401k Plan data: POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN plan

POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN 401k Plan overview

Plan Name	POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN
Plan identification number	001

POBLOCKI PAVING CORP. 401(K) 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.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

POBLOCKI PAVING CORP. has sponsored the creation of one or more 401k plans.

Company Name: POBLOCKI PAVING CORP.

Employer identification number (EIN): 391171250

NAIC Classification: 238900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 PAUL SAGAN 2023-10-08 PAUL SAGAN 2023-10-08
001 2021-01-01 PAUL SAGAN 2022-08-30 PAUL SAGAN 2022-08-30
001 2020-01-01 PAUL SAGAN 2021-08-03 PAUL SAGAN 2021-08-03
001 2019-01-01 PAUL SAGAN 2020-06-10 PAUL SAGAN 2020-06-10
001 2018-01-01
001 2017-01-01
001 2016-01-01
001 2015-01-01
001 2014-01-01
001 2013-01-01
001 2012-01-01 JOHN M POBLOCKI 2013-05-24 JOHN M POBLOCKI 2013-05-24
001 2011-01-01 PAUL J SAGAN 2012-05-17 PAUL J SAGAN 2012-05-17
001 2010-01-01 JOHN M POBLOCKI 2011-06-09 JOHN M POBLOCKI 2011-06-09

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	PAUL SAGAN	2023-10-08	PAUL SAGAN	2023-10-08
001	2021-01-01	PAUL SAGAN	2022-08-30	PAUL SAGAN	2022-08-30
001	2020-01-01	PAUL SAGAN	2021-08-03	PAUL SAGAN	2021-08-03
001	2019-01-01	PAUL SAGAN	2020-06-10	PAUL SAGAN	2020-06-10
001	2018-01-01
001	2017-01-01
001	2016-01-01
001	2015-01-01
001	2014-01-01
001	2013-01-01
001	2012-01-01	JOHN M POBLOCKI	2013-05-24	JOHN M POBLOCKI	2013-05-24
001	2011-01-01	PAUL J SAGAN	2012-05-17	PAUL J SAGAN	2012-05-17
001	2010-01-01	JOHN M POBLOCKI	2011-06-09	JOHN M POBLOCKI	2011-06-09

Plan Statistics for POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN

401k plan membership statisitcs for POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN

Measure Date Value
2022: POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 164
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 149
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 14
Total of all active and inactive participants 2022-01-01 163
Total participants 2022-01-01 163
Number of participants with account balances 2022-01-01 119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 3
2021: POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 151
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 147
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 13
Total of all active and inactive participants 2021-01-01 160
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 160
Number of participants with account balances 2021-01-01 106
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 3
2020: POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 153
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 139
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 12
Total of all active and inactive participants 2020-01-01 151
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 151
Number of participants with account balances 2020-01-01 96
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 6
2019: POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 135
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 128
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 8
Total of all active and inactive participants 2019-01-01 136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 136
Number of participants with account balances 2019-01-01 90
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 2
2018: POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 138
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 124
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 6
Total of all active and inactive participants 2018-01-01 130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 130
Number of participants with account balances 2018-01-01 75
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 2
2017: POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 144
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 130
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 4
Total of all active and inactive participants 2017-01-01 134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 134
Number of participants with account balances 2017-01-01 71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 1
2016: POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 136
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 131
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 5
Total of all active and inactive participants 2016-01-01 136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 136
Number of participants with account balances 2016-01-01 62
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 1

Measure	Date	Value
2022: POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	164
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	149
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	14
Total of all active and inactive participants	2022-01-01	163
Total participants	2022-01-01	163
Number of participants with account balances	2022-01-01	119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	3
2021: POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	151
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	147
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	13
Total of all active and inactive participants	2021-01-01	160
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	160
Number of participants with account balances	2021-01-01	106
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	3
2020: POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	153
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	139
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	12
Total of all active and inactive participants	2020-01-01	151
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	151
Number of participants with account balances	2020-01-01	96
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	6
2019: POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	135
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	128
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	8
Total of all active and inactive participants	2019-01-01	136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	136
Number of participants with account balances	2019-01-01	90
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	2
2018: POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	138
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	124
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	6
Total of all active and inactive participants	2018-01-01	130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	130
Number of participants with account balances	2018-01-01	75
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	2
2017: POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	144
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	130
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	4
Total of all active and inactive participants	2017-01-01	134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	134
Number of participants with account balances	2017-01-01	71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	1
2016: POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	136
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	131
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	5
Total of all active and inactive participants	2016-01-01	136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	136
Number of participants with account balances	2016-01-01	62
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	1

