HENRYS FOODS, INC. PROFIT SHARING PLAN 401k Plan overview

Plan Name	HENRYS FOODS, INC. PROFIT SHARING PLAN
Plan identification number	002

HENRYS FOODS, INC. PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1. Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met. Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash. Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities. 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. Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

HENRY'S FOOD INC. has sponsored the creation of one or more 401k plans.

Company Name:	HENRY'S FOOD INC.
Employer identification number (EIN):	410871850
NAIC Classification:	424990
NAIC Description:	Other Miscellaneous Nondurable Goods Merchant Wholesalers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HENRYS FOODS, INC. PROFIT SHARING PLAN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2022-02-01	STEVE FINNEGAN	2023-11-15
002	2021-02-01
002	2020-02-01
002	2019-02-01
002	2018-02-01
002	2017-02-01	BRIAN EIDSVOLD		BRIAN EIDSVOLD	2018-10-11
002	2016-02-01	BRIAN EIDSVOLD		BRIAN EIDSVOLD	2017-10-13
002	2015-02-01	BRIAN EIDSVOLD		BRIAN EIDSVOLD	2016-11-15
002	2015-02-01	BRIAN EIDSVOLD		BRIAN EIDSVOLD	2016-11-15
002	2014-02-01	BRIAN EIDSVOLD		BRIAN EIDSVOLD	2015-11-11
002	2013-02-01	BRIAN EIDSVOLD		BRIAN EIDSVOLD	2014-11-17
002	2012-02-01	BRIAN EIDSVOLD		BRIAN EIDSVOLD	2013-11-11
002	2011-02-01	BRIAN EIDSVOLD		BRIAN EIDSVOLD	2012-11-14
002	2009-02-01	BRIAN EIDSVOLD		BRIAN EIDSVOLD	2010-10-12
002	2009-02-01	BRIAN EIDSVOLD		BRIAN EIDSVOLD	2010-10-12
002	2009-02-01	BRIAN EIDSVOLD		BRIAN EIDSVOLD	2010-10-12

