401k Plan data: CRYSTAL CABINET WORKS, INC. MEDICAL PLAN plan

CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 401k Plan overview

Plan Name	CRYSTAL CABINET WORKS, INC. MEDICAL PLAN
Plan identification number	503

CRYSTAL CABINET WORKS, INC. MEDICAL PLAN Benefits

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

401k Sponsoring company profile

CRYSTAL CABINET WORKS, INC. has sponsored the creation of one or more 401k plans.

Company Name: CRYSTAL CABINET WORKS, INC.

Employer identification number (EIN): 410828559

NAIC Classification: 337000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CRYSTAL CABINET WORKS, INC. MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2021-07-01 ROBERT NORDLAND 2023-04-18 ROBERT NORDLAND 2023-04-18
503 2020-07-01 ROBERT NORDLAND 2022-04-14 ROBERT NORDLAND 2022-04-14
503 2019-07-01 ROBERT NORDLAND 2021-02-01 ROBERT NORDLAND 2021-02-01
503 2018-07-01 ROBERT NORDLAND 2020-01-22 ROBERT NORDLAND 2020-01-22
503 2017-07-01 ROBERT NORDLAND 2019-04-12 ROBERT NORDLAND 2019-04-12
503 2016-07-01 ROBERT NORDLAND ROBERT NORDLAND 2018-04-13
503 2015-07-01 ROBERT NORDLAND ROBERT NORDLAND 2017-04-14
503 2014-07-01 ROBERT NORDLAND ROBERT NORDLAND 2016-04-14
503 2013-07-01 ROBERT NORDLAND ROBERT NORDLAND 2015-04-13
503 2012-07-01 ROBERT NORDLAND ROBERT NORDLAND 2014-04-11
503 2011-07-01 ROBERT NORDLAND ROBERT NORDLAND 2013-04-15
503 2009-07-01 ROBERT NORDLAND 2011-04-14
503 2009-07-01 ROBERT NORDLAND

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2021-07-01	ROBERT NORDLAND	2023-04-18	ROBERT NORDLAND	2023-04-18
503	2020-07-01	ROBERT NORDLAND	2022-04-14	ROBERT NORDLAND	2022-04-14
503	2019-07-01	ROBERT NORDLAND	2021-02-01	ROBERT NORDLAND	2021-02-01
503	2018-07-01	ROBERT NORDLAND	2020-01-22	ROBERT NORDLAND	2020-01-22
503	2017-07-01	ROBERT NORDLAND	2019-04-12	ROBERT NORDLAND	2019-04-12
503	2016-07-01	ROBERT NORDLAND		ROBERT NORDLAND	2018-04-13
503	2015-07-01	ROBERT NORDLAND		ROBERT NORDLAND	2017-04-14
503	2014-07-01	ROBERT NORDLAND		ROBERT NORDLAND	2016-04-14
503	2013-07-01	ROBERT NORDLAND		ROBERT NORDLAND	2015-04-13
503	2012-07-01	ROBERT NORDLAND		ROBERT NORDLAND	2014-04-11
503	2011-07-01	ROBERT NORDLAND		ROBERT NORDLAND	2013-04-15
503	2009-07-01			ROBERT NORDLAND	2011-04-14
503	2009-07-01	ROBERT NORDLAND

