401k Plan data: TAX SHELTERED ANNUITY plan

TAX SHELTERED ANNUITY 401k Plan overview

Plan Name	TAX SHELTERED ANNUITY
Plan identification number	001

TAX SHELTERED ANNUITY Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
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.

401k Sponsoring company profile

THRESHOLDS, INC. has sponsored the creation of one or more 401k plans.

Company Name: THRESHOLDS, INC.

Employer identification number (EIN): 382063018

NAIC Classification: 813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Additional information about THRESHOLDS, INC.

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 1967-01-19

Company Identification Number: 206189

More information about THRESHOLDS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TAX SHELTERED ANNUITY

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2021-07-01 STEVEN VAN HOUTEN 2023-02-23
001 2020-07-01 STEVEN VAN HOUTEN 2022-03-30
001 2019-07-01 STEVEN VAN HOUTEN 2021-03-24
001 2018-07-01 STEVEN VAN HOUTEN 2020-03-17
001 2017-07-01 THOMAS FERCH
001 2016-07-01 THOMAS FERCH
001 2015-07-01 THOMAS FERCH
001 2014-07-01 THOMAS FERCH
001 2013-07-01 THOMAS FERCH
001 2012-07-01 THOMAS FERCH
001 2011-07-01 THOMAS FERCH
001 2009-07-01 THOMAS FERCH
001 2009-07-01 THOMAS FERCH

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2021-07-01	STEVEN VAN HOUTEN	2023-02-23
001	2020-07-01	STEVEN VAN HOUTEN	2022-03-30
001	2019-07-01	STEVEN VAN HOUTEN	2021-03-24
001	2018-07-01	STEVEN VAN HOUTEN	2020-03-17
001	2017-07-01	THOMAS FERCH
001	2016-07-01	THOMAS FERCH
001	2015-07-01	THOMAS FERCH
001	2014-07-01	THOMAS FERCH
001	2013-07-01	THOMAS FERCH
001	2012-07-01	THOMAS FERCH
001	2011-07-01	THOMAS FERCH
001	2009-07-01	THOMAS FERCH
001	2009-07-01	THOMAS FERCH

Plan Statistics for TAX SHELTERED ANNUITY

401k plan membership statisitcs for TAX SHELTERED ANNUITY

Measure Date Value
2021: TAX SHELTERED ANNUITY 2021 401k membership
Total participants, beginning-of-year 2021-07-01 275
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 185
Number of retired or separated participants receiving benefits 2021-07-01 0
Number of other retired or separated participants entitled to future benefits 2021-07-01 85
Total of all active and inactive participants 2021-07-01 270
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-07-01 0
Total participants 2021-07-01 270
Number of participants with account balances 2021-07-01 146
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-07-01 0
2020: TAX SHELTERED ANNUITY 2020 401k membership
Total participants, beginning-of-year 2020-07-01 291
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 181
Number of retired or separated participants receiving benefits 2020-07-01 0
Number of other retired or separated participants entitled to future benefits 2020-07-01 94
Total of all active and inactive participants 2020-07-01 275
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-07-01 0
Total participants 2020-07-01 275
Number of participants with account balances 2020-07-01 156
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-07-01 0
2019: TAX SHELTERED ANNUITY 2019 401k membership
Total participants, beginning-of-year 2019-07-01 391
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 206
Number of retired or separated participants receiving benefits 2019-07-01 0
Number of other retired or separated participants entitled to future benefits 2019-07-01 99
Total of all active and inactive participants 2019-07-01 305
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-07-01 0
Total participants 2019-07-01 305
Number of participants with account balances 2019-07-01 159
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-07-01 0
2018: TAX SHELTERED ANNUITY 2018 401k membership
Total participants, beginning-of-year 2018-07-01 162
Total number of active participants reported on line 7a of the Form 5500 2018-07-01 311
Number of retired or separated participants receiving benefits 2018-07-01 0
Number of other retired or separated participants entitled to future benefits 2018-07-01 80
Total of all active and inactive participants 2018-07-01 391
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-07-01 0
Total participants 2018-07-01 391
Number of participants with account balances 2018-07-01 160
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-07-01 0
2017: TAX SHELTERED ANNUITY 2017 401k membership
Total participants, beginning-of-year 2017-07-01 226
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 86
Number of retired or separated participants receiving benefits 2017-07-01 2
Number of other retired or separated participants entitled to future benefits 2017-07-01 74
Total of all active and inactive participants 2017-07-01 162
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-07-01 0
Total participants 2017-07-01 162
Number of participants with account balances 2017-07-01 162
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-07-01 0
2016: TAX SHELTERED ANNUITY 2016 401k membership
Total participants, beginning-of-year 2016-07-01 230
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 153
Number of retired or separated participants receiving benefits 2016-07-01 85
Total of all active and inactive participants 2016-07-01 238
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-07-01 0
Total participants 2016-07-01 238
Number of participants with account balances 2016-07-01 166
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-07-01 0
2015: TAX SHELTERED ANNUITY 2015 401k membership
Total participants, beginning-of-year 2015-07-01 249
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 161
Number of retired or separated participants receiving benefits 2015-07-01 0
Number of other retired or separated participants entitled to future benefits 2015-07-01 76
Total of all active and inactive participants 2015-07-01 237
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-07-01 0
Total participants 2015-07-01 237
Number of participants with account balances 2015-07-01 166
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-07-01 0
2014: TAX SHELTERED ANNUITY 2014 401k membership
Total participants, beginning-of-year 2014-07-01 242
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 149
Number of retired or separated participants receiving benefits 2014-07-01 0
Number of other retired or separated participants entitled to future benefits 2014-07-01 87
Total of all active and inactive participants 2014-07-01 236
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-07-01 1
Total participants 2014-07-01 237
Number of participants with account balances 2014-07-01 191
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-07-01 0
2013: TAX SHELTERED ANNUITY 2013 401k membership
Total participants, beginning-of-year 2013-07-01 234
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 124
Number of retired or separated participants receiving benefits 2013-07-01 0
Number of other retired or separated participants entitled to future benefits 2013-07-01 109
Total of all active and inactive participants 2013-07-01 233
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-07-01 1
Total participants 2013-07-01 234
Number of participants with account balances 2013-07-01 194
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-07-01 0
2012: TAX SHELTERED ANNUITY 2012 401k membership
Total participants, beginning-of-year 2012-07-01 227
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 138
Number of other retired or separated participants entitled to future benefits 2012-07-01 96
Total of all active and inactive participants 2012-07-01 234
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-07-01 0
Total participants 2012-07-01 234
Number of participants with account balances 2012-07-01 197
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-07-01 0
2011: TAX SHELTERED ANNUITY 2011 401k membership
Total participants, beginning-of-year 2011-07-01 227
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 136
Number of other retired or separated participants entitled to future benefits 2011-07-01 97
Total of all active and inactive participants 2011-07-01 233
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-07-01 0
Total participants 2011-07-01 233
Number of participants with account balances 2011-07-01 199
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-07-01 0
2009: TAX SHELTERED ANNUITY 2009 401k membership
Total participants, beginning-of-year 2009-07-01 207
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 137
Number of other retired or separated participants entitled to future benefits 2009-07-01 67
Total of all active and inactive participants 2009-07-01 204
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-07-01 0
Total participants 2009-07-01 204
Number of participants with account balances 2009-07-01 174
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-07-01 0