Plan Statistics for HENRYS FOODS, INC. PROFIT SHARING PLAN

401k plan membership statisitcs for HENRYS FOODS, INC. PROFIT SHARING PLAN

Measure	Date	Value
2022: HENRYS FOODS, INC. PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year	2022-02-01	343
Total number of active participants reported on line 7a of the Form 5500	2022-02-01	329
Number of retired or separated participants receiving benefits	2022-02-01	0
Number of other retired or separated participants entitled to future benefits	2022-02-01	30
Total of all active and inactive participants	2022-02-01	359
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-02-01	0
Total participants	2022-02-01	359
Number of participants with account balances	2022-02-01	180
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-02-01	5
2021: HENRYS FOODS, INC. PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year	2021-02-01	373
Total number of active participants reported on line 7a of the Form 5500	2021-02-01	303
Number of retired or separated participants receiving benefits	2021-02-01	1
Number of other retired or separated participants entitled to future benefits	2021-02-01	27
Total of all active and inactive participants	2021-02-01	331
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-02-01	0
Total participants	2021-02-01	331
Number of participants with account balances	2021-02-01	196
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-02-01	0
2020: HENRYS FOODS, INC. PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year	2020-02-01	350
Total number of active participants reported on line 7a of the Form 5500	2020-02-01	332
Number of retired or separated participants receiving benefits	2020-02-01	8
Number of other retired or separated participants entitled to future benefits	2020-02-01	22
Total of all active and inactive participants	2020-02-01	362
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-02-01	0
Total participants	2020-02-01	362
Number of participants with account balances	2020-02-01	204
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-02-01	3
2019: HENRYS FOODS, INC. PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year	2019-02-01	305
Total number of active participants reported on line 7a of the Form 5500	2019-02-01	330
Number of retired or separated participants receiving benefits	2019-02-01	5
Number of other retired or separated participants entitled to future benefits	2019-02-01	16
Total of all active and inactive participants	2019-02-01	351
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-02-01	0
Total participants	2019-02-01	351
Number of participants with account balances	2019-02-01	199
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-02-01	3
2018: HENRYS FOODS, INC. PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year	2018-02-01	228
Total number of active participants reported on line 7a of the Form 5500	2018-02-01	274
Number of retired or separated participants receiving benefits	2018-02-01	3
Number of other retired or separated participants entitled to future benefits	2018-02-01	18
Total of all active and inactive participants	2018-02-01	295
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-02-01	0
Total participants	2018-02-01	295
Number of participants with account balances	2018-02-01	199
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-02-01	7
2017: HENRYS FOODS, INC. PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year	2017-02-01	202
Total number of active participants reported on line 7a of the Form 5500	2017-02-01	202
Number of retired or separated participants receiving benefits	2017-02-01	2
Number of other retired or separated participants entitled to future benefits	2017-02-01	19
Total of all active and inactive participants	2017-02-01	223
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-02-01	0
Total participants	2017-02-01	223
Number of participants with account balances	2017-02-01	187
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-02-01	11
2016: HENRYS FOODS, INC. PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-02-01	170
Total number of active participants reported on line 7a of the Form 5500	2016-02-01	187
Number of retired or separated participants receiving benefits	2016-02-01	4
Number of other retired or separated participants entitled to future benefits	2016-02-01	10
Total of all active and inactive participants	2016-02-01	201
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-02-01	0
Total participants	2016-02-01	201
Number of participants with account balances	2016-02-01	188
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-02-01	0
2015: HENRYS FOODS, INC. PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-02-01	173
Total number of active participants reported on line 7a of the Form 5500	2015-02-01	137
Number of retired or separated participants receiving benefits	2015-02-01	0
Number of other retired or separated participants entitled to future benefits	2015-02-01	9
Total of all active and inactive participants	2015-02-01	146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-02-01	0
Total participants	2015-02-01	146
Number of participants with account balances	2015-02-01	146
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-02-01	0
2014: HENRYS FOODS, INC. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-02-01	182
Total number of active participants reported on line 7a of the Form 5500	2014-02-01	139
Number of retired or separated participants receiving benefits	2014-02-01	2
Number of other retired or separated participants entitled to future benefits	2014-02-01	18
Total of all active and inactive participants	2014-02-01	159
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-02-01	0
Total participants	2014-02-01	159
Number of participants with account balances	2014-02-01	159
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-02-01	12
2013: HENRYS FOODS, INC. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-02-01	158
Total number of active participants reported on line 7a of the Form 5500	2013-02-01	136
Number of retired or separated participants receiving benefits	2013-02-01	1
Number of other retired or separated participants entitled to future benefits	2013-02-01	8
Total of all active and inactive participants	2013-02-01	145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-02-01	0
Total participants	2013-02-01	145
Number of participants with account balances	2013-02-01	145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-02-01	5
2012: HENRYS FOODS, INC. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-02-01	175
Total number of active participants reported on line 7a of the Form 5500	2012-02-01	134
Number of retired or separated participants receiving benefits	2012-02-01	1
Number of other retired or separated participants entitled to future benefits	2012-02-01	7
Total of all active and inactive participants	2012-02-01	142
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-02-01	0
Total participants	2012-02-01	142
Number of participants with account balances	2012-02-01	142
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-02-01	7
2011: HENRYS FOODS, INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-02-01	177
Total number of active participants reported on line 7a of the Form 5500	2011-02-01	142
Number of retired or separated participants receiving benefits	2011-02-01	4
Number of other retired or separated participants entitled to future benefits	2011-02-01	13
Total of all active and inactive participants	2011-02-01	159
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-02-01	0
Total participants	2011-02-01	159
Number of participants with account balances	2011-02-01	159
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-02-01	9
2009: HENRYS FOODS, INC. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-02-01	163
Total number of active participants reported on line 7a of the Form 5500	2009-02-01	150
Number of retired or separated participants receiving benefits	2009-02-01	1
Number of other retired or separated participants entitled to future benefits	2009-02-01	5
Total of all active and inactive participants	2009-02-01	156
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-02-01	0
Total participants	2009-02-01	156
Number of participants with account balances	2009-02-01	155
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-02-01	1