Plan Statistics for CRYSTAL CABINET WORKS, INC. MEDICAL PLAN

401k plan membership statisitcs for CRYSTAL CABINET WORKS, INC. MEDICAL PLAN

Measure Date Value
2016: CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year 2016-07-01 367
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 347
Number of retired or separated participants receiving benefits 2016-07-01 32
Total of all active and inactive participants 2016-07-01 379
Total participants 2016-07-01 379
2015: CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year 2015-07-01 308
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 335
Total of all active and inactive participants 2015-07-01 335
Total participants 2015-07-01 335
Number of participants with account balances 2015-07-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-07-01 0
2014: CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year 2014-07-01 279
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 307
Number of retired or separated participants receiving benefits 2014-07-01 1
Number of other retired or separated participants entitled to future benefits 2014-07-01 0
Total of all active and inactive participants 2014-07-01 308
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-07-01 0
Total participants 2014-07-01 308
Number of participants with account balances 2014-07-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-07-01 0
2013: CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year 2013-07-01 263
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 277
Number of retired or separated participants receiving benefits 2013-07-01 1
Total of all active and inactive participants 2013-07-01 278
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-07-01 1
Total participants 2013-07-01 279
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-07-01 0
2012: CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 259
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 262
Number of retired or separated participants receiving benefits 2012-07-01 0
Number of other retired or separated participants entitled to future benefits 2012-07-01 0
Total of all active and inactive participants 2012-07-01 262
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-07-01 1
Total participants 2012-07-01 263
Number of participants with account balances 2012-07-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-07-01 0
2011: CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year 2011-07-01 260
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 258
Number of retired or separated participants receiving benefits 2011-07-01 1
Number of other retired or separated participants entitled to future benefits 2011-07-01 0
Total of all active and inactive participants 2011-07-01 259
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-07-01 0
Total participants 2011-07-01 259
Number of participants with account balances 2011-07-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-07-01 0
2009: CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year 2009-07-01 355
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 247
Number of retired or separated participants receiving benefits 2009-07-01 52
Number of other retired or separated participants entitled to future benefits 2009-07-01 0
Total of all active and inactive participants 2009-07-01 299
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-07-01 1
Total participants 2009-07-01 300
Number of participants with account balances 2009-07-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-07-01 0

Measure	Date	Value
2016: CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year	2016-07-01	367
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	347
Number of retired or separated participants receiving benefits	2016-07-01	32
Total of all active and inactive participants	2016-07-01	379
Total participants	2016-07-01	379
2015: CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year	2015-07-01	308
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	335
Total of all active and inactive participants	2015-07-01	335
Total participants	2015-07-01	335
Number of participants with account balances	2015-07-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-07-01	0
2014: CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year	2014-07-01	279
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	307
Number of retired or separated participants receiving benefits	2014-07-01	1
Number of other retired or separated participants entitled to future benefits	2014-07-01	0
Total of all active and inactive participants	2014-07-01	308
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-07-01	0
Total participants	2014-07-01	308
Number of participants with account balances	2014-07-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-07-01	0
2013: CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year	2013-07-01	263
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	277
Number of retired or separated participants receiving benefits	2013-07-01	1
Total of all active and inactive participants	2013-07-01	278
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-07-01	1
Total participants	2013-07-01	279
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-07-01	0
2012: CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	259
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	262
Number of retired or separated participants receiving benefits	2012-07-01	0
Number of other retired or separated participants entitled to future benefits	2012-07-01	0
Total of all active and inactive participants	2012-07-01	262
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-07-01	1
Total participants	2012-07-01	263
Number of participants with account balances	2012-07-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-07-01	0
2011: CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year	2011-07-01	260
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	258
Number of retired or separated participants receiving benefits	2011-07-01	1
Number of other retired or separated participants entitled to future benefits	2011-07-01	0
Total of all active and inactive participants	2011-07-01	259
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-07-01	0
Total participants	2011-07-01	259
Number of participants with account balances	2011-07-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-07-01	0
2009: CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year	2009-07-01	355
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	247
Number of retired or separated participants receiving benefits	2009-07-01	52
Number of other retired or separated participants entitled to future benefits	2009-07-01	0
Total of all active and inactive participants	2009-07-01	299
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-07-01	1
Total participants	2009-07-01	300
Number of participants with account balances	2009-07-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-07-01	0

