401k Plan data: THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN plan

THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 401k Plan overview

Plan Name	THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN
Plan identification number	001

THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
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.
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

THE PENDERGRAPH COMPANIES LLC has sponsored the creation of one or more 401k plans.

Company Name: THE PENDERGRAPH COMPANIES LLC

Employer identification number (EIN): 270080860

NAIC Classification: 531310

Additional information about THE PENDERGRAPH COMPANIES LLC

Jurisdiction of Incorporation: North Carolina Secretary of State

Incorporation Date:

Company Identification Number: 0701963

More information about THE PENDERGRAPH COMPANIES LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01 MICHAEL WEAVER
001 2017-01-01 MICHAEL WEAVER
001 2016-01-01 MICHAEL WEAVER 2017-07-20
001 2015-01-01 MICHAEL WEAVER 2016-05-04
001 2014-01-01 MICHAEL WEAVER 2015-06-03
001 2013-01-01 MICHAEL WEAVER 2014-08-21
001 2012-01-01 MICHAEL WEAVER 2013-10-14
001 2011-01-01 MICHAEL WEAVER 2013-10-03
001 2009-01-01 RON POTTER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-01-01
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2017-01-01	MICHAEL WEAVER
001	2017-01-01	MICHAEL WEAVER
001	2016-01-01	MICHAEL WEAVER	2017-07-20
001	2015-01-01	MICHAEL WEAVER	2016-05-04
001	2014-01-01	MICHAEL WEAVER	2015-06-03
001	2013-01-01	MICHAEL WEAVER	2014-08-21
001	2012-01-01	MICHAEL WEAVER	2013-10-14
001	2011-01-01	MICHAEL WEAVER	2013-10-03
001	2009-01-01	RON POTTER

Plan Statistics for THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN

401k plan membership statisitcs for THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN

Measure Date Value
2022: THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 216
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 126
Number of retired or separated participants receiving benefits 2022-01-01 9
Number of other retired or separated participants entitled to future benefits 2022-01-01 72
Total of all active and inactive participants 2022-01-01 207
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 207
Number of participants with account balances 2022-01-01 205
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 1
2021: THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 193
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 124
Number of retired or separated participants receiving benefits 2021-01-01 6
Number of other retired or separated participants entitled to future benefits 2021-01-01 79
Total of all active and inactive participants 2021-01-01 209
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 209
Number of participants with account balances 2021-01-01 209
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 2
2020: THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 192
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 131
Number of retired or separated participants receiving benefits 2020-01-01 1
Number of other retired or separated participants entitled to future benefits 2020-01-01 55
Total of all active and inactive participants 2020-01-01 187
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 187
Number of participants with account balances 2020-01-01 186
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 3
2019: THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 171
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 144
Number of retired or separated participants receiving benefits 2019-01-01 2
Number of other retired or separated participants entitled to future benefits 2019-01-01 40
Total of all active and inactive participants 2019-01-01 186
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 186
Number of participants with account balances 2019-01-01 184
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 8
2018: THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 172
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 133
Number of retired or separated participants receiving benefits 2018-01-01 1
Number of other retired or separated participants entitled to future benefits 2018-01-01 25
Total of all active and inactive participants 2018-01-01 159
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 159
Number of participants with account balances 2018-01-01 152
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 12
2017: THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 192
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 143
Number of retired or separated participants receiving benefits 2017-01-01 1
Number of other retired or separated participants entitled to future benefits 2017-01-01 30
Total of all active and inactive participants 2017-01-01 174
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 174
Number of participants with account balances 2017-01-01 146
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 8
2009: THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 79
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 89
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 8
Total of all active and inactive participants 2009-01-01 97
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 1
Total participants 2009-01-01 98
Number of participants with account balances 2009-01-01 24
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2022: THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	216
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	126
Number of retired or separated participants receiving benefits	2022-01-01	9
Number of other retired or separated participants entitled to future benefits	2022-01-01	72
Total of all active and inactive participants	2022-01-01	207
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	207
Number of participants with account balances	2022-01-01	205
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	1
2021: THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	193
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	124
Number of retired or separated participants receiving benefits	2021-01-01	6
Number of other retired or separated participants entitled to future benefits	2021-01-01	79
Total of all active and inactive participants	2021-01-01	209
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	209
Number of participants with account balances	2021-01-01	209
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	2
2020: THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	192
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	131
Number of retired or separated participants receiving benefits	2020-01-01	1
Number of other retired or separated participants entitled to future benefits	2020-01-01	55
Total of all active and inactive participants	2020-01-01	187
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	187
Number of participants with account balances	2020-01-01	186
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	3
2019: THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	171
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	144
Number of retired or separated participants receiving benefits	2019-01-01	2
Number of other retired or separated participants entitled to future benefits	2019-01-01	40
Total of all active and inactive participants	2019-01-01	186
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	186
Number of participants with account balances	2019-01-01	184
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	8
2018: THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	172
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	133
Number of retired or separated participants receiving benefits	2018-01-01	1
Number of other retired or separated participants entitled to future benefits	2018-01-01	25
Total of all active and inactive participants	2018-01-01	159
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	159
Number of participants with account balances	2018-01-01	152
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	12
2017: THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	192
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	143
Number of retired or separated participants receiving benefits	2017-01-01	1
Number of other retired or separated participants entitled to future benefits	2017-01-01	30
Total of all active and inactive participants	2017-01-01	174
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	174
Number of participants with account balances	2017-01-01	146
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	8
2009: THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	79
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	89
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	8
Total of all active and inactive participants	2009-01-01	97
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	1
Total participants	2009-01-01	98
Number of participants with account balances	2009-01-01	24
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN

