401k Plan data: RIGHTSOURCE RETIREMENT SAVINGS PLAN plan

RIGHTSOURCE RETIREMENT SAVINGS PLAN 401k Plan overview

Plan Name	RIGHTSOURCE RETIREMENT SAVINGS PLAN
Plan identification number	001

RIGHTSOURCE RETIREMENT SAVINGS 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.

401k Sponsoring company profile

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

Company Name: ANTIOCH TIRE, INC.

Employer identification number (EIN): 363878545

NAIC Classification: 441300
NAIC Description: Automotive Parts, Accessories, and Tire Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RIGHTSOURCE RETIREMENT SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2017-01-01 JOE VERLIN
001 2016-01-01 JOE VERLIN
001 2015-01-01 JOE VERLIN
001 2014-01-01 JOE VERLIN JOE VERLIN 2015-10-15
001 2014-01-01 2015-10-15

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2017-01-01	JOE VERLIN
001	2016-01-01	JOE VERLIN
001	2015-01-01	JOE VERLIN
001	2014-01-01	JOE VERLIN		JOE VERLIN	2015-10-15
001	2014-01-01		2015-10-15

Plan Statistics for RIGHTSOURCE RETIREMENT SAVINGS PLAN

401k plan membership statisitcs for RIGHTSOURCE RETIREMENT SAVINGS PLAN

Measure Date Value
2017: RIGHTSOURCE RETIREMENT SAVINGS PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 353
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 217
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 217
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 217
Number of participants with account balances 2017-01-01 209
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: RIGHTSOURCE RETIREMENT SAVINGS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 368
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 217
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 136
Total of all active and inactive participants 2016-01-01 353
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 353
Number of participants with account balances 2016-01-01 229
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 2
2015: RIGHTSOURCE RETIREMENT SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 411
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 237
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 131
Total of all active and inactive participants 2015-01-01 368
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 368
Number of participants with account balances 2015-01-01 243
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 2
2014: RIGHTSOURCE RETIREMENT SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 431
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 291
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 120
Total of all active and inactive participants 2014-01-01 411
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 411
Number of participants with account balances 2014-01-01 271
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0

Measure	Date	Value
2017: RIGHTSOURCE RETIREMENT SAVINGS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	353
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	217
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	217
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	217
Number of participants with account balances	2017-01-01	209
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: RIGHTSOURCE RETIREMENT SAVINGS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	368
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	217
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	136
Total of all active and inactive participants	2016-01-01	353
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	353
Number of participants with account balances	2016-01-01	229
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	2
2015: RIGHTSOURCE RETIREMENT SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	411
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	237
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	131
Total of all active and inactive participants	2015-01-01	368
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	368
Number of participants with account balances	2015-01-01	243
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	2
2014: RIGHTSOURCE RETIREMENT SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	431
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	291
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	120
Total of all active and inactive participants	2014-01-01	411
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	411
Number of participants with account balances	2014-01-01	271
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0