Financial Data on CRYSTAL CABINET WORKS, INC. MEDICAL PLAN

Measure	Date	Value
2017 : CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-06-30	$0
Total income from all sources (including contributions)	2017-06-30	$4,964
Total loss/gain on sale of assets	2017-06-30	$0
Total of all expenses incurred	2017-06-30	$25,707
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-06-30	$22,510
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-06-30	$0
Value of total assets at end of year	2017-06-30	$185,467
Value of total assets at beginning of year	2017-06-30	$206,210
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-06-30	$3,197
Total interest from all sources	2017-06-30	$2,005
Total dividends received (eg from common stock, registered investment company shares)	2017-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-06-30	No
Administrative expenses professional fees incurred	2017-06-30	$3,197
Was this plan covered by a fidelity bond	2017-06-30	Yes
Value of fidelity bond cover	2017-06-30	$500,000
If this is an individual account plan, was there a blackout period	2017-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2017-06-30	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-06-30	No
Value of net income/loss	2017-06-30	$-20,743
Value of net assets at end of year (total assets less liabilities)	2017-06-30	$185,467
Value of net assets at beginning of year (total assets less liabilities)	2017-06-30	$206,210
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-06-30	No
Were any leases to which the plan was party in default or uncollectible	2017-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-06-30	$46,767
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-06-30	$45,494
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-06-30	$138,700
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-06-30	$160,716
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-06-30	$160,716
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-06-30	$2,005
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-06-30	$2,959
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-06-30	No
Was there a failure to transmit to the plan any participant contributions	2017-06-30	No
Has the plan failed to provide any benefit when due under the plan	2017-06-30	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-06-30	$22,510
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2017-06-30	No
Did the plan have assets held for investment	2017-06-30	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	2017-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2017-06-30	Disclaimer
Accountancy firm name	2017-06-30	BERGANKDV, LTD.
Accountancy firm EIN	2017-06-30	411431613
2016 : CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-06-30	$0
Total income from all sources (including contributions)	2016-06-30	$-386
Total loss/gain on sale of assets	2016-06-30	$0
Total of all expenses incurred	2016-06-30	$28,299
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-06-30	$24,675
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-06-30	$0
Value of total assets at end of year	2016-06-30	$206,210
Value of total assets at beginning of year	2016-06-30	$234,895
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-06-30	$3,624
Total interest from all sources	2016-06-30	$1,256
Total dividends received (eg from common stock, registered investment company shares)	2016-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-06-30	No
Administrative expenses professional fees incurred	2016-06-30	$3,624
Was this plan covered by a fidelity bond	2016-06-30	Yes
Value of fidelity bond cover	2016-06-30	$500,000
If this is an individual account plan, was there a blackout period	2016-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2016-06-30	No
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-06-30	$65
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-06-30	No
Value of net income/loss	2016-06-30	$-28,685
Value of net assets at end of year (total assets less liabilities)	2016-06-30	$206,210
Value of net assets at beginning of year (total assets less liabilities)	2016-06-30	$234,895
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-06-30	No
Were any leases to which the plan was party in default or uncollectible	2016-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-06-30	$45,494
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-06-30	$50,964
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2016-06-30	$160,716
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-06-30	$183,866
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-06-30	$183,866
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-06-30	$1,256
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-06-30	$-1,642
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-06-30	No
Was there a failure to transmit to the plan any participant contributions	2016-06-30	No
Has the plan failed to provide any benefit when due under the plan	2016-06-30	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-06-30	$24,675
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2016-06-30	No
Did the plan have assets held for investment	2016-06-30	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	2016-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2016-06-30	Disclaimer
Accountancy firm name	2016-06-30	BERGAN KDV, LTD.
Accountancy firm EIN	2016-06-30	411431613
2015 : CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-06-30	$0
Total income from all sources (including contributions)	2015-06-30	$806
Total loss/gain on sale of assets	2015-06-30	$4,830
Total of all expenses incurred	2015-06-30	$26,664
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-06-30	$22,384
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-06-30	$0
Value of total assets at end of year	2015-06-30	$234,895
Value of total assets at beginning of year	2015-06-30	$260,753
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-06-30	$4,280
Total interest from all sources	2015-06-30	$1,905
Total dividends received (eg from common stock, registered investment company shares)	2015-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-06-30	No
Administrative expenses professional fees incurred	2015-06-30	$4,280
