401k Plan data: AC & A RETIREMENT PLAN plan

AC & A RETIREMENT PLAN 401k Plan overview

Plan Name	AC & A RETIREMENT PLAN
Plan identification number	001

AC & A 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.
Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of 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.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Plan covering Self-Employed individuals.
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

APPLIED COMPOSITES HOLDINGS, LLC has sponsored the creation of one or more 401k plans.

Company Name: APPLIED COMPOSITES HOLDINGS, LLC

Employer identification number (EIN): 201695946

NAIC Classification: 336410

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AC & A RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2019-01-01
001 2018-01-01
001 2018-01-01
001 2018-01-01
001 2017-01-01 JORGE GARCIA
001 2016-01-01 JORGE GARCIA 2017-05-15
001 2015-01-01 JORGE GARCIA 2016-07-19 JORGE GARCIA 2016-07-19
001 2014-01-01 KELLY CECUTTI 2015-09-30

Plan Statistics for AC & A RETIREMENT PLAN

401k plan membership statisitcs for AC & A RETIREMENT PLAN

Measure Date Value
2022: AC & A RETIREMENT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 930
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 749
Number of retired or separated participants receiving benefits 2022-01-01 3
Number of other retired or separated participants entitled to future benefits 2022-01-01 141
Total of all active and inactive participants 2022-01-01 893
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 1
Total participants 2022-01-01 894
Number of participants with account balances 2022-01-01 675
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: AC & A RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 808
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 752
Number of retired or separated participants receiving benefits 2021-01-01 18
Number of other retired or separated participants entitled to future benefits 2021-01-01 125
Total of all active and inactive participants 2021-01-01 895
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 895
Number of participants with account balances 2021-01-01 623
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 7
2020: AC & A RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 881
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 701
Number of retired or separated participants receiving benefits 2020-01-01 4
Number of other retired or separated participants entitled to future benefits 2020-01-01 77
Total of all active and inactive participants 2020-01-01 782
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 782
Number of participants with account balances 2020-01-01 555
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 15
2019: AC & A RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 543
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 672
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 52
Total of all active and inactive participants 2019-01-01 724
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 724
Number of participants with account balances 2019-01-01 414
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: AC & A RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 520
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 460
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 66
Total of all active and inactive participants 2018-01-01 526
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 526
Number of participants with account balances 2018-01-01 405
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: AC & A RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 139
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 177
Number of retired or separated participants receiving benefits 2017-01-01 2
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 179
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 179
Number of participants with account balances 2017-01-01 140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0

Measure	Date	Value
2022: AC & A RETIREMENT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	930
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	749
Number of retired or separated participants receiving benefits	2022-01-01	3
Number of other retired or separated participants entitled to future benefits	2022-01-01	141
Total of all active and inactive participants	2022-01-01	893
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	1
Total participants	2022-01-01	894
Number of participants with account balances	2022-01-01	675
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: AC & A RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	808
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	752
Number of retired or separated participants receiving benefits	2021-01-01	18
Number of other retired or separated participants entitled to future benefits	2021-01-01	125
Total of all active and inactive participants	2021-01-01	895
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	895
Number of participants with account balances	2021-01-01	623
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	7
2020: AC & A RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	881
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	701
Number of retired or separated participants receiving benefits	2020-01-01	4
Number of other retired or separated participants entitled to future benefits	2020-01-01	77
Total of all active and inactive participants	2020-01-01	782
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	782
Number of participants with account balances	2020-01-01	555
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	15
2019: AC & A RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	543
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	672
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	52
Total of all active and inactive participants	2019-01-01	724
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	724
Number of participants with account balances	2019-01-01	414
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: AC & A RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	520
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	460
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	66
Total of all active and inactive participants	2018-01-01	526
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	526
Number of participants with account balances	2018-01-01	405
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: AC & A RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	139
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	177
Number of retired or separated participants receiving benefits	2017-01-01	2
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	179
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	179
Number of participants with account balances	2017-01-01	140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0