Financial Data on HENRYS FOODS, INC. PROFIT SHARING PLAN

Measure	Date	Value
2023 : HENRYS FOODS, INC. PROFIT SHARING PLAN 2023 401k financial data
Total unrealized appreciation/depreciation of assets	2023-01-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2023-01-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2023-01-31	$0
Total income from all sources (including contributions)	2023-01-31	$308,670
Total loss/gain on sale of assets	2023-01-31	$0
Total of all expenses incurred	2023-01-31	$873,863
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2023-01-31	$768,456
Expenses. Certain deemed distributions of participant loans	2023-01-31	$18,451
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2023-01-31	$1,152,856
Value of total assets at end of year	2023-01-31	$10,227,878
Value of total assets at beginning of year	2023-01-31	$10,793,071
Total of administrative expenses incurred including professional, contract, advisory and management fees	2023-01-31	$86,956
Total interest from all sources	2023-01-31	$9,375
Total dividends received (eg from common stock, registered investment company shares)	2023-01-31	$209,526
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2023-01-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2023-01-31	$209,526
Administrative expenses professional fees incurred	2023-01-31	$0
Was this plan covered by a fidelity bond	2023-01-31	Yes
Value of fidelity bond cover	2023-01-31	$1,000,000
If this is an individual account plan, was there a blackout period	2023-01-31	No
Were there any nonexempt tranactions with any party-in-interest	2023-01-31	No
Contributions received from participants	2023-01-31	$717,731
Participant contributions at end of year	2023-01-31	$67,061
Participant contributions at beginning of year	2023-01-31	$123,604
Assets. Other investments not covered elsewhere at end of year	2023-01-31	$64,836
Assets. Other investments not covered elsewhere at beginning of year	2023-01-31	$72,082
Income. Received or receivable in cash from other sources (including rollovers)	2023-01-31	$125,789
Other income not declared elsewhere	2023-01-31	$-7,246
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2023-01-31	No
Value of net income/loss	2023-01-31	$-565,193
Value of net assets at end of year (total assets less liabilities)	2023-01-31	$10,227,878
Value of net assets at beginning of year (total assets less liabilities)	2023-01-31	$10,793,071
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2023-01-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2023-01-31	No
Were any leases to which the plan was party in default or uncollectible	2023-01-31	No
Investment advisory and management fees	2023-01-31	$65,405
Value of interest in registered invesment companies (eg mutual funds) at end of year	2023-01-31	$9,602,252
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2023-01-31	$10,142,224
Interest on participant loans	2023-01-31	$5,357
Interest earned on other investments	2023-01-31	$4,018
Value of interest in common/collective trusts at end of year	2023-01-31	$35,196
Value of interest in common/collective trusts at beginning of year	2023-01-31	$34,824
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2023-01-31	$432,773
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2023-01-31	$420,337
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2023-01-31	$-1,052,021
Net investment gain or loss from common/collective trusts	2023-01-31	$-3,820
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2023-01-31	No
Was there a failure to transmit to the plan any participant contributions	2023-01-31	No
Has the plan failed to provide any benefit when due under the plan	2023-01-31	No
Contributions received in cash from employer	2023-01-31	$309,336
Employer contributions (assets) at end of year	2023-01-31	$25,760
Employer contributions (assets) at beginning of year	2023-01-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2023-01-31	$768,456
Contract administrator fees	2023-01-31	$21,551
Did the plan have assets held for investment	2023-01-31	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	2023-01-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2023-01-31	No
Opinion of an independent qualified public accountant for this plan	2023-01-31	Unqualified
Accountancy firm name	2023-01-31	COPELAND BUHL & COMPANY PLLP
Accountancy firm EIN	2023-01-31	411292716
2022 : HENRYS FOODS, INC. PROFIT SHARING PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-01-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-01-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-01-31	$0
Total income from all sources (including contributions)	2022-01-31	$1,696,134
Total loss/gain on sale of assets	2022-01-31	$0
Total of all expenses incurred	2022-01-31	$1,017,434
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-01-31	$908,595
Expenses. Certain deemed distributions of participant loans	2022-01-31	$6,430
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-01-31	$930,559
Value of total assets at end of year	2022-01-31	$10,793,071
Value of total assets at beginning of year	2022-01-31	$10,114,371
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-01-31	$102,409
Total interest from all sources	2022-01-31	$9,477
Total dividends received (eg from common stock, registered investment company shares)	2022-01-31	$240,860
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-01-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-01-31	$240,860
Was this plan covered by a fidelity bond	2022-01-31	Yes
Value of fidelity bond cover	2022-01-31	$1,000,000
If this is an individual account plan, was there a blackout period	2022-01-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2022-01-31	$0
Were there any nonexempt tranactions with any party-in-interest	2022-01-31	No
Contributions received from participants	2022-01-31	$671,019
Participant contributions at end of year	2022-01-31	$123,604
Participant contributions at beginning of year	2022-01-31	$148,355
Assets. Other investments not covered elsewhere at end of year	2022-01-31	$72,082
Assets. Other investments not covered elsewhere at beginning of year	2022-01-31	$69,599
Income. Received or receivable in cash from other sources (including rollovers)	2022-01-31	$52,997
Other income not declared elsewhere	2022-01-31	$2,483
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-01-31	No
Value of net income/loss	2022-01-31	$678,700
Value of net assets at end of year (total assets less liabilities)	2022-01-31	$10,793,071
Value of net assets at beginning of year (total assets less liabilities)	2022-01-31	$10,114,371
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-01-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-01-31	No
Were any leases to which the plan was party in default or uncollectible	2022-01-31	No
Investment advisory and management fees	2022-01-31	$99,527
