401k Plan data: COMBINE INTERNATIONAL, INC. 401(K) PLAN plan

COMBINE INTERNATIONAL, INC. 401(K) PLAN 401k Plan overview

Plan Name	COMBINE INTERNATIONAL, INC. 401(K) PLAN
Plan identification number	001

COMBINE INTERNATIONAL, INC. 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
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.
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

COMBINE INTERNATIONAL, INC. has sponsored the creation of one or more 401k plans.

Company Name: COMBINE INTERNATIONAL, INC.

Employer identification number (EIN): 382160071

NAIC Classification: 423940
NAIC Description: Jewelry, Watch, Precious Stone, and Precious Metal Merchant Wholesalers

Additional information about COMBINE INTERNATIONAL, INC.

Jurisdiction of Incorporation: Michigan Secretary of State

Incorporation Date: 0000-00-00

Company Identification Number: 006345

Legal Registered Office Address: 354 INDUSCO CT. TROY

United States of America (USA)
48083

More information about COMBINE INTERNATIONAL, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COMBINE INTERNATIONAL, INC. 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
001 2016-01-01
001 2015-01-01
001 2014-01-01 ROGER PARSONS
001 2013-01-01 ROGER PARSONS
001 2012-01-01 ROGER PARSONS
001 2011-01-01 ROGER PARSONS
001 2010-01-01 ROGER PARSONS
001 2009-01-01 ROGER PARSONS

Plan Statistics for COMBINE INTERNATIONAL, INC. 401(K) PLAN

401k plan membership statisitcs for COMBINE INTERNATIONAL, INC. 401(K) PLAN

Measure Date Value
2015: COMBINE INTERNATIONAL, INC. 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 114
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 83
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 20
Total of all active and inactive participants 2015-01-01 103
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 103
Number of participants with account balances 2015-01-01 83
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: COMBINE INTERNATIONAL, INC. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 121
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 91
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 22
Total of all active and inactive participants 2014-01-01 113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 113
Number of participants with account balances 2014-01-01 92
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: COMBINE INTERNATIONAL, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 143
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 98
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 23
Total of all active and inactive participants 2013-01-01 121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 121
Number of participants with account balances 2013-01-01 96
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: COMBINE INTERNATIONAL, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 190
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 110
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 33
Total of all active and inactive participants 2012-01-01 143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 143
Number of participants with account balances 2012-01-01 111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: COMBINE INTERNATIONAL, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 200
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 168
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 22
Total of all active and inactive participants 2011-01-01 190
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 190
Number of participants with account balances 2011-01-01 132
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: COMBINE INTERNATIONAL, INC. 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 206
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 169
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 31
Total of all active and inactive participants 2010-01-01 200
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 200
Number of participants with account balances 2010-01-01 142
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 2
2009: COMBINE INTERNATIONAL, INC. 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 229
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 174
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 30
Total of all active and inactive participants 2009-01-01 204
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 204
Number of participants with account balances 2009-01-01 147
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 1

Measure	Date	Value
2015: COMBINE INTERNATIONAL, INC. 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	114
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	83
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	20
Total of all active and inactive participants	2015-01-01	103
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	103
Number of participants with account balances	2015-01-01	83
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: COMBINE INTERNATIONAL, INC. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	121
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	91
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	22
Total of all active and inactive participants	2014-01-01	113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	113
Number of participants with account balances	2014-01-01	92
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: COMBINE INTERNATIONAL, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	143
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	98
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	23
Total of all active and inactive participants	2013-01-01	121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	121
Number of participants with account balances	2013-01-01	96
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: COMBINE INTERNATIONAL, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	190
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	110
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	33
Total of all active and inactive participants	2012-01-01	143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	143
Number of participants with account balances	2012-01-01	111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: COMBINE INTERNATIONAL, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	200
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	168
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	22
Total of all active and inactive participants	2011-01-01	190
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	190
Number of participants with account balances	2011-01-01	132
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: COMBINE INTERNATIONAL, INC. 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	206
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	169
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	31
Total of all active and inactive participants	2010-01-01	200
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	200
Number of participants with account balances	2010-01-01	142
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	2
2009: COMBINE INTERNATIONAL, INC. 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	229
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	174
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	30
Total of all active and inactive participants	2009-01-01	204
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	204
Number of participants with account balances	2009-01-01	147
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	1