Measure	Date	Value
2021: TAX SHELTERED ANNUITY 2021 401k membership
Total participants, beginning-of-year	2021-07-01	275
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	185
Number of retired or separated participants receiving benefits	2021-07-01	0
Number of other retired or separated participants entitled to future benefits	2021-07-01	85
Total of all active and inactive participants	2021-07-01	270
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-07-01	0
Total participants	2021-07-01	270
Number of participants with account balances	2021-07-01	146
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-07-01	0
2020: TAX SHELTERED ANNUITY 2020 401k membership
Total participants, beginning-of-year	2020-07-01	291
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	181
Number of retired or separated participants receiving benefits	2020-07-01	0
Number of other retired or separated participants entitled to future benefits	2020-07-01	94
Total of all active and inactive participants	2020-07-01	275
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-07-01	0
Total participants	2020-07-01	275
Number of participants with account balances	2020-07-01	156
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-07-01	0
2019: TAX SHELTERED ANNUITY 2019 401k membership
Total participants, beginning-of-year	2019-07-01	391
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	206
Number of retired or separated participants receiving benefits	2019-07-01	0
Number of other retired or separated participants entitled to future benefits	2019-07-01	99
Total of all active and inactive participants	2019-07-01	305
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-07-01	0
Total participants	2019-07-01	305
Number of participants with account balances	2019-07-01	159
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-07-01	0
2018: TAX SHELTERED ANNUITY 2018 401k membership
Total participants, beginning-of-year	2018-07-01	162
Total number of active participants reported on line 7a of the Form 5500	2018-07-01	311
Number of retired or separated participants receiving benefits	2018-07-01	0
Number of other retired or separated participants entitled to future benefits	2018-07-01	80
Total of all active and inactive participants	2018-07-01	391
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-07-01	0
Total participants	2018-07-01	391
Number of participants with account balances	2018-07-01	160
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-07-01	0
2017: TAX SHELTERED ANNUITY 2017 401k membership
Total participants, beginning-of-year	2017-07-01	226
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	86
Number of retired or separated participants receiving benefits	2017-07-01	2
Number of other retired or separated participants entitled to future benefits	2017-07-01	74
Total of all active and inactive participants	2017-07-01	162
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-07-01	0
Total participants	2017-07-01	162
Number of participants with account balances	2017-07-01	162
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-07-01	0
2016: TAX SHELTERED ANNUITY 2016 401k membership
Total participants, beginning-of-year	2016-07-01	230
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	153
Number of retired or separated participants receiving benefits	2016-07-01	85
Total of all active and inactive participants	2016-07-01	238
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-07-01	0
Total participants	2016-07-01	238
Number of participants with account balances	2016-07-01	166
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-07-01	0
2015: TAX SHELTERED ANNUITY 2015 401k membership
Total participants, beginning-of-year	2015-07-01	249
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	161
Number of retired or separated participants receiving benefits	2015-07-01	0
Number of other retired or separated participants entitled to future benefits	2015-07-01	76
Total of all active and inactive participants	2015-07-01	237
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-07-01	0
Total participants	2015-07-01	237
Number of participants with account balances	2015-07-01	166
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-07-01	0
2014: TAX SHELTERED ANNUITY 2014 401k membership
Total participants, beginning-of-year	2014-07-01	242
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	149
Number of retired or separated participants receiving benefits	2014-07-01	0
Number of other retired or separated participants entitled to future benefits	2014-07-01	87
Total of all active and inactive participants	2014-07-01	236
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-07-01	1
Total participants	2014-07-01	237
Number of participants with account balances	2014-07-01	191
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-07-01	0
2013: TAX SHELTERED ANNUITY 2013 401k membership
Total participants, beginning-of-year	2013-07-01	234
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	124
Number of retired or separated participants receiving benefits	2013-07-01	0
Number of other retired or separated participants entitled to future benefits	2013-07-01	109
Total of all active and inactive participants	2013-07-01	233
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-07-01	1
Total participants	2013-07-01	234
Number of participants with account balances	2013-07-01	194
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-07-01	0
2012: TAX SHELTERED ANNUITY 2012 401k membership
Total participants, beginning-of-year	2012-07-01	227
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	138
Number of other retired or separated participants entitled to future benefits	2012-07-01	96
Total of all active and inactive participants	2012-07-01	234
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-07-01	0
Total participants	2012-07-01	234
Number of participants with account balances	2012-07-01	197
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-07-01	0
2011: TAX SHELTERED ANNUITY 2011 401k membership
Total participants, beginning-of-year	2011-07-01	227
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	136
Number of other retired or separated participants entitled to future benefits	2011-07-01	97
Total of all active and inactive participants	2011-07-01	233
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-07-01	0
Total participants	2011-07-01	233
Number of participants with account balances	2011-07-01	199
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-07-01	0
2009: TAX SHELTERED ANNUITY 2009 401k membership
Total participants, beginning-of-year	2009-07-01	207
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	137
Number of other retired or separated participants entitled to future benefits	2009-07-01	67
Total of all active and inactive participants	2009-07-01	204
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-07-01	0
Total participants	2009-07-01	204
Number of participants with account balances	2009-07-01	174
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-07-01	0