Financial Data on RIGHTSOURCE RETIREMENT SAVINGS PLAN

Measure	Date	Value
2017 : RIGHTSOURCE RETIREMENT SAVINGS 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	$9,403
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	$1,132,598
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$1,700,799
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$1,616,189
Expenses. Certain deemed distributions of participant loans	2017-12-31	$52,353
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$0
Value of total assets at end of year	2017-12-31	$5,499,518
Value of total assets at beginning of year	2017-12-31	$6,058,316
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$32,257
Total interest from all sources	2017-12-31	$10,210
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	$1,000,000
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
Participant contributions at end of year	2017-12-31	$124,591
Participant contributions at beginning of year	2017-12-31	$212,302
Participant contributions at end of year	2017-12-31	$0
Participant contributions at beginning of year	2017-12-31	$22,552
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2017-12-31	$9,403
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2017-12-31	$0
Other income not declared elsewhere	2017-12-31	$394,053
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	$-568,201
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$5,490,115
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$6,058,316
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
Investment advisory and management fees	2017-12-31	$32,257
Value of interest in pooled separate accounts at end of year	2017-12-31	$5,235,982
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$5,685,707
Income. Interest from loans (other than to participants)	2017-12-31	$10,210
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$138,945
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$131,559
Net investment gain/loss from pooled separate accounts	2017-12-31	$728,335
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
Employer contributions (assets) at end of year	2017-12-31	$0
Employer contributions (assets) at beginning of year	2017-12-31	$6,196
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$1,616,189
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	MONROE SWEERIS & TROMP PLC
Accountancy firm EIN	2017-12-31	382621598
2016 : RIGHTSOURCE RETIREMENT SAVINGS PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$810,434
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$854,464
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$720,056
Expenses. Certain deemed distributions of participant loans	2016-12-31	$72,247
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$370,194
Value of total assets at end of year	2016-12-31	$6,058,316
Value of total assets at beginning of year	2016-12-31	$6,102,346
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$62,161
Total interest from all sources	2016-12-31	$10,526
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$297,567
Participant contributions at end of year	2016-12-31	$212,302
Participant contributions at beginning of year	2016-12-31	$271,002
Participant contributions at end of year	2016-12-31	$22,552
Participant contributions at beginning of year	2016-12-31	$32,164
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$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	2016-12-31	No
Value of net income/loss	2016-12-31	$-44,030
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$6,058,316
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$6,102,346
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Investment advisory and management fees	2016-12-31	$62,161
Value of interest in pooled separate accounts at end of year	2016-12-31	$5,685,707
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$5,574,528
Income. Interest from loans (other than to participants)	2016-12-31	$10,526
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$131,559
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$217,265
Net investment gain/loss from pooled separate accounts	2016-12-31	$429,714
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$72,627
Employer contributions (assets) at end of year	2016-12-31	$6,196
Employer contributions (assets) at beginning of year	2016-12-31	$7,387
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$720,056
Did the plan have assets held for investment	2016-12-31	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	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	MONROE SWEERIS & TROMP PLC
Accountancy firm EIN	2016-12-31	382621598
2015 : RIGHTSOURCE RETIREMENT SAVINGS PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$366,506
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$1,534,969
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$1,440,477
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$480,971
Value of total assets at end of year	2015-12-31	$6,102,346
Value of total assets at beginning of year	2015-12-31	$7,270,809
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$94,492
Total interest from all sources	2015-12-31	$18,979
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$373,436
Participant contributions at end of year	2015-12-31	$271,002
Participant contributions at beginning of year	2015-12-31	$281,205
Participant contributions at end of year	2015-12-31	$32,164
Participant contributions at beginning of year	2015-12-31	$31,520
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$2,313
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-1,168,463
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$6,102,346
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$7,270,809
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Investment advisory and management fees	2015-12-31	$94,492
Value of interest in pooled separate accounts at end of year	2015-12-31	$5,574,528
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$6,534,965
Income. Interest from loans (other than to participants)	2015-12-31	$13,619
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$5,360
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$217,265
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$413,154
Net investment gain/loss from pooled separate accounts	2015-12-31	$-133,444
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$105,222
Employer contributions (assets) at end of year	2015-12-31	$7,387
Employer contributions (assets) at beginning of year	2015-12-31	$9,965
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$1,440,477
Did the plan have assets held for investment	2015-12-31	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	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	MONROE SWEERIS & TROMP PLC
Accountancy firm EIN	2015-12-31	382621598
2014 : RIGHTSOURCE RETIREMENT SAVINGS PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$820,506
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$872,496
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$723,185
Expenses. Certain deemed distributions of participant loans	2014-12-31	$57,393
Value of total corrective distributions	2014-12-31	$750
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$518,826
Value of total assets at end of year	2014-12-31	$7,250,870
Value of total assets at beginning of year	2014-12-31	$7,302,860
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$91,168
Total interest from all sources	2014-12-31	$12,669
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$380,341
Participant contributions at end of year	2014-12-31	$261,266
Participant contributions at beginning of year	2014-12-31	$327,106
Participant contributions at end of year	2014-12-31	$9,965
Participant contributions at beginning of year	2014-12-31	$2,131
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$31,520
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$23,568
Other income not declared elsewhere	2014-12-31	$6,300
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-51,990
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$7,250,870
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$7,302,860
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Investment advisory and management fees	2014-12-31	$91,168
Value of interest in pooled separate accounts at end of year	2014-12-31	$6,534,965
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$6,692,869
Interest on participant loans	2014-12-31	$12,669
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$413,154
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$257,186
Net investment gain/loss from pooled separate accounts	2014-12-31	$282,711
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$138,485
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$723,185
Did the plan have assets held for investment	2014-12-31	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	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	MONROE SWEERIS & TROMP PLC
Accountancy firm EIN	2014-12-31	382621598

Form 5500 Responses for RIGHTSOURCE RETIREMENT SAVINGS PLAN

2017: RIGHTSOURCE RETIREMENT SAVINGS 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 - Trust	Yes
2016: RIGHTSOURCE RETIREMENT SAVINGS PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: RIGHTSOURCE RETIREMENT SAVINGS PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: RIGHTSOURCE RETIREMENT SAVINGS PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	Yes
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

GP 69411/FG4Y

Policy instance

Insurance contract or identification number	GP 69411/FG4Y
Number of Individuals Covered	47
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $510
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
Amount paid for insurance broker fees	510
Additional information about fees paid to insurance broker	TPA SUBSIDY
Insurance broker organization code?	5
Insurance broker name	LINCK LAW, PLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

GP 76958/FJL4

Policy instance

Insurance contract or identification number	GP 76958/FJL4
Number of Individuals Covered	183
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,010
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
Amount paid for insurance broker fees	2010
Additional information about fees paid to insurance broker	TPA SUBSIDY
Insurance broker organization code?	5
Insurance broker name	LINCK LAW, PLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

GP 69411/FG4Y

Policy instance

Insurance contract or identification number	GP 69411/FG4Y
Number of Individuals Covered	52
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $570
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 $0
Amount paid for insurance broker fees	570
Additional information about fees paid to insurance broker	TPA SUBSIDY
Insurance broker organization code?	5
Insurance broker name	GABRIDGE CO

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

GP 76958/FJL4

Policy instance

Insurance contract or identification number	GP 76958/FJL4
Number of Individuals Covered	204
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,110
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
Amount paid for insurance broker fees	2110
Additional information about fees paid to insurance broker	TPA SUBSIDY
Insurance broker organization code?	5
Insurance broker name	GABRIDGE CO

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

GP 69411/FG4Y

Policy instance

Insurance contract or identification number	GP 69411/FG4Y
Number of Individuals Covered	56
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,240
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
Amount paid for insurance broker fees	1240
Additional information about fees paid to insurance broker	TPA SUBSIDY
Insurance broker organization code?	5
Insurance broker name	GABRIDGE CO

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

GP 76958/FJL4

Policy instance

Insurance contract or identification number	GP 76958/FJL4
Number of Individuals Covered	213
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $4,430
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
Amount paid for insurance broker fees	4430
Additional information about fees paid to insurance broker	TPA SUBSIDY
Insurance broker organization code?	5
Insurance broker name	GABRIDGE CO

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Company Name:	ANTIOCH TIRE, INC.
Employer identification number (EIN):	363878545
NAIC Classification:	441300
NAIC Description:	Automotive Parts, Accessories, and Tire Stores