401k Plan data: SINGLE SOURCE ROOFING CORPORATION 401K PLAN plan

SINGLE SOURCE ROOFING CORPORATION 401K PLAN 401k Plan overview

Plan Name	SINGLE SOURCE ROOFING CORPORATION 401K PLAN
Plan identification number	001

SINGLE SOURCE ROOFING CORPORATION 401K PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
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.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
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

SINGLE SOURCE ROOFING CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: SINGLE SOURCE ROOFING CORPORATION

Employer identification number (EIN): 251738309

NAIC Classification: 238100

Additional information about SINGLE SOURCE ROOFING CORPORATION

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 4693415

More information about SINGLE SOURCE ROOFING CORPORATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SINGLE SOURCE ROOFING CORPORATION 401K PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2013-01-01 THOMAS MASTALSKI 2014-10-02
001 2012-01-01 KENNETH BRIAN KNAPP
001 2011-01-01 KENNETH BRIAN KNAPP
001 2009-01-01 JANELL DRESEL
001 2009-01-01 JANELL DRESEL

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2013-01-01	THOMAS MASTALSKI	2014-10-02
001	2012-01-01	KENNETH BRIAN KNAPP
001	2011-01-01	KENNETH BRIAN KNAPP
001	2009-01-01	JANELL DRESEL
001	2009-01-01	JANELL DRESEL

Plan Statistics for SINGLE SOURCE ROOFING CORPORATION 401K PLAN

401k plan membership statisitcs for SINGLE SOURCE ROOFING CORPORATION 401K PLAN

Measure Date Value
2012: SINGLE SOURCE ROOFING CORPORATION 401K PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 122
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 89
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 9
Total of all active and inactive participants 2012-01-01 98
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 98
Number of participants with account balances 2012-01-01 27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: SINGLE SOURCE ROOFING CORPORATION 401K PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 154
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 107
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 11
Total of all active and inactive participants 2011-01-01 118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 118
Number of participants with account balances 2011-01-01 28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: SINGLE SOURCE ROOFING CORPORATION 401K PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 169
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 122
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 14
Total of all active and inactive participants 2009-01-01 136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 136
Number of participants with account balances 2009-01-01 34
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2012: SINGLE SOURCE ROOFING CORPORATION 401K PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	122
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	89
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	9
Total of all active and inactive participants	2012-01-01	98
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	98
Number of participants with account balances	2012-01-01	27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: SINGLE SOURCE ROOFING CORPORATION 401K PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	154
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	107
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	11
Total of all active and inactive participants	2011-01-01	118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	118
Number of participants with account balances	2011-01-01	28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: SINGLE SOURCE ROOFING CORPORATION 401K PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	169
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	122
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	14
Total of all active and inactive participants	2009-01-01	136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	136
Number of participants with account balances	2009-01-01	34
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on SINGLE SOURCE ROOFING CORPORATION 401K PLAN

