401k Plan data: PINE CREEK RETIREMENT PLAN plan

PINE CREEK RETIREMENT PLAN 401k Plan overview

Plan Name	PINE CREEK RETIREMENT PLAN
Plan identification number	001

PINE CREEK 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.
Participant-directed brokerage accounts provided as an investment option under the plan.

401k Sponsoring company profile

PINE CREEK CORP. has sponsored the creation of one or more 401k plans.

Company Name: PINE CREEK CORP.

Employer identification number (EIN): 273159444

NAIC Classification: 722210
NAIC Description: Limited-Service Eating Places

Additional information about PINE CREEK CORP.

Jurisdiction of Incorporation: Colorado Department of State

Incorporation Date: 2010-07-29

Company Identification Number: 20101424783

Legal Registered Office Address: 8617 Fawnwood Drive

Castle Rock
United States of America (USA)
80108

More information about PINE CREEK CORP.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PINE CREEK RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2012-01-01 DAN WASHBURN DAN WASHBURN 2012-12-14
001 2011-01-01 JENNIFER WASHBURN JENNIFER WASHBURN 2012-02-29

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2012-01-01	DAN WASHBURN		DAN WASHBURN	2012-12-14
001	2011-01-01	JENNIFER WASHBURN		JENNIFER WASHBURN	2012-02-29

Plan Statistics for PINE CREEK RETIREMENT PLAN

401k plan membership statisitcs for PINE CREEK RETIREMENT PLAN

Measure Date Value
2012: PINE CREEK RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 0
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 0
Total of all active and inactive participants 2012-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 0
Number of participants with account balances 2012-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: PINE CREEK RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1
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 0
Total of all active and inactive participants 2011-01-01 1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 1
Number of participants with account balances 2011-01-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0

Measure	Date	Value
2012: PINE CREEK RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	0
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	0
Total of all active and inactive participants	2012-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	0
Number of participants with account balances	2012-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: PINE CREEK RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1
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	0
Total of all active and inactive participants	2011-01-01	1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	1
Number of participants with account balances	2011-01-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0

Financial Data on PINE CREEK RETIREMENT PLAN

Measure	Date	Value
2012 : PINE CREEK RETIREMENT PLAN 2012 401k financial data
Total income from all sources	2012-12-12	$-4,291
Expenses. Total of all expenses incurred	2012-12-12	$261,471
Benefits paid (including direct rollovers)	2012-12-12	$261,471
Total plan assets at end of year	2012-12-12	$0
Total plan assets at beginning of year	2012-12-12	$265,762
Other income received	2012-12-12	$-4,291
Net income (gross income less expenses)	2012-12-12	$-265,762
Net plan assets at end of year (total assets less liabilities)	2012-12-12	$0
Net plan assets at beginning of year (total assets less liabilities)	2012-12-12	$265,762
2011 : PINE CREEK RETIREMENT PLAN 2011 401k financial data
Total plan liabilities at beginning of year	2011-12-31	$100
Total income from all sources	2011-12-31	$10,102
Expenses. Total of all expenses incurred	2011-12-31	$12
Benefits paid (including direct rollovers)	2011-12-31	$12
Total plan assets at end of year	2011-12-31	$265,762
Total plan assets at beginning of year	2011-12-31	$255,772
Other income received	2011-12-31	$10,102
Net income (gross income less expenses)	2011-12-31	$10,090
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$265,762
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$255,672
Assets. Value of employer securities	2011-12-31	$265,762
2010 : PINE CREEK RETIREMENT PLAN 2010 401k financial data
Total plan liabilities at end of year	2010-12-31	$100
Total income from all sources	2010-12-31	$255,672
Expenses. Total of all expenses incurred	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$255,772
Contributions received from other sources (not participants or employers)	2010-12-31	$255,661
Other income received	2010-12-31	$11
Net income (gross income less expenses)	2010-12-31	$255,672
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$255,672
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$0
Assets. Value of employer securities	2010-12-31	$255,660

Form 5500 Responses for PINE CREEK RETIREMENT PLAN

2012: PINE CREEK RETIREMENT 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	Yes
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: PINE CREEK RETIREMENT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	Yes
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 – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	PINE CREEK CORP.
Employer identification number (EIN):	273159444
NAIC Classification:	722210
NAIC Description:	Limited-Service Eating Places

Jurisdiction of Incorporation:	Colorado Department of State
Incorporation Date:	2010-07-29
Company Identification Number:	20101424783
Legal Registered Office Address:	8617 Fawnwood Drive Castle Rock United States of America (USA) 80108