Financial Data on TAX SHELTERED ANNUITY

Measure	Date	Value
2022 : TAX SHELTERED ANNUITY 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-06-30	$0
Total income from all sources (including contributions)	2022-06-30	$-467,732
Total loss/gain on sale of assets	2022-06-30	$0
Total of all expenses incurred	2022-06-30	$1,713,697
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-06-30	$1,711,647
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-06-30	$412,925
Value of total assets at end of year	2022-06-30	$7,230,971
Value of total assets at beginning of year	2022-06-30	$9,412,400
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-06-30	$2,050
Total interest from all sources	2022-06-30	$19,938
Total dividends received (eg from common stock, registered investment company shares)	2022-06-30	$437,259
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-06-30	$437,259
Was this plan covered by a fidelity bond	2022-06-30	Yes
Value of fidelity bond cover	2022-06-30	$500,000
If this is an individual account plan, was there a blackout period	2022-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2022-06-30	No
Contributions received from participants	2022-06-30	$240,372
Participant contributions at end of year	2022-06-30	$268,727
Participant contributions at beginning of year	2022-06-30	$278,447
Assets. Other investments not covered elsewhere at end of year	2022-06-30	$1,016,367
Assets. Other investments not covered elsewhere at beginning of year	2022-06-30	$1,143,840
Income. Received or receivable in cash from other sources (including rollovers)	2022-06-30	$3,915
Other income not declared elsewhere	2022-06-30	$-1,337,854
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-06-30	No
Value of net income/loss	2022-06-30	$-2,181,429
Value of net assets at end of year (total assets less liabilities)	2022-06-30	$7,230,971
Value of net assets at beginning of year (total assets less liabilities)	2022-06-30	$9,412,400
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-06-30	No
Were any leases to which the plan was party in default or uncollectible	2022-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-06-30	$5,604,383
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-06-30	$7,679,711
Interest on participant loans	2022-06-30	$19,938
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-06-30	$172,856
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-06-30	$172,113
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-06-30	No
Was there a failure to transmit to the plan any participant contributions	2022-06-30	No
Has the plan failed to provide any benefit when due under the plan	2022-06-30	No
Contributions received in cash from employer	2022-06-30	$168,638
Employer contributions (assets) at end of year	2022-06-30	$168,638
Employer contributions (assets) at beginning of year	2022-06-30	$138,289
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-06-30	$1,711,647
Contract administrator fees	2022-06-30	$2,050
Did the plan have assets held for investment	2022-06-30	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	2022-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-06-30	No
Opinion of an independent qualified public accountant for this plan	2022-06-30	Unqualified
Accountancy firm name	2022-06-30	BEENE GARTER A DOEREN MAYHEW FIRM
Accountancy firm EIN	2022-06-30	382492570
2021 : TAX SHELTERED ANNUITY 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-06-30	$0
Total income from all sources (including contributions)	2021-06-30	$2,290,446
Total loss/gain on sale of assets	2021-06-30	$0
Total of all expenses incurred	2021-06-30	$569,636
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-06-30	$566,009
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-06-30	$350,124
Value of total assets at end of year	2021-06-30	$9,412,400
Value of total assets at beginning of year	2021-06-30	$7,691,590
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-06-30	$3,627
Total interest from all sources	2021-06-30	$22,394
Total dividends received (eg from common stock, registered investment company shares)	2021-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-06-30	No
Was this plan covered by a fidelity bond	2021-06-30	Yes
Value of fidelity bond cover	2021-06-30	$500,000
If this is an individual account plan, was there a blackout period	2021-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2021-06-30	No
Contributions received from participants	2021-06-30	$194,804
Participant contributions at end of year	2021-06-30	$278,447
Participant contributions at beginning of year	2021-06-30	$318,754
Assets. Other investments not covered elsewhere at end of year	2021-06-30	$1,143,840
Assets. Other investments not covered elsewhere at beginning of year	2021-06-30	$1,246,630
Income. Received or receivable in cash from other sources (including rollovers)	2021-06-30	$17,031
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2021-06-30	$0
Other income not declared elsewhere	2021-06-30	$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	2021-06-30	No
Value of net income/loss	2021-06-30	$1,720,810
Value of net assets at end of year (total assets less liabilities)	2021-06-30	$9,412,400
Value of net assets at beginning of year (total assets less liabilities)	2021-06-30	$7,691,590
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-06-30	No
Were any leases to which the plan was party in default or uncollectible	2021-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-06-30	$7,679,711
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-06-30	$5,846,438
Interest on participant loans	2021-06-30	$22,394
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-06-30	$172,113
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-06-30	$166,802
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-06-30	$1,917,928
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-06-30	No
Was there a failure to transmit to the plan any participant contributions	2021-06-30	No
Has the plan failed to provide any benefit when due under the plan	2021-06-30	No
Contributions received in cash from employer	2021-06-30	$138,289
Employer contributions (assets) at end of year	2021-06-30	$138,289
Employer contributions (assets) at beginning of year	2021-06-30	$112,966
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-06-30	$566,009
Contract administrator fees	2021-06-30	$3,627
Did the plan have assets held for investment	2021-06-30	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	2021-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-06-30	No
Opinion of an independent qualified public accountant for this plan	2021-06-30	Disclaimer
Accountancy firm name	2021-06-30	BEENE GARTER A DOEREN MAYHEW FIRM
Accountancy firm EIN	2021-06-30	382492570
2020 : TAX SHELTERED ANNUITY 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-06-30	$0
Total income from all sources (including contributions)	2020-06-30	$682,701
Total loss/gain on sale of assets	2020-06-30	$0
Total of all expenses incurred	2020-06-30	$1,839,183
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-06-30	$1,833,880
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-06-30	$272,397
Value of total assets at end of year	2020-06-30	$7,691,590
Value of total assets at beginning of year	2020-06-30	$8,848,072
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-06-30	$5,303
Total interest from all sources	2020-06-30	$28,945
Total dividends received (eg from common stock, registered investment company shares)	2020-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-06-30	No
Was this plan covered by a fidelity bond	2020-06-30	Yes
Value of fidelity bond cover	2020-06-30	$500,000
If this is an individual account plan, was there a blackout period	2020-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2020-06-30	No
Contributions received from participants	2020-06-30	$155,264
Participant contributions at end of year	2020-06-30	$318,754
Participant contributions at beginning of year	2020-06-30	$314,786
Assets. Other investments not covered elsewhere at end of year	2020-06-30	$1,246,630
Assets. Other investments not covered elsewhere at beginning of year	2020-06-30	$1,479,361
Income. Received or receivable in cash from other sources (including rollovers)	2020-06-30	$4,167
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-06-30	No
Value of net income/loss	2020-06-30	$-1,156,482
Value of net assets at end of year (total assets less liabilities)	2020-06-30	$7,691,590
Value of net assets at beginning of year (total assets less liabilities)	2020-06-30	$8,848,072
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-06-30	No
Were any leases to which the plan was party in default or uncollectible	2020-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-06-30	$5,846,438
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-06-30	$6,769,763
Income. Interest from loans (other than to participants)	2020-06-30	$28,945
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-06-30	$166,802
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-06-30	$170,135
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-06-30	$381,359
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-06-30	No
Was there a failure to transmit to the plan any participant contributions	2020-06-30	No
Has the plan failed to provide any benefit when due under the plan	2020-06-30	No
Contributions received in cash from employer	2020-06-30	$112,966
Employer contributions (assets) at end of year	2020-06-30	$112,966
Employer contributions (assets) at beginning of year	2020-06-30	$114,027
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-06-30	$1,833,880
Contract administrator fees	2020-06-30	$5,303
Did the plan have assets held for investment	2020-06-30	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	2020-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2020-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2020-06-30	Disclaimer
Accountancy firm name	2020-06-30	BEENE GARTER LLP
Accountancy firm EIN	2020-06-30	381337372
2019 : TAX SHELTERED ANNUITY 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-06-30	$0
Total income from all sources (including contributions)	2019-06-30	$787,997
Total loss/gain on sale of assets	2019-06-30	$0