Financial Data on AC & A RETIREMENT PLAN

Measure	Date	Value
2022 : AC & A RETIREMENT PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$1,044,282
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$3,401,355
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$3,183,855
Expenses. Certain deemed distributions of participant loans	2022-12-31	$-13
Value of total corrective distributions	2022-12-31	$882
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$6,118,874
Value of total assets at end of year	2022-12-31	$26,632,652
Value of total assets at beginning of year	2022-12-31	$28,989,725
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$216,631
Total interest from all sources	2022-12-31	$6,520
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$92,070
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$92,070
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$3,385,164
Participant contributions at end of year	2022-12-31	$94
Participant contributions at beginning of year	2022-12-31	$3,942
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$1,118,825
Other income not declared elsewhere	2022-12-31	$73,098
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-2,357,073
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$26,632,652
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$28,989,725
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Investment advisory and management fees	2022-12-31	$73,356
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$3,580,517
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$3,555,864
Interest on participant loans	2022-12-31	$80
Interest earned on other investments	2022-12-31	$6,440
Value of interest in common/collective trusts at end of year	2022-12-31	$22,383,324
Value of interest in common/collective trusts at beginning of year	2022-12-31	$25,376,503
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$668,717
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$53,416
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-802,368
Net investment gain or loss from common/collective trusts	2022-12-31	$-4,443,912
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$1,614,885
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$3,183,855
Contract administrator fees	2022-12-31	$143,275
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Disclaimer
Accountancy firm name	2022-12-31	BAROLDI GUNDERSEN LLP
Accountancy firm EIN	2022-12-31	330978713
2021 : AC & A RETIREMENT PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$9,664,570
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$2,892,636
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$2,668,537
Expenses. Certain deemed distributions of participant loans	2021-12-31	$720
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$5,920,549
Value of total assets at end of year	2021-12-31	$28,989,725
Value of total assets at beginning of year	2021-12-31	$22,217,791
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$223,379
Total interest from all sources	2021-12-31	$2,815
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$116,952
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$116,952
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$2,982,960
Participant contributions at end of year	2021-12-31	$3,942
Participant contributions at beginning of year	2021-12-31	$13,390
Participant contributions at end of year	2021-12-31	$0
Participant contributions at beginning of year	2021-12-31	$91,101
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$1,541,446
Other income not declared elsewhere	2021-12-31	$75,000
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$6,771,934
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$28,989,725
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$22,217,791
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Investment advisory and management fees	2021-12-31	$75,000
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$3,555,864
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$2,554,605
Interest on participant loans	2021-12-31	$641
Interest earned on other investments	2021-12-31	$2,174
Value of interest in common/collective trusts at end of year	2021-12-31	$25,376,503
Value of interest in common/collective trusts at beginning of year	2021-12-31	$19,271,141
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$53,416
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$215,705
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$401,540
Net investment gain or loss from common/collective trusts	2021-12-31	$3,147,714
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$1,396,143
Employer contributions (assets) at end of year	2021-12-31	$0
Employer contributions (assets) at beginning of year	2021-12-31	$71,849
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$2,668,537
Contract administrator fees	2021-12-31	$148,379
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Disclaimer
Accountancy firm name	2021-12-31	CHRISTINA GEE
Accountancy firm EIN	2021-12-31	330978713
2020 : AC & A RETIREMENT PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$6,711
Total income from all sources (including contributions)	2020-12-31	$10,040,392
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$2,386,945
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$2,240,718
Value of total corrective distributions	2020-12-31	$1,725
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$7,311,968
Value of total assets at end of year	2020-12-31	$22,217,791
Value of total assets at beginning of year	2020-12-31	$14,571,055
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$144,502
Total interest from all sources	2020-12-31	$6,814
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$50,989
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$50,989
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$2,030,292
Participant contributions at end of year	2020-12-31	$13,390
Participant contributions at beginning of year	2020-12-31	$40,467
Participant contributions at end of year	2020-12-31	$91,101
Participant contributions at beginning of year	2020-12-31	$29,407
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$4,208,883
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2020-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-12-31	$6,711
Other income not declared elsewhere	2020-12-31	$45,140
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$7,653,447
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$22,217,791
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$14,564,344
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Investment advisory and management fees	2020-12-31	$36
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$2,554,605
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$1,024,439
Interest on participant loans	2020-12-31	$1,331
Interest earned on other investments	2020-12-31	$5,483
Value of interest in common/collective trusts at end of year	2020-12-31	$19,271,141
Value of interest in common/collective trusts at beginning of year	2020-12-31	$13,250,855
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$215,705
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$196,610
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$312,904
Net investment gain or loss from common/collective trusts	2020-12-31	$2,312,577
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$1,072,793
Employer contributions (assets) at end of year	2020-12-31	$71,849
Employer contributions (assets) at beginning of year	2020-12-31	$29,277
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$2,240,718
Contract administrator fees	2020-12-31	$144,466
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	CHRISTINA GEE
Accountancy firm EIN	2020-12-31	330978713
2019 : AC & A RETIREMENT PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$6,711
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$12,940
Total income from all sources (including contributions)	2019-12-31	$5,683,822
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$998,828
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$975,296
Value of total corrective distributions	2019-12-31	$1,368
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$2,972,299
Value of total assets at end of year	2019-12-31	$14,571,055
Value of total assets at beginning of year	2019-12-31	$9,892,290
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$22,164
Total interest from all sources	2019-12-31	$18,512
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$25,914
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$25,914
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$1,705,540
Participant contributions at end of year	2019-12-31	$40,467
Participant contributions at beginning of year	2019-12-31	$133,437
Participant contributions at end of year	2019-12-31	$29,407
Participant contributions at beginning of year	2019-12-31	$22,551
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$314,049
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$94
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$6,711
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$12,940
Other income not declared elsewhere	2019-12-31	$22,677
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$4,684,994
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$14,564,344
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$9,879,350
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$1,024,439
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$0
Value of interest in pooled separate accounts at end of year	2019-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$9,724,171
Interest on participant loans	2019-12-31	$2,195
Interest earned on other investments	2019-12-31	$16,317
Value of interest in common/collective trusts at end of year	2019-12-31	$13,250,855
Value of interest in common/collective trusts at beginning of year	2019-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$196,610
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$63,732
Net investment gain/loss from pooled separate accounts	2019-12-31	$1,339,641
Net investment gain or loss from common/collective trusts	2019-12-31	$1,241,047
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$952,710
Employer contributions (assets) at end of year	2019-12-31	$29,277
Employer contributions (assets) at beginning of year	2019-12-31	$12,037
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$975,296
Contract administrator fees	2019-12-31	$22,164
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2019-12-31	Yes
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	BAROLDI GUNDERSEN
Accountancy firm EIN	2019-12-31	824308881
2018 : AC & A RETIREMENT PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$16,324
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$10,078,153
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$1,618,727
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$1,618,632
Expenses. Certain deemed distributions of participant loans	2018-12-31	$42,699
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$10,496,069
Value of total assets at end of year	2018-12-31	$9,887,351
Value of total assets at beginning of year	2018-12-31	$1,411,601
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$95
Total interest from all sources	2018-12-31	$7,293
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Administrative expenses professional fees incurred	2018-12-31	$95
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$200,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$1,408,755
Participant contributions at end of year	2018-12-31	$163,180
Participant contributions at end of year	2018-12-31	$22,551
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$8,344,112
Value of other receiveables (less allowance for doubtful accounts) at end of year	2018-12-31	$94
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2018-12-31	$16,324
Other income not declared elsewhere	2018-12-31	$412,872
Total non interest bearing cash at end of year	2018-12-31	$170,681
Total non interest bearing cash at beginning of year	2018-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$8,459,426
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$9,871,027
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$1,411,601
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in pooled separate accounts at end of year	2018-12-31	$9,553,490
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$1,411,601
Interest on participant loans	2018-12-31	$7,293
Net investment gain/loss from pooled separate accounts	2018-12-31	$-838,081
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$743,202
Employer contributions (assets) at end of year	2018-12-31	$12,037
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$1,618,632
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	BAROLDI GUNDERSEN
Accountancy firm EIN	2018-12-31	824308881
2017 : AC & A RETIREMENT PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$728,414
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$48,651
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$45,301
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$545,259
Value of total assets at end of year	2017-12-31	$1,411,601
Value of total assets at beginning of year	2017-12-31	$731,838
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$3,350
Total interest from all sources	2017-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Administrative expenses professional fees incurred	2017-12-31	$3,350
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$30,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$313,956
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$27,128
Total non interest bearing cash at end of year	2017-12-31	$0
Total non interest bearing cash at beginning of year	2017-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$679,763
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$1,411,601
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$731,838
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in pooled separate accounts at end of year	2017-12-31	$1,411,601
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$731,838
Net investment gain/loss from pooled separate accounts	2017-12-31	$183,155
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$204,175
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$45,301
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	BAROLDI GUNDERSEN
Accountancy firm EIN	2017-12-31	824308881