Measure	Date	Value
2022 : THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$1,144
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$1,144
Total income from all sources (including contributions)	2022-12-31	$-630,814
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$188,169
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$167,085
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$405,947
Value of total assets at end of year	2022-12-31	$4,185,470
Value of total assets at beginning of year	2022-12-31	$5,004,453
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$21,084
Total interest from all sources	2022-12-31	$3,091
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$215,677
Participant contributions at end of year	2022-12-31	$80,503
Participant contributions at beginning of year	2022-12-31	$96,440
Participant contributions at end of year	2022-12-31	$0
Participant contributions at beginning of year	2022-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2022-12-31	$145
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2022-12-31	$116
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2022-12-31	$1,144
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2022-12-31	$1,144
Total non interest bearing cash at end of year	2022-12-31	$5,427
Total non interest bearing cash at beginning of year	2022-12-31	$4,230
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-818,983
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$4,184,326
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$5,003,309
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$3,910,285
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$4,741,686
Interest on participant loans	2022-12-31	$2,946
Interest earned on other investments	2022-12-31	$145
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$177,708
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$157,659
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-1,039,852
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$190,270
Employer contributions (assets) at end of year	2022-12-31	$11,402
Employer contributions (assets) at beginning of year	2022-12-31	$4,322
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$167,085
Contract administrator fees	2022-12-31	$21,084
Did the plan have assets held for investment	2022-12-31	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	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	STANCIL PC
Accountancy firm EIN	2022-12-31	561131459
2021 : THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$1,144
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$1,118,289
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$119,262
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$102,240
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$411,496
Value of total assets at end of year	2021-12-31	$5,004,453
Value of total assets at beginning of year	2021-12-31	$4,004,282
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$17,022
Total interest from all sources	2021-12-31	$2,646
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$201,233
Participant contributions at end of year	2021-12-31	$96,440
Participant contributions at beginning of year	2021-12-31	$43,260
Participant contributions at end of year	2021-12-31	$0
Participant contributions at beginning of year	2021-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$37,447
Value of other receiveables (less allowance for doubtful accounts) at end of year	2021-12-31	$116
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2021-12-31	$111
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2021-12-31	$1,144
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2021-12-31	$0
Total non interest bearing cash at end of year	2021-12-31	$4,230
Total non interest bearing cash at beginning of year	2021-12-31	$9,851
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$999,027
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$5,003,309
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$4,004,282
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$4,741,686
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$3,809,408
Interest on participant loans	2021-12-31	$2,641
Interest earned on other investments	2021-12-31	$5
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$157,659
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$133,189
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$704,147
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$172,816
Employer contributions (assets) at end of year	2021-12-31	$4,322
Employer contributions (assets) at beginning of year	2021-12-31	$8,463
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$102,240
Contract administrator fees	2021-12-31	$17,022
Did the plan have assets held for investment	2021-12-31	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	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	STANCIL PC
Accountancy firm EIN	2021-12-31	561131459
2020 : THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$1,044,458
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$299,971
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$289,113
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$357,914
Value of total assets at end of year	2020-12-31	$4,004,282
Value of total assets at beginning of year	2020-12-31	$3,259,795
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$10,858
Total interest from all sources	2020-12-31	$1,203
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$171,797
Participant contributions at end of year	2020-12-31	$43,260
Participant contributions at beginning of year	2020-12-31	$8,858
Participant contributions at end of year	2020-12-31	$0
Participant contributions at beginning of year	2020-12-31	$5,698
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$7,925
Value of other receiveables (less allowance for doubtful accounts) at end of year	2020-12-31	$111
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2020-12-31	$325
Total non interest bearing cash at end of year	2020-12-31	$9,851
Total non interest bearing cash at beginning of year	2020-12-31	$10,103
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$744,487
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$4,004,282
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$3,259,795
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$3,809,408
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$3,116,149
Interest on participant loans	2020-12-31	$1,092
Interest earned on other investments	2020-12-31	$111
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$133,189
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$111,731
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$685,341
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$178,192
Employer contributions (assets) at end of year	2020-12-31	$8,463
Employer contributions (assets) at beginning of year	2020-12-31	$6,931
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$289,113
Contract administrator fees	2020-12-31	$10,858
Did the plan have assets held for investment	2020-12-31	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	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Unqualified
Accountancy firm name	2020-12-31	STANCIL PC
Accountancy firm EIN	2020-12-31	561131459
2019 : THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
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	$968,704
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$96,772
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$79,924
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$344,135
Value of total assets at end of year	2019-12-31	$3,259,795
Value of total assets at beginning of year	2019-12-31	$2,387,863
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$16,848