Financial Data on POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN

Measure	Date	Value
2022 : POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN 2022 401k financial data
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-1,449,376
Total of all expenses incurred	2022-12-31	$798,938
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$795,512
Expenses. Certain deemed distributions of participant loans	2022-12-31	$2,789
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$1,194,299
Value of total assets at end of year	2022-12-31	$15,710,954
Value of total assets at beginning of year	2022-12-31	$17,959,268
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$637
Total interest from all sources	2022-12-31	$41,044
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$591,801
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$591,801
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$866,343
Participant contributions at end of year	2022-12-31	$183,784
Participant contributions at beginning of year	2022-12-31	$77,927
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$25,983
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-2,248,314
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$15,710,954
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$17,959,268
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$12,026,828
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$13,762,844
Income. Interest from loans (other than to participants)	2022-12-31	$5,707
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2022-12-31	$35,337
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$3,497,192
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$4,118,497
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-3,276,520
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$301,973
Employer contributions (assets) at end of year	2022-12-31	$3,150
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$795,512
Contract administrator fees	2022-12-31	$637
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	WIPFLI LLP
Accountancy firm EIN	2022-12-31	390758449
2021 : POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$3,113,653
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$478,580
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$472,314
Value of total corrective distributions	2021-12-31	$4,329
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$1,219,558
Value of total assets at end of year	2021-12-31	$17,959,268
Value of total assets at beginning of year	2021-12-31	$15,324,195
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$1,937
Total interest from all sources	2021-12-31	$46,754
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$1,121,096
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$1,121,096
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$778,014
Participant contributions at end of year	2021-12-31	$77,927
Participant contributions at beginning of year	2021-12-31	$124,095
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$184,750
Other income not declared elsewhere	2021-12-31	$2,379
Administrative expenses (other) incurred	2021-12-31	$1,937
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$2,635,073
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$17,959,268
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$15,324,195
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Investment advisory and management fees	2021-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$13,762,844
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$10,431,996
Interest on participant loans	2021-12-31	$6,305
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2021-12-31	$40,449
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$4,118,497
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$4,768,104
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$723,866
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$256,794
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$472,314
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	WIPFLI LLP
Accountancy firm EIN	2021-12-31	390758449
2020 : POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$2,655,991
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$259,930
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$240,684
Value of total corrective distributions	2020-12-31	$17,534
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$903,635
Value of total assets at end of year	2020-12-31	$15,324,195
Value of total assets at beginning of year	2020-12-31	$12,928,134
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$1,712
Total interest from all sources	2020-12-31	$31,755
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$482,036
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$482,036
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$671,446
Participant contributions at end of year	2020-12-31	$124,095
Participant contributions at beginning of year	2020-12-31	$172,753
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$0
Administrative expenses (other) incurred	2020-12-31	$1,712
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$2,396,061
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$15,324,195
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$12,928,134
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$10,431,996
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$11,262,149
Interest on participant loans	2020-12-31	$9,095
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-12-31	$22,660
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$4,768,104
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$1,493,232
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$1,238,565
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$232,189
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$240,684
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	SITZBERGER & COMPANY, S.C.
Accountancy firm EIN	2020-12-31	391777761
2019 : POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$3,240,785
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$568,488
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$551,407
Value of total corrective distributions	2019-12-31	$15,831
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$919,369
Value of total assets at end of year	2019-12-31	$12,928,134
Value of total assets at beginning of year	2019-12-31	$10,255,837
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$1,250
Total interest from all sources	2019-12-31	$23,928
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$586,397
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$586,397
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$660,461
Participant contributions at end of year	2019-12-31	$172,753
Participant contributions at beginning of year	2019-12-31	$101,574
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$31,290
Administrative expenses (other) incurred	2019-12-31	$1,250
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$2,672,297
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$12,928,134
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$10,255,837
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$11,262,149
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$9,343,429
Interest on participant loans	2019-12-31	$6,569
Value of interest in common/collective trusts at beginning of year	2019-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$17,359
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$1,493,232
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$810,834
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$1,711,091
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$227,618
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$551,407
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	SITZBERGER & COMPANY, S.C.
Accountancy firm EIN	2019-12-31	391777761
2018 : POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$-4,272
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$105,379
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$66,637
Value of total corrective distributions	2018-12-31	$37,592
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$742,630
Value of total assets at end of year	2018-12-31	$10,255,837
Value of total assets at beginning of year	2018-12-31	$10,365,488
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$1,150
Total interest from all sources	2018-12-31	$15,263
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$774,221
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$774,221
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$500,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$547,944
Participant contributions at end of year	2018-12-31	$101,574
Participant contributions at beginning of year	2018-12-31	$168,621
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$0
Other income not declared elsewhere	2018-12-31	$45
Administrative expenses (other) incurred	2018-12-31	$1,150
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$-109,651
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$10,255,837
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$10,365,488
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$9,343,429
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$9,093,485
Interest on participant loans	2018-12-31	$6,350
Value of interest in common/collective trusts at end of year	2018-12-31	$0
Value of interest in common/collective trusts at beginning of year	2018-12-31	$205,590
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-31	$8,913
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$810,834
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$897,792
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-1,549,494
Net investment gain or loss from common/collective trusts	2018-12-31	$13,063
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$194,686
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$66,637
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	SITZBERGER & COMPANY, S.C.
Accountancy firm EIN	2018-12-31	391777761
2017 : POBLOCKI PAVING CORP. 401(K) 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	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$2,184,772
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$695,254
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$659,579
Value of total corrective distributions	2017-12-31	$34,925
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$666,255
Value of total assets at end of year	2017-12-31	$10,365,488
Value of total assets at beginning of year	2017-12-31	$8,875,970
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$750
Total interest from all sources	2017-12-31	$19,120
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$482,180
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$482,180
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$500,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$499,645
Participant contributions at end of year	2017-12-31	$168,621
Participant contributions at beginning of year	2017-12-31	$197,463
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$0
Administrative expenses (other) incurred	2017-12-31	$750
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	$1,489,518
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$10,365,488
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$8,875,970
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$9,093,485
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$7,390,494
Interest on participant loans	2017-12-31	$7,917
Value of interest in common/collective trusts at end of year	2017-12-31	$205,590
Value of interest in common/collective trusts at beginning of year	2017-12-31	$116,317
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-12-31	$11,203
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$897,792
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$1,171,696
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$991,480
Net investment gain or loss from common/collective trusts	2017-12-31	$25,737
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	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$166,610
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$659,579
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	SITZBERGER & COMPANY, S.C.
Accountancy firm EIN	2017-12-31	391777761
2016 : POBLOCKI PAVING CORP. 401(K) 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	$1,306,043
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$417,635
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$399,306
Value of total corrective distributions	2016-12-31	$16,441
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$619,807
Value of total assets at end of year	2016-12-31	$8,875,970
Value of total assets at beginning of year	2016-12-31	$7,987,562
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$1,888
Total interest from all sources	2016-12-31	$22,538
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$299,072
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$299,072
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$455,202
Participant contributions at end of year	2016-12-31	$197,463
Participant contributions at beginning of year	2016-12-31	$199,242
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$13,635
Administrative expenses (other) incurred	2016-12-31	$1,888
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	$888,408
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$8,875,970
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$7,987,562
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$7,390,494
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$6,545,815
Interest on participant loans	2016-12-31	$8,622
Value of interest in common/collective trusts at end of year	2016-12-31	$116,317
Value of interest in common/collective trusts at beginning of year	2016-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-12-31	$13,916
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$1,171,696
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$1,242,505
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$364,869
Net investment gain or loss from common/collective trusts	2016-12-31	$-243
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	No
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	$150,970
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$399,306
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	SITZBERGER, HAU & CO., INC.
Accountancy firm EIN	2016-12-31	391777761

