401k Plan data: plan

Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision

Form 5500 Filing Information

Submission information for form 5500 for 401k plan

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2020-01-01
501 2019-09-01 STEPHEN MILLARD 2021-06-15

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2020-01-01
501	2019-09-01	STEPHEN MILLARD	2021-06-15

Plan Statistics for

401k plan membership statisitcs for

Measure Date Value
2020: 2020 401k membership
Total participants, beginning-of-year 2020-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 6
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 6

Measure	Date	Value
2020: 2020 401k membership
Total participants, beginning-of-year	2020-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	6
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	6

Financial Data on

Measure	Date	Value
2020 : 2020 401k financial data
Transfers to/from the plan	2020-12-31	$6
Total plan liabilities at end of year	2020-12-31	$3,991
Total plan liabilities at beginning of year	2020-12-31	$715
Total income from all sources	2020-12-31	$38,525
Expenses. Total of all expenses incurred	2020-12-31	$35,589
Benefits paid (including direct rollovers)	2020-12-31	$418
Total plan assets at end of year	2020-12-31	$7,234
Total plan assets at beginning of year	2020-12-31	$1,016
Total contributions received or receivable from participants	2020-12-31	$25,338
Expenses. Other expenses not covered elsewhere	2020-12-31	$29
Net income (gross income less expenses)	2020-12-31	$2,936
Net plan assets at end of year (total assets less liabilities)	2020-12-31	$3,243
Net plan assets at beginning of year (total assets less liabilities)	2020-12-31	$301
Total contributions received or receivable from employer(s)	2020-12-31	$13,187
Expenses. Administrative service providers (salaries,fees and commissions)	2020-12-31	$35,142

Form 5500 Responses for

2020: 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	First time form 5500 has been submitted	Yes
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MCKINLEY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 77216 )

Policy contract number

HF1885

Policy instance

Insurance contract or identification number	HF1885
Number of Individuals Covered	17
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,395
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,395

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