Was this plan covered by a fidelity bond	2015-06-30	Yes
Value of fidelity bond cover	2015-06-30	$500,000
If this is an individual account plan, was there a blackout period	2015-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2015-06-30	No
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-06-30	$65
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-06-30	No
Value of net income/loss	2015-06-30	$-25,858
Value of net assets at end of year (total assets less liabilities)	2015-06-30	$234,895
Value of net assets at beginning of year (total assets less liabilities)	2015-06-30	$260,753
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-06-30	No
Were any leases to which the plan was party in default or uncollectible	2015-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-06-30	$50,964
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-06-30	$57,173
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-06-30	$183,866
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-06-30	$203,580
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-06-30	$203,580
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-06-30	$1,905
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-06-30	$-5,929
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-06-30	No
Was there a failure to transmit to the plan any participant contributions	2015-06-30	No
Has the plan failed to provide any benefit when due under the plan	2015-06-30	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-06-30	$22,384
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2015-06-30	No
Did the plan have assets held for investment	2015-06-30	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	2015-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-06-30	No
Aggregate proceeds on sale of assets	2015-06-30	$30,039
Aggregate carrying amount (costs) on sale of assets	2015-06-30	$25,209
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2015-06-30	Disclaimer
Accountancy firm name	2015-06-30	BERGANKDV, LTD.
Accountancy firm EIN	2015-06-30	411431613
2014 : CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-06-30	$0
Total income from all sources (including contributions)	2014-06-30	$9,297
Total loss/gain on sale of assets	2014-06-30	$0
Total of all expenses incurred	2014-06-30	$33,450
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-06-30	$28,754
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-06-30	$0
Value of total assets at end of year	2014-06-30	$260,753
Value of total assets at beginning of year	2014-06-30	$284,906
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-06-30	$4,696
Total interest from all sources	2014-06-30	$1,791
Total dividends received (eg from common stock, registered investment company shares)	2014-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-06-30	No
Administrative expenses professional fees incurred	2014-06-30	$4,600
Was this plan covered by a fidelity bond	2014-06-30	Yes
Value of fidelity bond cover	2014-06-30	$500,000
If this is an individual account plan, was there a blackout period	2014-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2014-06-30	No
Other income not declared elsewhere	2014-06-30	$6
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-06-30	No
Value of net income/loss	2014-06-30	$-24,153
Value of net assets at end of year (total assets less liabilities)	2014-06-30	$260,753
Value of net assets at beginning of year (total assets less liabilities)	2014-06-30	$284,906
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-06-30	No
Were any leases to which the plan was party in default or uncollectible	2014-06-30	No
Investment advisory and management fees	2014-06-30	$96
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-06-30	$57,173
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-06-30	$59,792
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-06-30	$203,580
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-06-30	$225,114
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-06-30	$225,114
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-06-30	$1,791
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-06-30	$7,500
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-06-30	No
Was there a failure to transmit to the plan any participant contributions	2014-06-30	No
Has the plan failed to provide any benefit when due under the plan	2014-06-30	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-06-30	$28,754
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2014-06-30	No
Did the plan have assets held for investment	2014-06-30	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	2014-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2014-06-30	Disclaimer
Accountancy firm name	2014-06-30	KERN DEWENTER VIERE LTD.
Accountancy firm EIN	2014-06-30	411431613
2013 : CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-06-30	$0
Total income from all sources (including contributions)	2013-06-30	$7,380
Total loss/gain on sale of assets	2013-06-30	$0
Total of all expenses incurred	2013-06-30	$56,582
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-06-30	$50,840
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-06-30	$0
Value of total assets at end of year	2013-06-30	$284,906
Value of total assets at beginning of year	2013-06-30	$334,108
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-06-30	$5,742
Total interest from all sources	2013-06-30	$1,589
Total dividends received (eg from common stock, registered investment company shares)	2013-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-06-30	No
Administrative expenses professional fees incurred	2013-06-30	$5,742
Was this plan covered by a fidelity bond	2013-06-30	Yes
Value of fidelity bond cover	2013-06-30	$500,000
If this is an individual account plan, was there a blackout period	2013-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2013-06-30	No
Other income not declared elsewhere	2013-06-30	$232
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-06-30	No
Value of net income/loss	2013-06-30	$-49,202
Value of net assets at end of year (total assets less liabilities)	2013-06-30	$284,906
Value of net assets at beginning of year (total assets less liabilities)	2013-06-30	$334,108