Total of all expenses incurred	2019-06-30	$303,569
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-06-30	$294,846
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-06-30	$356,281
Value of total assets at end of year	2019-06-30	$8,848,072
Value of total assets at beginning of year	2019-06-30	$8,363,644
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-06-30	$8,723
Total interest from all sources	2019-06-30	$22,770
Total dividends received (eg from common stock, registered investment company shares)	2019-06-30	$484,878
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-06-30	$484,878
Was this plan covered by a fidelity bond	2019-06-30	Yes
Value of fidelity bond cover	2019-06-30	$500,000
If this is an individual account plan, was there a blackout period	2019-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2019-06-30	No
Contributions received from participants	2019-06-30	$251,995
Participant contributions at end of year	2019-06-30	$314,786
Participant contributions at beginning of year	2019-06-30	$292,016
Assets. Other investments not covered elsewhere at end of year	2019-06-30	$1,479,361
Assets. Other investments not covered elsewhere at beginning of year	2019-06-30	$1,417,047
Income. Received or receivable in cash from other sources (including rollovers)	2019-06-30	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-06-30	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-06-30	$58,177
Administrative expenses (other) incurred	2019-06-30	$8,723
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-06-30	No
Value of net income/loss	2019-06-30	$484,428
Value of net assets at end of year (total assets less liabilities)	2019-06-30	$8,848,072
Value of net assets at beginning of year (total assets less liabilities)	2019-06-30	$8,363,644
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-06-30	No
Were any leases to which the plan was party in default or uncollectible	2019-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-06-30	$6,769,763
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-06-30	$6,208,478
Income. Interest from loans (other than to participants)	2019-06-30	$22,770
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-06-30	$170,135
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-06-30	$228,988
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-06-30	$-75,932
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-06-30	No
Was there a failure to transmit to the plan any participant contributions	2019-06-30	No
Has the plan failed to provide any benefit when due under the plan	2019-06-30	No
Contributions received in cash from employer	2019-06-30	$104,286
Employer contributions (assets) at end of year	2019-06-30	$114,027
Employer contributions (assets) at beginning of year	2019-06-30	$158,938
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-06-30	$294,846
Did the plan have assets held for investment	2019-06-30	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	2019-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2019-06-30	Disclaimer
Accountancy firm name	2019-06-30	BEENE GARTER LLP
Accountancy firm EIN	2019-06-30	381337372
2018 : TAX SHELTERED ANNUITY 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-06-30	$0
Total income from all sources (including contributions)	2018-06-30	$1,172,080
Total loss/gain on sale of assets	2018-06-30	$0
Total of all expenses incurred	2018-06-30	$748,854
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-06-30	$748,192
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-06-30	$390,223
Value of total assets at end of year	2018-06-30	$8,363,644
Value of total assets at beginning of year	2018-06-30	$7,940,418
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-06-30	$662
Total interest from all sources	2018-06-30	$21,772
Total dividends received (eg from common stock, registered investment company shares)	2018-06-30	$95,086
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-06-30	$95,086
Was this plan covered by a fidelity bond	2018-06-30	Yes
Value of fidelity bond cover	2018-06-30	$500,000
If this is an individual account plan, was there a blackout period	2018-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2018-06-30	No
Contributions received from participants	2018-06-30	$223,987
Participant contributions at end of year	2018-06-30	$292,016
Participant contributions at beginning of year	2018-06-30	$296,813
Assets. Other investments not covered elsewhere at end of year	2018-06-30	$1,417,047
Assets. Other investments not covered elsewhere at beginning of year	2018-06-30	$1,413,394
Income. Received or receivable in cash from other sources (including rollovers)	2018-06-30	$7,298
Value of other receiveables (less allowance for doubtful accounts) at end of year	2018-06-30	$58,177
Administrative expenses (other) incurred	2018-06-30	$662
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-06-30	No
Value of net income/loss	2018-06-30	$423,226
Value of net assets at end of year (total assets less liabilities)	2018-06-30	$8,363,644
Value of net assets at beginning of year (total assets less liabilities)	2018-06-30	$7,940,418
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-06-30	No
Were any leases to which the plan was party in default or uncollectible	2018-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-06-30	$6,208,478
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-06-30	$5,572,301
Interest on participant loans	2018-06-30	$21,772
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-06-30	$310,561
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-06-30	$310,561
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-06-30	$228,988
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-06-30	$213,254
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-06-30	$664,999
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-06-30	No
Was there a failure to transmit to the plan any participant contributions	2018-06-30	No
Has the plan failed to provide any benefit when due under the plan	2018-06-30	No
Contributions received in cash from employer	2018-06-30	$158,938
Employer contributions (assets) at end of year	2018-06-30	$158,938
Employer contributions (assets) at beginning of year	2018-06-30	$134,095
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-06-30	$748,192
Did the plan have assets held for investment	2018-06-30	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	2018-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-06-30	No
Opinion of an independent qualified public accountant for this plan	2018-06-30	Unqualified
Accountancy firm name	2018-06-30	BEENE GARTER LLP
Accountancy firm EIN	2018-06-30	381337372
2017 : TAX SHELTERED ANNUITY 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-06-30	$0
Total income from all sources (including contributions)	2017-06-30	$1,148,940
Total loss/gain on sale of assets	2017-06-30	$0
Total of all expenses incurred	2017-06-30	$524,912
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-06-30	$524,687
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-06-30	$340,612
Value of total assets at end of year	2017-06-30	$7,940,418
Value of total assets at beginning of year	2017-06-30	$7,316,390
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-06-30	$225
Total interest from all sources	2017-06-30	$21,074
Total dividends received (eg from common stock, registered investment company shares)	2017-06-30	$91,311
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-06-30	$91,311
Was this plan covered by a fidelity bond	2017-06-30	Yes
Value of fidelity bond cover	2017-06-30	$500,000
If this is an individual account plan, was there a blackout period	2017-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2017-06-30	No
Contributions received from participants	2017-06-30	$195,204
Participant contributions at end of year	2017-06-30	$296,813
Participant contributions at beginning of year	2017-06-30	$291,117
Assets. Other investments not covered elsewhere at end of year	2017-06-30	$1,413,394
Assets. Other investments not covered elsewhere at beginning of year	2017-06-30	$1,455,904
Income. Received or receivable in cash from other sources (including rollovers)	2017-06-30	$11,313
Administrative expenses (other) incurred	2017-06-30	$225
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-06-30	No
Value of net income/loss	2017-06-30	$624,028
Value of net assets at end of year (total assets less liabilities)	2017-06-30	$7,940,418
Value of net assets at beginning of year (total assets less liabilities)	2017-06-30	$7,316,390
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-06-30	No
Were any leases to which the plan was party in default or uncollectible	2017-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-06-30	$5,572,301
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-06-30	$5,026,407
Income. Interest from loans (other than to participants)	2017-06-30	$21,074
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-06-30	$310,561
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-06-30	$215,893
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-06-30	$215,893
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-06-30	$213,254
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-06-30	$198,216
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-06-30	$695,943
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-06-30	No
Was there a failure to transmit to the plan any participant contributions	2017-06-30	No
Has the plan failed to provide any benefit when due under the plan	2017-06-30	No
Contributions received in cash from employer	2017-06-30	$134,095
Employer contributions (assets) at end of year	2017-06-30	$134,095
Employer contributions (assets) at beginning of year	2017-06-30	$128,853
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-06-30	$524,687
Did the plan have assets held for investment	2017-06-30	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	2017-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-06-30	No
Opinion of an independent qualified public accountant for this plan	2017-06-30	Unqualified
Accountancy firm name	2017-06-30	BEENE GARTER LLP
Accountancy firm EIN	2017-06-30	381333737
