401k Plan data: GALVANON, AN NCR COMPANY RETIREMENT PLAN plan

GALVANON, AN NCR COMPANY RETIREMENT PLAN 401k Plan overview

Plan Name	GALVANON, AN NCR COMPANY RETIREMENT PLAN
Plan identification number	002

GALVANON, AN NCR COMPANY RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Prototype plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion or notification letter; and under which a seperate funding medium (for example, a seperate trust or custodial account) is established for the use of each adopting employer.

401k Sponsoring company profile

NCR SELF-SERVICE, LLC - DBA GALVANON has sponsored the creation of one or more 401k plans.

Company Name: NCR SELF-SERVICE, LLC - DBA GALVANON

Employer identification number (EIN): 201589862

NAIC Classification: 541511
NAIC Description: Custom Computer Programming Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GALVANON, AN NCR COMPANY RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2006-01-01 EILEEN ALLEN 2010-08-27
002 2005-01-01 EILEEN ALLEN 2010-12-29

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2006-01-01			EILEEN ALLEN	2010-08-27
002	2005-01-01			EILEEN ALLEN	2010-12-29

Plan Statistics for GALVANON, AN NCR COMPANY RETIREMENT PLAN

401k plan membership statisitcs for GALVANON, AN NCR COMPANY RETIREMENT PLAN

Measure Date Value
2006: GALVANON, AN NCR COMPANY RETIREMENT PLAN 2006 401k membership
Total participants, beginning-of-year 2006-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2006-01-01 5
Total of all active and inactive participants 2006-01-01 5
Total participants 2006-01-01 5
Number of participants with account balances 2006-01-01 5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2006-01-01 0
2005: GALVANON, AN NCR COMPANY RETIREMENT PLAN 2005 401k membership
Total participants, beginning-of-year 2005-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2005-01-01 5
Total of all active and inactive participants 2005-01-01 5
Total participants 2005-01-01 5
Number of participants with account balances 2005-01-01 5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2005-01-01 0

Measure	Date	Value
2006: GALVANON, AN NCR COMPANY RETIREMENT PLAN 2006 401k membership
Total participants, beginning-of-year	2006-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2006-01-01	5
Total of all active and inactive participants	2006-01-01	5
Total participants	2006-01-01	5
Number of participants with account balances	2006-01-01	5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2006-01-01	0
2005: GALVANON, AN NCR COMPANY RETIREMENT PLAN 2005 401k membership
Total participants, beginning-of-year	2005-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2005-01-01	5
Total of all active and inactive participants	2005-01-01	5
Total participants	2005-01-01	5
Number of participants with account balances	2005-01-01	5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2005-01-01	0

Financial Data on GALVANON, AN NCR COMPANY RETIREMENT PLAN

Measure	Date	Value
2010 : GALVANON, AN NCR COMPANY RETIREMENT PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$-239,544
Total income from all sources	2010-12-31	$39,273
Expenses. Total of all expenses incurred	2010-12-31	$69,820
Benefits paid (including direct rollovers)	2010-12-31	$45,391
Total plan assets at end of year	2010-12-31	$0
Total plan assets at beginning of year	2010-12-31	$270,091
Value of fidelity bond covering the plan	2010-12-31	$100,000
Other income received	2010-12-31	$39,273
Net income (gross income less expenses)	2010-12-31	$-30,547
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$270,091
Value of corrective distributions	2010-12-31	$21,911
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$2,518

Form 5500 Responses for GALVANON, AN NCR COMPANY RETIREMENT PLAN

2006: GALVANON, AN NCR COMPANY RETIREMENT PLAN 2006 form 5500 responses
2006-01-01	Type of plan entity	Single employer plan
2006-01-01	Submission has been amended	No
2006-01-01	This submission is the final filing	No
2006-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2006-01-01	Plan is a collectively bargained plan	No
2006-01-01	Plan funding arrangement – Insurance	Yes
2006-01-01	Plan funding arrangement – Trust	Yes
2006-01-01	Plan benefit arrangement – Insurance	Yes
2006-01-01	Plan benefit arrangement - Trust	Yes
2005: GALVANON, AN NCR COMPANY RETIREMENT PLAN 2005 form 5500 responses
2005-01-01	Type of plan entity	Single employer plan
2005-01-01	Submission has been amended	No
2005-01-01	This submission is the final filing	No
2005-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2005-01-01	Plan is a collectively bargained plan	No
2005-01-01	Plan funding arrangement – Insurance	Yes
2005-01-01	Plan funding arrangement – Trust	Yes
2005-01-01	Plan benefit arrangement – Insurance	Yes
2005-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	NCR SELF-SERVICE, LLC - DBA GALVANON
Employer identification number (EIN):	201589862
NAIC Classification:	541511
NAIC Description:	Custom Computer Programming Services