Total interest from all sources	2019-12-31	$359
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	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
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	$164,343
Participant contributions at end of year	2019-12-31	$8,858
Participant contributions at beginning of year	2019-12-31	$8,848
Participant contributions at end of year	2019-12-31	$5,698
Participant contributions at beginning of year	2019-12-31	$5,304
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$1,668
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-12-31	$325
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$0
Total non interest bearing cash at end of year	2019-12-31	$10,103
Total non interest bearing cash at beginning of year	2019-12-31	$4,224
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	$871,932
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$3,259,795
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$2,387,863
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	$3,116,149
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$2,263,331
Interest on participant loans	2019-12-31	$359
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$111,731
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$99,451
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$624,210
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	$178,124
Employer contributions (assets) at end of year	2019-12-31	$6,931
Employer contributions (assets) at beginning of year	2019-12-31	$6,705
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$79,924
Contract administrator fees	2019-12-31	$16,848
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	No
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	DAUBY O'CONNOR & ZALESKI, LLC
Accountancy firm EIN	2019-12-31	351750664
2018 : THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 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	$179,704
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$80,680
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$66,077
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$330,409
Value of total assets at end of year	2018-12-31	$2,387,863
Value of total assets at beginning of year	2018-12-31	$2,288,839
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$14,603
Total interest from all sources	2018-12-31	$474
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	$1,500,000
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	$161,277
Participant contributions at end of year	2018-12-31	$8,848
Participant contributions at beginning of year	2018-12-31	$16,000
Participant contributions at end of year	2018-12-31	$5,304
Participant contributions at beginning of year	2018-12-31	$16,859
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$3,880
Total non interest bearing cash at end of year	2018-12-31	$4,224
Total non interest bearing cash at beginning of year	2018-12-31	$924
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	$99,024
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$2,387,863
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$2,288,839
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	$2,263,331
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$2,147,474
Interest on participant loans	2018-12-31	$474
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$99,451
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$89,169
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-151,179
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	$165,252
Employer contributions (assets) at end of year	2018-12-31	$6,705
Employer contributions (assets) at beginning of year	2018-12-31	$18,413
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$66,077
Contract administrator fees	2018-12-31	$14,603
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	2018-12-31	No
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	DAUBY O'CONNOR & ZALESKI, LLC
Accountancy firm EIN	2018-12-31	351750664
2017 : THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$658,314
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$29,071
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$18,678
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$337,356
Value of total assets at end of year	2017-12-31	$2,288,839
Value of total assets at beginning of year	2017-12-31	$1,659,596
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$10,393
Total interest from all sources	2017-12-31	$573
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$500,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$153,225
Participant contributions at end of year	2017-12-31	$16,000
Participant contributions at beginning of year	2017-12-31	$19,717
Participant contributions at end of year	2017-12-31	$16,859
Participant contributions at beginning of year	2017-12-31	$394
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$20,617
Total non interest bearing cash at end of year	2017-12-31	$924
Total non interest bearing cash at beginning of year	2017-12-31	$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	2017-12-31	No
Value of net income/loss	2017-12-31	$629,243
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$2,288,839
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$1,659,596
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$2,147,474
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$1,506,635
Interest on participant loans	2017-12-31	$573
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$89,169
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$73,789
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$320,385
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$163,514
Employer contributions (assets) at end of year	2017-12-31	$18,413
Employer contributions (assets) at beginning of year	2017-12-31	$59,061
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$18,678
Contract administrator fees	2017-12-31	$10,393
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	2017-12-31	No
Did the plan have assets held for investment	2017-12-31	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	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	DAUBY O'CONNOR & ZALESKI, LLC
Accountancy firm EIN	2017-12-31	351750664
2010 : THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total income from all sources	2010-12-31	$161,475
Expenses. Total of all expenses incurred	2010-12-31	$8,389
Benefits paid (including direct rollovers)	2010-12-31	$4,225
Total plan assets at end of year	2010-12-31	$739,253
Total plan assets at beginning of year	2010-12-31	$586,167
Value of fidelity bond covering the plan	2010-12-31	$500,000
Total contributions received or receivable from participants	2010-12-31	$65,512
Expenses. Other expenses not covered elsewhere	2010-12-31	$310
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$75,663
Net income (gross income less expenses)	2010-12-31	$153,086
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$739,253
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$586,167
Assets. Value of participant loans	2010-12-31	$5,553
Total contributions received or receivable from employer(s)	2010-12-31	$20,300
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$3,854
Funding deficiency by the employer to the plan for this plan year	2010-12-31	$0
Minimum employer required contribution for this plan year	2010-12-31	$0
Amount contributed by the employer to the plan for this plan year	2010-12-31	$0
2009 : THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 2009 401k financial data
Funding deficiency by the employer to the plan for this plan year	2009-12-31	$0
Minimum employer required contribution for this plan year	2009-12-31	$0
Amount contributed by the employer to the plan for this plan year	2009-12-31	$0