2016 : TAX SHELTERED ANNUITY 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-06-30	$0
Total income from all sources (including contributions)	2016-06-30	$555,552
Total loss/gain on sale of assets	2016-06-30	$0
Total of all expenses incurred	2016-06-30	$660,140
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-06-30	$659,865
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-06-30	$321,760
Value of total assets at end of year	2016-06-30	$7,316,390
Value of total assets at beginning of year	2016-06-30	$7,420,978
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-06-30	$275
Total interest from all sources	2016-06-30	$17,966
Total dividends received (eg from common stock, registered investment company shares)	2016-06-30	$84,939
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-06-30	$84,939
Was this plan covered by a fidelity bond	2016-06-30	Yes
Value of fidelity bond cover	2016-06-30	$500,000
If this is an individual account plan, was there a blackout period	2016-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2016-06-30	No
Contributions received from participants	2016-06-30	$193,385
Participant contributions at end of year	2016-06-30	$291,117
Participant contributions at beginning of year	2016-06-30	$338,554
Assets. Other investments not covered elsewhere at end of year	2016-06-30	$1,455,904
Assets. Other investments not covered elsewhere at beginning of year	2016-06-30	$1,945,926
Administrative expenses (other) incurred	2016-06-30	$275
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-06-30	No
Value of net income/loss	2016-06-30	$-104,588
Value of net assets at end of year (total assets less liabilities)	2016-06-30	$7,316,390
Value of net assets at beginning of year (total assets less liabilities)	2016-06-30	$7,420,978
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-06-30	No
Were any leases to which the plan was party in default or uncollectible	2016-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-06-30	$5,026,407
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-06-30	$4,715,347
Interest on participant loans	2016-06-30	$17,966
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2016-06-30	$215,893
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-06-30	$206,154
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-06-30	$206,154
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-06-30	$198,216
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-06-30	$148,639
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-06-30	$130,887
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-06-30	No
Was there a failure to transmit to the plan any participant contributions	2016-06-30	No
Has the plan failed to provide any benefit when due under the plan	2016-06-30	No
Contributions received in cash from employer	2016-06-30	$128,375
Employer contributions (assets) at end of year	2016-06-30	$128,853
Employer contributions (assets) at beginning of year	2016-06-30	$66,358
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-06-30	$659,865
Did the plan have assets held for investment	2016-06-30	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	2016-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-06-30	No
Opinion of an independent qualified public accountant for this plan	2016-06-30	Disclaimer
Accountancy firm name	2016-06-30	BEENE GARTER LLP
Accountancy firm EIN	2016-06-30	381337372
2015 : TAX SHELTERED ANNUITY 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-06-30	$0
Total income from all sources (including contributions)	2015-06-30	$560,203
Total loss/gain on sale of assets	2015-06-30	$0
Total of all expenses incurred	2015-06-30	$1,298,226
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-06-30	$1,297,951
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-06-30	$253,661
Value of total assets at end of year	2015-06-30	$7,420,978
Value of total assets at beginning of year	2015-06-30	$8,159,001
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-06-30	$275
Total interest from all sources	2015-06-30	$24,470
Total dividends received (eg from common stock, registered investment company shares)	2015-06-30	$92,855
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-06-30	$92,855
Was this plan covered by a fidelity bond	2015-06-30	Yes
Value of fidelity bond cover	2015-06-30	$1,000,000
If this is an individual account plan, was there a blackout period	2015-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2015-06-30	No
Contributions received from participants	2015-06-30	$189,083
Participant contributions at end of year	2015-06-30	$338,554
Participant contributions at beginning of year	2015-06-30	$382,767
Assets. Other investments not covered elsewhere at end of year	2015-06-30	$1,945,926
Assets. Other investments not covered elsewhere at beginning of year	2015-06-30	$1,891,599
Administrative expenses (other) incurred	2015-06-30	$275
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-06-30	No
Value of net income/loss	2015-06-30	$-738,023
Value of net assets at end of year (total assets less liabilities)	2015-06-30	$7,420,978
Value of net assets at beginning of year (total assets less liabilities)	2015-06-30	$8,159,001
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-06-30	No
Were any leases to which the plan was party in default or uncollectible	2015-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-06-30	$4,715,347
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-06-30	$5,458,478
Interest on participant loans	2015-06-30	$24,470
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-06-30	$206,154
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-06-30	$156,659
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-06-30	$156,659
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-06-30	$148,639
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-06-30	$136,113
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-06-30	$189,217
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-06-30	No
Was there a failure to transmit to the plan any participant contributions	2015-06-30	No
Has the plan failed to provide any benefit when due under the plan	2015-06-30	No
Contributions received in cash from employer	2015-06-30	$64,578
Employer contributions (assets) at end of year	2015-06-30	$66,358
Employer contributions (assets) at beginning of year	2015-06-30	$133,385
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-06-30	$1,297,951
Did the plan have assets held for investment	2015-06-30	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	2015-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-06-30	No
Opinion of an independent qualified public accountant for this plan	2015-06-30	Disclaimer
Accountancy firm name	2015-06-30	BEENE GARTER LLP
Accountancy firm EIN	2015-06-30	381337372
2014 : TAX SHELTERED ANNUITY 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-06-30	$0
Total income from all sources (including contributions)	2014-06-30	$1,364,759
Total loss/gain on sale of assets	2014-06-30	$0
Total of all expenses incurred	2014-06-30	$635,223
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-06-30	$634,948
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-06-30	$310,690
Value of total assets at end of year	2014-06-30	$8,159,001
Value of total assets at beginning of year	2014-06-30	$7,429,465
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-06-30	$275
Total interest from all sources	2014-06-30	$26,454
Total dividends received (eg from common stock, registered investment company shares)	2014-06-30	$95,585
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-06-30	$95,585
Was this plan covered by a fidelity bond	2014-06-30	Yes
Value of fidelity bond cover	2014-06-30	$1,000,000
If this is an individual account plan, was there a blackout period	2014-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2014-06-30	No
Contributions received from participants	2014-06-30	$177,636
Participant contributions at end of year	2014-06-30	$382,767
Participant contributions at beginning of year	2014-06-30	$418,738
Assets. Other investments not covered elsewhere at end of year	2014-06-30	$1,891,599
Assets. Other investments not covered elsewhere at beginning of year	2014-06-30	$2,187,511
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-06-30	No
Value of net income/loss	2014-06-30	$729,536
Value of net assets at end of year (total assets less liabilities)	2014-06-30	$8,159,001
Value of net assets at beginning of year (total assets less liabilities)	2014-06-30	$7,429,465
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-06-30	No
Were any leases to which the plan was party in default or uncollectible	2014-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-06-30	$5,458,478
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-06-30	$4,423,150
Interest on participant loans	2014-06-30	$26,454
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-06-30	$156,659
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-06-30	$109,275
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-06-30	$109,275
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-06-30	$136,113
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-06-30	$159,874
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-06-30	$932,030
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-06-30	No
Was there a failure to transmit to the plan any participant contributions	2014-06-30	No
Has the plan failed to provide any benefit when due under the plan	2014-06-30	No
Contributions received in cash from employer	2014-06-30	$133,054
Employer contributions (assets) at end of year	2014-06-30	$133,385
Employer contributions (assets) at beginning of year	2014-06-30	$130,917
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-06-30	$634,948
Contract administrator fees	2014-06-30	$275
Did the plan have assets held for investment	2014-06-30	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	2014-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-06-30	No
Opinion of an independent qualified public accountant for this plan	2014-06-30	Disclaimer
Accountancy firm name	2014-06-30	BEENE GARTER LLP
Accountancy firm EIN	2014-06-30	381337372
2013 : TAX SHELTERED ANNUITY 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-06-30	$0