Financial Data on COMBINE INTERNATIONAL, INC. 401(K) PLAN

Measure	Date	Value
2015 : COMBINE INTERNATIONAL, INC. 401(K) 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	$994
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$500
Total income from all sources (including contributions)	2015-12-31	$262,198
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$751,249
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$658,230
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$295,353
Value of total assets at end of year	2015-12-31	$8,426,136
Value of total assets at beginning of year	2015-12-31	$8,914,693
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$93,019
Total interest from all sources	2015-12-31	$0
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
Administrative expenses professional fees incurred	2015-12-31	$8,959
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$750,000
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	$295,353
Participant contributions at end of year	2015-12-31	$4,826
Participant contributions at beginning of year	2015-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-12-31	$994
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$500
Other income not declared elsewhere	2015-12-31	$5,904
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	$-489,051
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$8,425,142
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$8,914,193
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$8,032,180
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$8,452,856
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$389,130
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$461,837
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-39,059
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	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$658,230
Contract administrator fees	2015-12-31	$84,060
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	FENNER, MELSTROM & DOOLING PLC
Accountancy firm EIN	2015-12-31	381402622
2014 : COMBINE INTERNATIONAL, INC. 401(K) 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	$500
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	$741,636
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$362,821
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$267,808
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$298,581
Value of total assets at end of year	2014-12-31	$8,914,693
Value of total assets at beginning of year	2014-12-31	$8,535,378
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$95,013
Total interest from all sources	2014-12-31	$0
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
Administrative expenses professional fees incurred	2014-12-31	$6,183
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$750,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$298,581
Participant contributions at end of year	2014-12-31	$0
Participant contributions at beginning of year	2014-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-12-31	$500
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$0
Other income not declared elsewhere	2014-12-31	$7,664
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	$378,815
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$8,914,193
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$8,535,378
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$8,452,856
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$8,128,277
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$461,837
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$407,101
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$435,391
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	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$267,808
Contract administrator fees	2014-12-31	$88,830
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	FENNER, MELSTROM & DOOLING PLC
Accountancy firm EIN	2014-12-31	381402622
2013 : COMBINE INTERNATIONAL, INC. 401(K) PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$1,842,151
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$802,242
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$709,692
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$293,861
Value of total assets at end of year	2013-12-31	$8,535,378
Value of total assets at beginning of year	2013-12-31	$7,495,469
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$92,550
Total interest from all sources	2013-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Administrative expenses professional fees incurred	2013-12-31	$8,943
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$750,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$293,861
Participant contributions at end of year	2013-12-31	$0
Participant contributions at beginning of year	2013-12-31	$11,663
Other income not declared elsewhere	2013-12-31	$8,088
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$1,039,909
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$8,535,378
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$7,495,469
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$8,128,277
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$7,102,393
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$407,101
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$381,413
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$1,540,202
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$709,692
Contract administrator fees	2013-12-31	$83,607
Did the plan have assets held for investment	2013-12-31	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	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	FENNER, MELSTROM & DOOLING PLC
Accountancy firm EIN	2013-12-31	381402622
2012 : COMBINE INTERNATIONAL, INC. 401(K) PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$1,276,460
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$1,097,309
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$1,008,965
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$325,047
Value of total assets at end of year	2012-12-31	$7,495,469
Value of total assets at beginning of year	2012-12-31	$7,316,318
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$88,344
Total interest from all sources	2012-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Administrative expenses professional fees incurred	2012-12-31	$7,573
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$750,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$325,047
Participant contributions at end of year	2012-12-31	$11,663
Participant contributions at beginning of year	2012-12-31	$0
Other income not declared elsewhere	2012-12-31	$9,116
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$179,151
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$7,495,469
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$7,316,318
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$7,102,393
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$6,968,218
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$381,413
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$348,100
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$942,297
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Employer contributions (assets) at end of year	2012-12-31	$0
Employer contributions (assets) at beginning of year	2012-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$1,008,965
Contract administrator fees	2012-12-31	$80,771
Did the plan have assets held for investment	2012-12-31	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	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	FENNER, MELSTROM & DOOLING PLC
Accountancy firm EIN	2012-12-31	381402622
2011 : COMBINE INTERNATIONAL, INC. 401(K) PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$26,621
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$515,696
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$423,775
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$309,577
Value of total assets at end of year	2011-12-31	$7,316,318
Value of total assets at beginning of year	2011-12-31	$7,805,393
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$91,921
Total interest from all sources	2011-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Administrative expenses professional fees incurred	2011-12-31	$8,583
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$750,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$309,577
Participant contributions at end of year	2011-12-31	$0
Participant contributions at beginning of year	2011-12-31	$9,057
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$0
Other income not declared elsewhere	2011-12-31	$7,641
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$-489,075
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$7,316,318
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$7,805,393
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$6,968,218
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$7,494,977
Value of interest in pooled separate accounts at end of year	2011-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$348,100
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$301,359
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-290,597
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Employer contributions (assets) at end of year	2011-12-31	$0
Employer contributions (assets) at beginning of year	2011-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$423,775
Contract administrator fees	2011-12-31	$83,338
Did the plan have assets held for investment	2011-12-31	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	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	FENNER, MELSTROM & DOOLING PLC
Accountancy firm EIN	2011-12-31	381402622
2010 : COMBINE INTERNATIONAL, INC. 401(K) PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$7,038
Total income from all sources (including contributions)	2010-12-31	$1,129,576
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$440,927
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$351,793
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$317,429
Value of total assets at end of year	2010-12-31	$7,805,393
Value of total assets at beginning of year	2010-12-31	$7,123,782
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$89,134
Total interest from all sources	2010-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Administrative expenses professional fees incurred	2010-12-31	$9,575
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$750,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$317,429
Participant contributions at end of year	2010-12-31	$9,057
Participant contributions at beginning of year	2010-12-31	$9,670
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$7,038
Other income not declared elsewhere	2010-12-31	$7,846
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$688,649
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$7,805,393
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$7,116,744
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$7,494,977
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$6,813,275
Value of interest in pooled separate accounts at end of year	2010-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$301,359
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$300,837
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$804,301
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Employer contributions (assets) at end of year	2010-12-31	$0
Employer contributions (assets) at beginning of year	2010-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$351,793
Contract administrator fees	2010-12-31	$79,559
Did the plan have assets held for investment	2010-12-31	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	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	FENNER, MELSTROM & DOOLING PLC
Accountancy firm EIN	2010-12-31	381402622

