 3S, CHICAGO, IL, 60625	Manager	2024-12-12

Date of last update: 30 Jan 2025