Total income from all sources (including contributions)	2013-06-30	$1,071,705
Total loss/gain on sale of assets	2013-06-30	$0
Total of all expenses incurred	2013-06-30	$319,402
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-06-30	$319,052
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-06-30	$320,913
Value of total assets at end of year	2013-06-30	$7,429,465
Value of total assets at beginning of year	2013-06-30	$6,677,162
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-06-30	$350
Total interest from all sources	2013-06-30	$26,428
Total dividends received (eg from common stock, registered investment company shares)	2013-06-30	$96,068
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-06-30	$96,068
Was this plan covered by a fidelity bond	2013-06-30	Yes
Value of fidelity bond cover	2013-06-30	$1,000,000
If this is an individual account plan, was there a blackout period	2013-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2013-06-30	No
Contributions received from participants	2013-06-30	$192,460
Participant contributions at end of year	2013-06-30	$418,738
Participant contributions at beginning of year	2013-06-30	$476,620
Assets. Other investments not covered elsewhere at end of year	2013-06-30	$2,187,511
Assets. Other investments not covered elsewhere at beginning of year	2013-06-30	$2,140,578
Administrative expenses (other) incurred	2013-06-30	$350
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-06-30	No
Value of net income/loss	2013-06-30	$752,303
Value of net assets at end of year (total assets less liabilities)	2013-06-30	$7,429,465
Value of net assets at beginning of year (total assets less liabilities)	2013-06-30	$6,677,162
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-06-30	No
Were any leases to which the plan was party in default or uncollectible	2013-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-06-30	$4,423,150
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-06-30	$3,705,264
Interest on participant loans	2013-06-30	$26,428
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-06-30	$109,275
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-06-30	$81,954
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-06-30	$81,954
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-06-30	$159,874
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-06-30	$146,436
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-06-30	$628,296
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-06-30	No
Was there a failure to transmit to the plan any participant contributions	2013-06-30	No
Has the plan failed to provide any benefit when due under the plan	2013-06-30	No
Contributions received in cash from employer	2013-06-30	$128,453
Employer contributions (assets) at end of year	2013-06-30	$130,917
Employer contributions (assets) at beginning of year	2013-06-30	$126,310
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-06-30	$319,052
Did the plan have assets held for investment	2013-06-30	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	2013-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-06-30	No
Opinion of an independent qualified public accountant for this plan	2013-06-30	Disclaimer
Accountancy firm name	2013-06-30	BEENE GARTER LLP
Accountancy firm EIN	2013-06-30	381337372
2012 : TAX SHELTERED ANNUITY 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-06-30	$0
Total income from all sources (including contributions)	2012-06-30	$528,191
Total loss/gain on sale of assets	2012-06-30	$0
Total of all expenses incurred	2012-06-30	$219,448
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-06-30	$219,048
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-06-30	$301,536
Value of total assets at end of year	2012-06-30	$6,677,162
Value of total assets at beginning of year	2012-06-30	$6,368,419
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-06-30	$400
Total interest from all sources	2012-06-30	$38,480
Total dividends received (eg from common stock, registered investment company shares)	2012-06-30	$88,806
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-06-30	$88,806
Was this plan covered by a fidelity bond	2012-06-30	Yes
Value of fidelity bond cover	2012-06-30	$1,000,000
If this is an individual account plan, was there a blackout period	2012-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2012-06-30	No
Contributions received from participants	2012-06-30	$130,129
Participant contributions at end of year	2012-06-30	$476,620
Participant contributions at beginning of year	2012-06-30	$466,595
Assets. Other investments not covered elsewhere at end of year	2012-06-30	$2,140,578
Assets. Other investments not covered elsewhere at beginning of year	2012-06-30	$2,123,110
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-06-30	No
Value of net income/loss	2012-06-30	$308,743
Value of net assets at end of year (total assets less liabilities)	2012-06-30	$6,677,162
Value of net assets at beginning of year (total assets less liabilities)	2012-06-30	$6,368,419
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-06-30	No
Were any leases to which the plan was party in default or uncollectible	2012-06-30	No
Investment advisory and management fees	2012-06-30	$400
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-06-30	$3,705,264
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-06-30	$3,479,161
Income. Interest from loans (other than to participants)	2012-06-30	$38,480
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-06-30	$81,954
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-06-30	$76,669
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-06-30	$76,669
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-06-30	$146,436
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-06-30	$130,818
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-06-30	$99,369
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-06-30	No
Was there a failure to transmit to the plan any participant contributions	2012-06-30	No
Has the plan failed to provide any benefit when due under the plan	2012-06-30	No
Contributions received in cash from employer	2012-06-30	$171,407
Employer contributions (assets) at end of year	2012-06-30	$126,310
Employer contributions (assets) at beginning of year	2012-06-30	$92,066
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-06-30	$219,048
Did the plan have assets held for investment	2012-06-30	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	2012-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-06-30	No
Opinion of an independent qualified public accountant for this plan	2012-06-30	Qualified
Accountancy firm name	2012-06-30	BEENE GARTER LLP
Accountancy firm EIN	2012-06-30	381337372
2011 : TAX SHELTERED ANNUITY 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-06-30	$0
Total income from all sources (including contributions)	2011-06-30	$1,202,780
Total loss/gain on sale of assets	2011-06-30	$0
Total of all expenses incurred	2011-06-30	$465,140
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-06-30	$464,390
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-06-30	$280,060
Value of total assets at end of year	2011-06-30	$6,368,419
Value of total assets at beginning of year	2011-06-30	$5,630,779
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-06-30	$750
Total interest from all sources	2011-06-30	$36,868
Total dividends received (eg from common stock, registered investment company shares)	2011-06-30	$208,280
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-06-30	$208,280
Was this plan covered by a fidelity bond	2011-06-30	Yes
Value of fidelity bond cover	2011-06-30	$1,000,000
If this is an individual account plan, was there a blackout period	2011-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2011-06-30	No
Contributions received from participants	2011-06-30	$187,994
Participant contributions at end of year	2011-06-30	$466,595
Participant contributions at beginning of year	2011-06-30	$431,044
Assets. Other investments not covered elsewhere at end of year	2011-06-30	$2,123,110
Assets. Other investments not covered elsewhere at beginning of year	2011-06-30	$2,043,039
Administrative expenses (other) incurred	2011-06-30	$750
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-06-30	No
Value of net income/loss	2011-06-30	$737,640
Value of net assets at end of year (total assets less liabilities)	2011-06-30	$6,368,419
Value of net assets at beginning of year (total assets less liabilities)	2011-06-30	$5,630,779
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-06-30	No
Were any leases to which the plan was party in default or uncollectible	2011-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-06-30	$3,479,161
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-06-30	$3,000,609
Interest on participant loans	2011-06-30	$36,868
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-06-30	$76,669
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-06-30	$72,539
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-06-30	$72,539
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-06-30	$130,818
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-06-30	$1,094
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-06-30	$677,572
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-06-30	No
Was there a failure to transmit to the plan any participant contributions	2011-06-30	No
Has the plan failed to provide any benefit when due under the plan	2011-06-30	No
Contributions received in cash from employer	2011-06-30	$92,066
Employer contributions (assets) at end of year	2011-06-30	$92,066
Employer contributions (assets) at beginning of year	2011-06-30	$82,454
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-06-30	$464,390
Did the plan have assets held for investment	2011-06-30	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	2011-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-06-30	No
Opinion of an independent qualified public accountant for this plan	2011-06-30	Qualified
Accountancy firm name	2011-06-30	BEENE GARTER LLP
Accountancy firm EIN	2011-06-30	381337372
2010 : TAX SHELTERED ANNUITY 2010 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-06-30	$0