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-06-30	No
Were any leases to which the plan was party in default or uncollectible	2013-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-06-30	$59,792
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-06-30	$66,909
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-06-30	$225,114
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-06-30	$267,199
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-06-30	$267,199
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-06-30	$1,589
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-06-30	$5,559
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-06-30	Yes
Was there a failure to transmit to the plan any participant contributions	2013-06-30	No
Has the plan failed to provide any benefit when due under the plan	2013-06-30	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-06-30	$50,840
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2013-06-30	No
Did the plan have assets held for investment	2013-06-30	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	2013-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2013-06-30	Disclaimer
Accountancy firm name	2013-06-30	KERN DEWENTER VIERE LTD.
Accountancy firm EIN	2013-06-30	411431613
2012 : CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2012 401k financial data
Total income from all sources (including contributions)	2012-06-30	$889
Total of all expenses incurred	2012-06-30	$57,796
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-06-30	$51,370
Value of total assets at end of year	2012-06-30	$334,108
Value of total assets at beginning of year	2012-06-30	$391,015
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-06-30	$6,426
Total interest from all sources	2012-06-30	$1,084
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-06-30	No
Administrative expenses professional fees incurred	2012-06-30	$6,426
Was this plan covered by a fidelity bond	2012-06-30	Yes
Value of fidelity bond cover	2012-06-30	$500,000
If this is an individual account plan, was there a blackout period	2012-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2012-06-30	No
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-06-30	$61
Other income not declared elsewhere	2012-06-30	$1,474
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-06-30	No
Value of net income/loss	2012-06-30	$-56,907
Value of net assets at end of year (total assets less liabilities)	2012-06-30	$334,108
Value of net assets at beginning of year (total assets less liabilities)	2012-06-30	$391,015
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-06-30	No
Were any leases to which the plan was party in default or uncollectible	2012-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-06-30	$66,909
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-06-30	$74,981
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-06-30	$267,199
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-06-30	$315,973
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-06-30	$315,973
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-06-30	$1,084
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-06-30	$-1,669
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-06-30	No
Was there a failure to transmit to the plan any participant contributions	2012-06-30	No
Has the plan failed to provide any benefit when due under the plan	2012-06-30	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-06-30	$51,370
Did the plan have assets held for investment	2012-06-30	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	2012-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2012-06-30	Disclaimer
Accountancy firm name	2012-06-30	KERN DEWENTER VIERE LTD.
Accountancy firm EIN	2012-06-30	411431613
2011 : CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2011 401k financial data
Total income from all sources (including contributions)	2011-06-30	$19,669
Total of all expenses incurred	2011-06-30	$115,330
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-06-30	$107,440
Value of total assets at end of year	2011-06-30	$391,015
Value of total assets at beginning of year	2011-06-30	$486,676
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-06-30	$7,890
Total interest from all sources	2011-06-30	$1,615
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-06-30	No
Administrative expenses professional fees incurred	2011-06-30	$7,890
Was this plan covered by a fidelity bond	2011-06-30	No
If this is an individual account plan, was there a blackout period	2011-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2011-06-30	No
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-06-30	$61
Other income not declared elsewhere	2011-06-30	$2,154
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-06-30	No
Value of net income/loss	2011-06-30	$-95,661
Value of net assets at end of year (total assets less liabilities)	2011-06-30	$391,015
Value of net assets at beginning of year (total assets less liabilities)	2011-06-30	$486,676
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-06-30	No
Were any leases to which the plan was party in default or uncollectible	2011-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-06-30	$74,981
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-06-30	$83,756
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-06-30	$315,973
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-06-30	$402,920
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-06-30	$402,920
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-06-30	$1,615
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-06-30	$15,900
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-06-30	No
Was there a failure to transmit to the plan any participant contributions	2011-06-30	No
Has the plan failed to provide any benefit when due under the plan	2011-06-30	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-06-30	$107,440
Did the plan have assets held for investment	2011-06-30	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	2011-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2011-06-30	Disclaimer
Accountancy firm name	2011-06-30	KERN DEWENTER VIERE LTD.
Accountancy firm EIN	2011-06-30	411431613