Form 5500 Responses for THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN

2022: THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 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	No
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: THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 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
2017: THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2009: THE PENDERGRAPH COMPANIES, LLC 401(K) PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

375141-01

Policy instance

Insurance contract or identification number	375141-01
Number of Individuals Covered	23
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

375141-01

Policy instance

Insurance contract or identification number	375141-01
Number of Individuals Covered	24
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

375141-01

Policy instance

Insurance contract or identification number	375141-01
Number of Individuals Covered	21
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

375141-01

Policy instance

Insurance contract or identification number	375141-01
Number of Individuals Covered	21
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

375141-01

Policy instance

Insurance contract or identification number	375141-01
Number of Individuals Covered	23
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

375141-01

Policy instance

Insurance contract or identification number	375141-01
Number of Individuals Covered	24
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
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

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-023885

Policy instance

Insurance contract or identification number	GA-023885
Number of Individuals Covered	25
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,509
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?	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
Commission paid to Insurance Broker	USD $2,509
Insurance broker organization code?	3
Insurance broker name	UBS FINANCIAL SVCS INS AGCY

Potentially related plans

THE PENDERGRAPH COMPANIES LLC EMPLOYEE BENEFIT PLAN [EIN = 270090860]

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Company Name:	THE PENDERGRAPH COMPANIES LLC
Employer identification number (EIN):	270080860
NAIC Classification:	531310

Jurisdiction of Incorporation:	North Carolina Secretary of State
Incorporation Date:
Company Identification Number:	0701963