Form 5500 Responses for TAX SHELTERED ANNUITY

2021: TAX SHELTERED ANNUITY 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Submission has been amended	No
2021-07-01	This submission is the final filing	No
2021-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-07-01	Plan is a collectively bargained plan	No
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan funding arrangement – Trust	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement - Trust	Yes
2020: TAX SHELTERED ANNUITY 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	Submission has been amended	No
2020-07-01	This submission is the final filing	No
2020-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-07-01	Plan is a collectively bargained plan	No
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan funding arrangement – Trust	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement - Trust	Yes
2019: TAX SHELTERED ANNUITY 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Submission has been amended	No
2019-07-01	This submission is the final filing	No
2019-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-07-01	Plan is a collectively bargained plan	No
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan funding arrangement – Trust	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement - Trust	Yes
2018: TAX SHELTERED ANNUITY 2018 form 5500 responses
2018-07-01	Type of plan entity	Single employer plan
2018-07-01	Submission has been amended	No
2018-07-01	This submission is the final filing	No
2018-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-07-01	Plan is a collectively bargained plan	No
2018-07-01	Plan funding arrangement – Insurance	Yes
2018-07-01	Plan funding arrangement – Trust	Yes
2018-07-01	Plan benefit arrangement – Insurance	Yes
2018-07-01	Plan benefit arrangement - Trust	Yes
2017: TAX SHELTERED ANNUITY 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	Submission has been amended	No
2017-07-01	This submission is the final filing	No
2017-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-07-01	Plan is a collectively bargained plan	No
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan funding arrangement – Trust	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement - Trust	Yes
2016: TAX SHELTERED ANNUITY 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Submission has been amended	No
2016-07-01	This submission is the final filing	No
2016-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-07-01	Plan is a collectively bargained plan	No
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan funding arrangement – Trust	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement - Trust	Yes
2015: TAX SHELTERED ANNUITY 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Submission has been amended	No
2015-07-01	This submission is the final filing	No
2015-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-07-01	Plan is a collectively bargained plan	No
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan funding arrangement – Trust	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement - Trust	Yes
2014: TAX SHELTERED ANNUITY 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Submission has been amended	No
2014-07-01	This submission is the final filing	No
2014-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-07-01	Plan is a collectively bargained plan	No
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan funding arrangement – Trust	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement - Trust	Yes
2013: TAX SHELTERED ANNUITY 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Submission has been amended	No
2013-07-01	This submission is the final filing	No
2013-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-07-01	Plan is a collectively bargained plan	No
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan funding arrangement – Trust	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement - Trust	Yes
2012: TAX SHELTERED ANNUITY 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Submission has been amended	No
2012-07-01	This submission is the final filing	No
2012-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-07-01	Plan is a collectively bargained plan	No
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan funding arrangement – Trust	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement - Trust	Yes
2011: TAX SHELTERED ANNUITY 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Submission has been amended	No
2011-07-01	This submission is the final filing	No
2011-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-07-01	Plan is a collectively bargained plan	No
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan funding arrangement – Trust	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement - Trust	Yes
2009: TAX SHELTERED ANNUITY 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	Submission has been amended	No
2009-07-01	This submission is the final filing	No
2009-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-07-01	Plan is a collectively bargained plan	No
2009-07-01	Plan funding arrangement – Insurance	Yes
2009-07-01	Plan funding arrangement – Trust	Yes
2009-07-01	Plan benefit arrangement – Insurance	Yes
2009-07-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