Form 5500 Responses for CRYSTAL CABINET WORKS, INC. MEDICAL PLAN

2016: CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Submission has been amended	No
2016-07-01	This submission is the final filing	No
2016-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-07-01	Plan is a collectively bargained plan	No
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan funding arrangement – Trust	Yes
2016-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement - Trust	Yes
2016-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	First time form 5500 has been submitted	Yes
2015-07-01	Submission has been amended	No
2015-07-01	This submission is the final filing	No
2015-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-07-01	Plan is a collectively bargained plan	No
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan funding arrangement – Trust	Yes
2015-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement - Trust	Yes
2015-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	First time form 5500 has been submitted	Yes
2014-07-01	Submission has been amended	No
2014-07-01	This submission is the final filing	No
2014-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-07-01	Plan is a collectively bargained plan	No
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan funding arrangement – Trust	Yes
2014-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement - Trust	Yes
2014-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	First time form 5500 has been submitted	Yes
2013-07-01	Submission has been amended	No
2013-07-01	This submission is the final filing	No
2013-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-07-01	Plan is a collectively bargained plan	No
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan funding arrangement – Trust	Yes
2013-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement - Trust	Yes
2013-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	First time form 5500 has been submitted	Yes
2012-07-01	Submission has been amended	No
2012-07-01	This submission is the final filing	No
2012-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-07-01	Plan is a collectively bargained plan	No
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan funding arrangement – Trust	Yes
2012-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement - Trust	Yes
2012-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	First time form 5500 has been submitted	Yes
2011-07-01	Submission has been amended	No
2011-07-01	This submission is the final filing	No
2011-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-07-01	Plan is a collectively bargained plan	No
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan funding arrangement – Trust	Yes
2011-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement - Trust	Yes
2011-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: CRYSTAL CABINET WORKS, INC. MEDICAL PLAN 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	Submission has been amended	No
2009-07-01	This submission is the final filing	No
2009-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-07-01	Plan is a collectively bargained plan	No
2009-07-01	Plan funding arrangement – Insurance	Yes
2009-07-01	Plan funding arrangement – Trust	Yes
2009-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-07-01	Plan benefit arrangement – Insurance	Yes
2009-07-01	Plan benefit arrangement - Trust	Yes
2009-07-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

PREFERREDONE ADMINISTRATIVE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

PKA20423

Policy instance

Insurance contract or identification number	PKA20423
Number of Individuals Covered	625
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $16,046
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?	No
Health Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $278,626
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	16046
Additional information about fees paid to insurance broker	AGENT
Insurance broker organization code?	3
Insurance broker name	THE CHRISTENSEN GROUP

MEDICA (National Association of Insurance Commissioners NAIC id number: 1259 )

Policy contract number

MULTIPLE

Policy instance

Insurance contract or identification number	MULTIPLE
Number of Individuals Covered	595
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $25,212
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?	No
Health Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $177,057
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	15816
Additional information about fees paid to insurance broker	AGENT
Insurance broker organization code?	3
Insurance broker name	ADAM WYNIA, THE CHRISTENSEN GROUP

MEDICA (National Association of Insurance Commissioners NAIC id number: 1259 )

Policy contract number

MULTIPLE

Policy instance

Insurance contract or identification number	MULTIPLE
Number of Individuals Covered	279
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $23,980
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?	No
Health Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $239,921
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	23980
Additional information about fees paid to insurance broker	AGENT
Insurance broker organization code?	3
Insurance broker name	RICHARD ALLEN JR., EBT SYSTEMS LLC

MEDICA (National Association of Insurance Commissioners NAIC id number: 1259 )

Policy contract number

MULTIPLE

Policy instance

Insurance contract or identification number	MULTIPLE
Number of Individuals Covered	263
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $22,450
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?	No
Health Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $224,412
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	22450
Additional information about fees paid to insurance broker	AGENT
Insurance broker organization code?	3
Insurance broker name	RICHARD ALLEN JR., EBT SYSTEMS LLC

MEDICA (National Association of Insurance Commissioners NAIC id number: 1259 )

Policy contract number

MULTIPLE

Policy instance

Insurance contract or identification number	MULTIPLE
Number of Individuals Covered	259
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $20,765
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $207,653
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MEDICA (National Association of Insurance Commissioners NAIC id number: 1259 )

Policy contract number

113540

Policy instance

Insurance contract or identification number	113540
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $143,255
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	CRYSTAL CABINET WORKS, INC.
Employer identification number (EIN):	410828559
NAIC Classification:	337000