Form 5500 Responses for AC & A RETIREMENT PLAN

2022: AC & A RETIREMENT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	Yes
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: AC & A RETIREMENT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: AC & A RETIREMENT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: AC & A RETIREMENT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	Yes
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 – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: AC & A RETIREMENT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	Yes
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 – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: AC & A RETIREMENT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

89587900087

Policy instance

Insurance contract or identification number	89587900087
Number of Individuals Covered	20
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Are there contracts with allocated funds for individual policies?	0
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

89587900087

Policy instance

Insurance contract or identification number	89587900087
Number of Individuals Covered	17
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Are there contracts with allocated funds for individual policies?	0
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

89587900087

Policy instance

Insurance contract or identification number	89587900087
Number of Individuals Covered	7
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Are there contracts with allocated funds for individual policies?	0
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )

Policy contract number

012215

Policy instance

Insurance contract or identification number	012215
Number of Individuals Covered	0
Insurance policy start date	2019-01-01
Insurance policy end date	2019-04-30
Total amount of commissions paid to insurance broker	USD $28,185
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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	No
Dental Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,185
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

89587900087

Policy instance

Insurance contract or identification number	89587900087
Number of Individuals Covered	4
Insurance policy start date	2019-05-01
Insurance policy end date	2019-12-31
Are there contracts with allocated funds for individual policies?	0
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )

Policy contract number

GP4430/RP012215

Policy instance

Insurance contract or identification number	GP4430/RP012215
Number of Individuals Covered	405
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $33,040
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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	No
Dental Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,421
Insurance broker organization code?	3

THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )

Policy contract number

GP4430

Policy instance

Insurance contract or identification number	GP4430
Number of Individuals Covered	140
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,582
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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	No
Dental Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,124
Insurance broker organization code?	3
Insurance broker name	CARMADELLA, LAUREN

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Company Name:	APPLIED COMPOSITES HOLDINGS, LLC
Employer identification number (EIN):	201695946
NAIC Classification:	336410