C.M. LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93432 )

Policy contract number

ART0111940EE

Policy instance

Insurance contract or identification number	ART0111940EE
Number of Individuals Covered	9
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Are there contracts with allocated funds for individual policies?	1
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

JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 )

Policy contract number

KENT CLIENT SER

Policy instance

Insurance contract or identification number	KENT CLIENT SER
Number of Individuals Covered	35
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
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

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

0229

Policy instance

Insurance contract or identification number	0229
Number of Individuals Covered	5
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $513
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	1
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 $513
Insurance broker organization code?	3

C.M. LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93432 )

Policy contract number

ART0111940EE

Policy instance

Insurance contract or identification number	ART0111940EE
Number of Individuals Covered	9
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Are there contracts with allocated funds for individual policies?	1
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

JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 )

Policy contract number

KENT

Policy instance

Insurance contract or identification number	KENT
Number of Individuals Covered	40
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
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

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

0229

Policy instance

Insurance contract or identification number	0229
Number of Individuals Covered	5
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $572
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 $572
Insurance broker organization code?	3

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

0229

Policy instance

Insurance contract or identification number	0229
Number of Individuals Covered	5
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $488
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 $488
Insurance broker organization code?	3

JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 )

Policy contract number

KENT

Policy instance

Insurance contract or identification number	KENT
Number of Individuals Covered	40
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $0
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

C.M. LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93432 )

Policy contract number

ART0111940EE

Policy instance

Insurance contract or identification number	ART0111940EE
Number of Individuals Covered	10
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	1
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

C.M. LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93432 )

Policy contract number

ART0111940EE

Policy instance

Insurance contract or identification number	ART0111940EE
Number of Individuals Covered	10
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $86
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	1
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 $86
Insurance broker organization code?	3

JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 )

Policy contract number

KENT

Policy instance

Insurance contract or identification number	KENT
Number of Individuals Covered	31
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $65
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	1
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 $65
Insurance broker organization code?	3

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

0229

Policy instance

Insurance contract or identification number	0229
Number of Individuals Covered	5
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $644
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 $644
Insurance broker organization code?	3

C.M. LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93432 )

Policy contract number

ART0111940EE

Policy instance

Insurance contract or identification number	ART0111940EE
Number of Individuals Covered	10
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $165
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	1
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

JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 )

Policy contract number

KENT

Policy instance

Insurance contract or identification number	KENT
Number of Individuals Covered	40
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $65
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	1
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

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

0229

Policy instance

Insurance contract or identification number	0229
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $437
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

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

0229

Policy instance

Insurance contract or identification number	0229
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $288
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 $288
Insurance broker organization code?	3
Insurance broker name	DAVID FISHMAN

JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 )

Policy contract number

KENT

Policy instance

Insurance contract or identification number	KENT
Number of Individuals Covered	44
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $629
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
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
Commission paid to Insurance Broker	USD $629
Insurance broker organization code?	3
Insurance broker name	MICHAEL FISHMAN

C.M. LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93432 )

Policy contract number

ART0111940EE

Policy instance

Insurance contract or identification number	ART0111940EE
Number of Individuals Covered	12
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $361
Are there contracts with allocated funds for individual policies?	Yes
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 $361
Insurance broker organization code?	3
Insurance broker name	INTERSECURITES INSURANCE AGENCY, IN

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

0229

Policy instance

Insurance contract or identification number	0229
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $491
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 $491
Insurance broker organization code?	3
Insurance broker name	DAVID FISHMAN

C.M. LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93432 )

Policy contract number

ART0111940EE

Policy instance

Insurance contract or identification number	ART0111940EE
Number of Individuals Covered	14
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $464
Are there contracts with allocated funds for individual policies?	Yes
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 $464
Insurance broker organization code?	3
Insurance broker name	INTERSECURITES INSURANCE AGENCY, IN

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

0229

Policy instance

Insurance contract or identification number	0229
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $561
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 $561
Insurance broker organization code?	3
Insurance broker name	DAVID FISHMAN

C.M. LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93432 )

Policy contract number

ART0111940EE

Policy instance

Insurance contract or identification number	ART0111940EE
Number of Individuals Covered	16
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $407
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
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 $407
Insurance broker organization code?	3
Insurance broker name	INTERSECURITES INSURANCE AGENCY, IN

C.M. LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93432 )

Policy contract number

ART0111940EE

Policy instance

Insurance contract or identification number	ART0111940EE
Number of Individuals Covered	18
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $637
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
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 $637
Insurance broker organization code?	3
Insurance broker name	INTERSECURITES INSURANCE AGENCY, IN

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

0229

Policy instance

Insurance contract or identification number	0229
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $494
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 $494
Insurance broker organization code?	3
Insurance broker name	DAVID FISHMAN

C.M. LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93432 )

Policy contract number

ART0111940EE

Policy instance

Insurance contract or identification number	ART0111940EE
Number of Individuals Covered	18
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $464
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
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

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

JP34

Policy instance

Insurance contract or identification number	JP34
Number of Individuals Covered	12
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $827
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

C.M. LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93432 )

Policy contract number

ART0111940EE

Policy instance

Insurance contract or identification number	ART0111940EE
Number of Individuals Covered	20
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $681
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
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

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

JP34

Policy instance

Insurance contract or identification number	JP34
Number of Individuals Covered	2
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $8,993
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

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Company Name:	THRESHOLDS, INC.
Employer identification number (EIN):	382063018
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	1967-01-19
Company Identification Number:	206189