401k Plan data: ROLL FORM GROUP 401(K) PLAN A DIVISION OF SAMUEL, SON & CO. (USA) INC. plan

ROLL FORM GROUP 401(K) PLAN A DIVISION OF SAMUEL, SON & CO. (USA) INC. 401k Plan overview

Plan Name	ROLL FORM GROUP 401(K) PLAN A DIVISION OF SAMUEL, SON & CO. (USA) INC.
Plan identification number	005

ROLL FORM GROUP 401(K) PLAN A DIVISION OF SAMUEL, SON & CO. (USA) INC. Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

SAMUEL SON & CO (USA) INC. 401K has sponsored the creation of one or more 401k plans.

Company Name: SAMUEL SON & CO (USA) INC. 401K

Employer identification number (EIN): 061251791

NAIC Classification: 332900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ROLL FORM GROUP 401(K) PLAN A DIVISION OF SAMUEL, SON & CO. (USA) INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
005 2019-01-01
005 2018-01-01

Plan Statistics for ROLL FORM GROUP 401(K) PLAN A DIVISION OF SAMUEL, SON & CO. (USA) INC.

401k plan membership statisitcs for ROLL FORM GROUP 401(K) PLAN A DIVISION OF SAMUEL, SON & CO. (USA) INC.

Measure Date Value
2019: ROLL FORM GROUP 401(K) PLAN A DIVISION OF SAMUEL, SON & CO. (USA) INC. 2019 401k membership
Total participants, beginning-of-year 2019-01-01 207
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 0
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 0
Number of participants with account balances 2019-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: ROLL FORM GROUP 401(K) PLAN A DIVISION OF SAMUEL, SON & CO. (USA) INC. 2018 401k membership
Total participants, beginning-of-year 2018-01-01 171
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 159
Number of retired or separated participants receiving benefits 2018-01-01 6
Number of other retired or separated participants entitled to future benefits 2018-01-01 15
Total of all active and inactive participants 2018-01-01 180
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 180
Number of participants with account balances 2018-01-01 112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0

Measure	Date	Value
2019: ROLL FORM GROUP 401(K) PLAN A DIVISION OF SAMUEL, SON & CO. (USA) INC. 2019 401k membership
Total participants, beginning-of-year	2019-01-01	207
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	0
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	0
Number of participants with account balances	2019-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: ROLL FORM GROUP 401(K) PLAN A DIVISION OF SAMUEL, SON & CO. (USA) INC. 2018 401k membership
Total participants, beginning-of-year	2018-01-01	171
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	159
Number of retired or separated participants receiving benefits	2018-01-01	6
Number of other retired or separated participants entitled to future benefits	2018-01-01	15
Total of all active and inactive participants	2018-01-01	180
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	180
Number of participants with account balances	2018-01-01	112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0

Financial Data on ROLL FORM GROUP 401(K) PLAN A DIVISION OF SAMUEL, SON & CO. (USA) INC.

Measure	Date	Value
2019 : ROLL FORM GROUP 401(K) PLAN A DIVISION OF SAMUEL, SON & CO. (USA) INC. 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total transfer of assets from this plan	2019-12-31	$2,203,941
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$770,775
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$570,183
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$556,296
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$387,245
Value of total assets at end of year	2019-12-31	$0
Value of total assets at beginning of year	2019-12-31	$2,003,349
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$13,887
Total interest from all sources	2019-12-31	$7,391
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2019-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$205,834
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$89,264
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$14,006
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$36,169
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$200,592
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$2,003,349
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$1,777,324
Interest on participant loans	2019-12-31	$7,391
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$112,771
Net investment gain/loss from pooled separate accounts	2019-12-31	$376,139
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$145,242
Employer contributions (assets) at end of year	2019-12-31	$0
Employer contributions (assets) at beginning of year	2019-12-31	$9,984
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$556,296
Contract administrator fees	2019-12-31	$13,887
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2019-12-31	Yes
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	HENDERSON HUTCHERSON & MCCULLOUGH
Accountancy firm EIN	2019-12-31	621114363
2018 : ROLL FORM GROUP 401(K) PLAN A DIVISION OF SAMUEL, SON & CO. (USA) INC. 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$222,431
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$72,099
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$58,004
Expenses. Certain deemed distributions of participant loans	2018-12-31	$1,169
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$333,339
Value of total assets at end of year	2018-12-31	$2,003,349
Value of total assets at beginning of year	2018-12-31	$1,853,017
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$12,926
Total interest from all sources	2018-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$250,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$189,219
Participant contributions at end of year	2018-12-31	$89,264
Participant contributions at beginning of year	2018-12-31	$77,314
Participant contributions at end of year	2018-12-31	$14,006
Participant contributions at beginning of year	2018-12-31	$5,793
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$7,334
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$150,332
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$2,003,349
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$1,853,017
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$1,777,324
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$1,658,847
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$112,771
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$106,982
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$6,919
Net investment gain/loss from pooled separate accounts	2018-12-31	$-117,827
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$136,786
Employer contributions (assets) at end of year	2018-12-31	$9,984
Employer contributions (assets) at beginning of year	2018-12-31	$4,081
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$58,004
Contract administrator fees	2018-12-31	$12,926
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	GODWIN & ASSOCIATES PLLC
Accountancy firm EIN	2018-12-31	621649263

Form 5500 Responses for ROLL FORM GROUP 401(K) PLAN A DIVISION OF SAMUEL, SON & CO. (USA) INC.

2019: ROLL FORM GROUP 401(K) PLAN A DIVISION OF SAMUEL, SON & CO. (USA) INC. 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	Yes
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: ROLL FORM GROUP 401(K) PLAN A DIVISION OF SAMUEL, SON & CO. (USA) INC. 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

RM 86282-5

Policy instance

Insurance contract or identification number	RM 86282-5
Number of Individuals Covered	0
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

RM 86282-5

Policy instance

Insurance contract or identification number	RM 86282-5
Number of Individuals Covered	112
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	SAMUEL SON & CO (USA) INC. 401K
Employer identification number (EIN):	061251791
NAIC Classification:	332900