Measure	Date	Value
2012 : SINGLE SOURCE ROOFING CORPORATION 401K PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$7,239
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$15,771
Total income from all sources (including contributions)	2012-12-31	$180,638
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$32,994
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$25,655
Value of total corrective distributions	2012-12-31	$7,239
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$60,092
Value of total assets at end of year	2012-12-31	$1,019,962
Value of total assets at beginning of year	2012-12-31	$880,850
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$100
Total interest from all sources	2012-12-31	$56
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$75,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$60,092
Participant contributions at end of year	2012-12-31	$658
Participant contributions at beginning of year	2012-12-31	$1,441
Participant contributions at end of year	2012-12-31	$0
Participant contributions at beginning of year	2012-12-31	$217
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$147,644
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$1,012,723
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$865,079
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in pooled separate accounts at end of year	2012-12-31	$951,359
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$816,133
Income. Interest from loans (other than to participants)	2012-12-31	$56
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$67,945
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$63,059
Net investment gain/loss from pooled separate accounts	2012-12-31	$120,490
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$25,655
Contract administrator fees	2012-12-31	$100
Liabilities. Value of benefit claims payable at end of year	2012-12-31	$7,239
Liabilities. Value of benefit claims payable at beginning of year	2012-12-31	$15,771
Did the plan have assets held for investment	2012-12-31	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	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	STELMACK DOBRANSKY & EANNACE, LLC
Accountancy firm EIN	2012-12-31	251900686
2011 : SINGLE SOURCE ROOFING CORPORATION 401K PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$15,771
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$12,130
Total income from all sources (including contributions)	2011-12-31	$50,794
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$19,073
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$3,152
Value of total corrective distributions	2011-12-31	$15,771
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$61,029
Value of total assets at end of year	2011-12-31	$880,850
Value of total assets at beginning of year	2011-12-31	$845,488
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$150
Total interest from all sources	2011-12-31	$204
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$75,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$61,029
Participant contributions at end of year	2011-12-31	$1,441
Participant contributions at beginning of year	2011-12-31	$2,168
Participant contributions at end of year	2011-12-31	$217
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$31,721
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$865,079
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$833,358
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in pooled separate accounts at end of year	2011-12-31	$816,133
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$773,891
Interest on participant loans	2011-12-31	$204
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$63,059
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$69,429
Net investment gain/loss from pooled separate accounts	2011-12-31	$-10,439
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$3,152
Contract administrator fees	2011-12-31	$150
Liabilities. Value of benefit claims payable at end of year	2011-12-31	$15,771
Liabilities. Value of benefit claims payable at beginning of year	2011-12-31	$12,130
Did the plan have assets held for investment	2011-12-31	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	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	STELMACK DOBRANSKY & EANNACE, LLC
Accountancy firm EIN	2011-12-31	251900686
2010 : SINGLE SOURCE ROOFING CORPORATION 401K PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$12,130
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$16,376
Total income from all sources (including contributions)	2010-12-31	$173,189
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$143,659
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$131,279
Value of total corrective distributions	2010-12-31	$12,130
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$76,514
Value of total assets at end of year	2010-12-31	$845,488
Value of total assets at beginning of year	2010-12-31	$820,204
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$250
Total interest from all sources	2010-12-31	$172
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$75,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$76,514
Participant contributions at end of year	2010-12-31	$2,168
Participant contributions at beginning of year	2010-12-31	$4,108
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$29,530
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$833,358
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$803,828
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in pooled separate accounts at end of year	2010-12-31	$773,891
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$816,096
Interest on participant loans	2010-12-31	$172
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$69,429
Net investment gain/loss from pooled separate accounts	2010-12-31	$96,503
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$131,279
Contract administrator fees	2010-12-31	$250
Liabilities. Value of benefit claims payable at end of year	2010-12-31	$12,130
Liabilities. Value of benefit claims payable at beginning of year	2010-12-31	$16,376
Did the plan have assets held for investment	2010-12-31	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	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	STELMACK DOBRANSKY & EANNACE, LLC
Accountancy firm EIN	2010-12-31	251900686
2009 : SINGLE SOURCE ROOFING CORPORATION 401K PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for SINGLE SOURCE ROOFING CORPORATION 401K PLAN

2012: SINGLE SOURCE ROOFING CORPORATION 401K PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: SINGLE SOURCE ROOFING CORPORATION 401K PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: SINGLE SOURCE ROOFING CORPORATION 401K PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

PHU587

Policy instance

Insurance contract or identification number	PHU587
Number of Individuals Covered	31
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,353
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
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 $2,353
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	NA
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO ADVISORS INS ATTN COMM

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

PHU587

Policy instance

Insurance contract or identification number	PHU587
Number of Individuals Covered	33
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,185
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

PHU587

Policy instance

Insurance contract or identification number	PHU587
Number of Individuals Covered	37
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,076
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
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 $2,076
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO ADVISORS INS ATTN COMM

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Company Name:	SINGLE SOURCE ROOFING CORPORATION
Employer identification number (EIN):	251738309
NAIC Classification:	238100

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	4693415