Form 5500 Responses for COMBINE INTERNATIONAL, INC. 401(K) PLAN

2015: COMBINE INTERNATIONAL, INC. 401(K) 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 – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: COMBINE INTERNATIONAL, INC. 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
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 – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: COMBINE INTERNATIONAL, INC. 401(K) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: COMBINE INTERNATIONAL, INC. 401(K) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: COMBINE INTERNATIONAL, INC. 401(K) PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: COMBINE INTERNATIONAL, INC. 401(K) PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: COMBINE INTERNATIONAL, INC. 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
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

269-80050

Policy instance

Insurance contract or identification number	269-80050
Number of Individuals Covered	83
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $4,460
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 $4,460
Insurance broker organization code?	4
Insurance broker name	INVEST FINANCIAL CORPORATION

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

269-80050

Policy instance

Insurance contract or identification number	269-80050
Number of Individuals Covered	92
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $4,760
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 $4,760
Insurance broker organization code?	4
Insurance broker name	INVEST FINANCIAL CORPORATION

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

269-80050

Policy instance

Insurance contract or identification number	269-80050
Number of Individuals Covered	96
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $4,124
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 $4,124
Insurance broker organization code?	4
Insurance broker name	INVEST FINANCIAL CORPORATION

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

269-80050

Policy instance

Insurance contract or identification number	269-80050
Number of Individuals Covered	111
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,017
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 $4,017
Insurance broker organization code?	4
Insurance broker name	INVEST FINANCIAL CORPORATION

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

269-80050

Policy instance

Insurance contract or identification number	269-80050
Number of Individuals Covered	132
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,492
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

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

269-80050

Policy instance

Insurance contract or identification number	269-80050
Number of Individuals Covered	142
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,133
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

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Company Name:	COMBINE INTERNATIONAL, INC.
Employer identification number (EIN):	382160071
NAIC Classification:	423940
NAIC Description:	Jewelry, Watch, Precious Stone, and Precious Metal Merchant Wholesalers

Jurisdiction of Incorporation:	Michigan Secretary of State
Incorporation Date:	0000-00-00
Company Identification Number:	006345
Legal Registered Office Address:	354 INDUSCO CT. TROY United States of America (USA) 48083

Plan id#	Filing Submission Date	Name of Administrator
001	2022-01-01
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2017-01-01
001	2016-01-01
001	2015-01-01
001	2014-01-01	ROGER PARSONS
001	2013-01-01	ROGER PARSONS
001	2012-01-01	ROGER PARSONS
001	2011-01-01	ROGER PARSONS
001	2010-01-01	ROGER PARSONS
001	2009-01-01	ROGER PARSONS