Form 5500 Responses for POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN

2022: POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: POBLOCKI PAVING CORP. 401(K) SAVINGS PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: POBLOCKI PAVING CORP. 401(K) 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 – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: POBLOCKI PAVING CORP. 401(K) 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 – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

384254-01

Policy instance

Insurance contract or identification number	384254-01
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $8,831
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Commission paid to Insurance Broker	USD $8,831
Additional information about fees paid to insurance broker	ADVISOR COMMISSIONS
Insurance broker organization code?	3

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

Policy contract number

384254-01

Policy instance

Insurance contract or identification number	384254-01
Number of Individuals Covered	20
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $9,136
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Commission paid to Insurance Broker	USD $0
Insurance broker organization code?	3

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

Policy contract number

384254-01

Policy instance

Insurance contract or identification number	384254-01
Number of Individuals Covered	21
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $9,640
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Commission paid to Insurance Broker	USD $9,640
Insurance broker organization code?	3

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

Policy contract number

384254-01

Policy instance

Insurance contract or identification number	384254-01
Number of Individuals Covered	15
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,191
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $3,191

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

Policy contract number

384254-01

Policy instance

Insurance contract or identification number	384254-01
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Insurance broker organization code?	3

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

Policy contract number

384254-01

Policy instance

Insurance contract or identification number	384254-01
Number of Individuals Covered	16
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,990
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Commission paid to Insurance Broker	USD $1,990
Insurance broker organization code?	3
Insurance broker name	JEFF SCHNEISS

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Company Name:	POBLOCKI PAVING CORP.
Employer identification number (EIN):	391171250
NAIC Classification:	238900