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-01-31	$10,142,224
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-01-31	$9,483,294
Interest on participant loans	2022-01-31	$7,011
Interest earned on other investments	2022-01-31	$2,466
Value of interest in common/collective trusts at end of year	2022-01-31	$34,824
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-01-31	$420,337
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-01-31	$413,123
Expenses. Payments to insurance carriers foe the provision of benefits	2022-01-31	$423
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-01-31	$519,924
Net investment gain or loss from common/collective trusts	2022-01-31	$-7,169
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-01-31	No
Was there a failure to transmit to the plan any participant contributions	2022-01-31	No
Has the plan failed to provide any benefit when due under the plan	2022-01-31	No
Contributions received in cash from employer	2022-01-31	$206,543
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-01-31	$908,172
Contract administrator fees	2022-01-31	$2,882
Did the plan have assets held for investment	2022-01-31	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	2022-01-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-01-31	No
Opinion of an independent qualified public accountant for this plan	2022-01-31	Unqualified
Accountancy firm name	2022-01-31	COPELAND BUHL & COMPANY PLLP
Accountancy firm EIN	2022-01-31	411292716
2021 : HENRYS FOODS, INC. PROFIT SHARING PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-01-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-01-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-01-31	$0
Total income from all sources (including contributions)	2021-01-31	$1,977,088
Total loss/gain on sale of assets	2021-01-31	$0
Total of all expenses incurred	2021-01-31	$528,315
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-01-31	$447,445
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-01-31	$851,804
Value of total assets at end of year	2021-01-31	$10,114,371
Value of total assets at beginning of year	2021-01-31	$8,665,598
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-01-31	$80,870
Total interest from all sources	2021-01-31	$14,106
Total dividends received (eg from common stock, registered investment company shares)	2021-01-31	$212,281
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-01-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-01-31	$212,281
Was this plan covered by a fidelity bond	2021-01-31	Yes
Value of fidelity bond cover	2021-01-31	$1,000,000
If this is an individual account plan, was there a blackout period	2021-01-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-01-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-01-31	No
Contributions received from participants	2021-01-31	$592,720
Participant contributions at end of year	2021-01-31	$148,355
Participant contributions at beginning of year	2021-01-31	$200,685
Assets. Other investments not covered elsewhere at end of year	2021-01-31	$69,599
Assets. Other investments not covered elsewhere at beginning of year	2021-01-31	$62,003
Income. Received or receivable in cash from other sources (including rollovers)	2021-01-31	$68,529
Other income not declared elsewhere	2021-01-31	$7,595
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-01-31	No
Value of net income/loss	2021-01-31	$1,448,773
Value of net assets at end of year (total assets less liabilities)	2021-01-31	$10,114,371
Value of net assets at beginning of year (total assets less liabilities)	2021-01-31	$8,665,598
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-01-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-01-31	No
Were any leases to which the plan was party in default or uncollectible	2021-01-31	No
Investment advisory and management fees	2021-01-31	$78,458
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-01-31	$9,483,294
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-01-31	$8,191,849
Interest on participant loans	2021-01-31	$10,245
Interest earned on other investments	2021-01-31	$3,861
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-01-31	$413,123
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-01-31	$207,657
Expenses. Payments to insurance carriers foe the provision of benefits	2021-01-31	$423
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-01-31	$891,302
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-01-31	No
Was there a failure to transmit to the plan any participant contributions	2021-01-31	No
Has the plan failed to provide any benefit when due under the plan	2021-01-31	No
Contributions received in cash from employer	2021-01-31	$190,555
Employer contributions (assets) at beginning of year	2021-01-31	$3,404
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-01-31	$447,022
Contract administrator fees	2021-01-31	$2,412
Did the plan have assets held for investment	2021-01-31	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	2021-01-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-01-31	No
Opinion of an independent qualified public accountant for this plan	2021-01-31	Unqualified
Accountancy firm name	2021-01-31	COPELAND BUHL & COMPANY PLLP
Accountancy firm EIN	2021-01-31	411292716
2020 : HENRYS FOODS, INC. PROFIT SHARING PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-01-31	$0
Total unrealized appreciation/depreciation of assets	2020-01-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-01-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-01-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-01-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-01-31	$0
Total income from all sources (including contributions)	2020-01-31	$1,564,490
Total loss/gain on sale of assets	2020-01-31	$0
Total loss/gain on sale of assets	2020-01-31	$0
Total of all expenses incurred	2020-01-31	$567,575
Total of all expenses incurred	2020-01-31	$567,575
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-01-31	$534,151
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-01-31	$534,151
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-01-31	$745,919
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-01-31	$745,919
Value of total assets at end of year	2020-01-31	$8,665,598
Value of total assets at end of year	2020-01-31	$8,665,598
Value of total assets at beginning of year	2020-01-31	$7,668,683
Value of total assets at beginning of year	2020-01-31	$7,668,683
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-01-31	$33,424
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-01-31	$33,424
Total interest from all sources	2020-01-31	$13,411
Total interest from all sources	2020-01-31	$13,411
Total dividends received (eg from common stock, registered investment company shares)	2020-01-31	$623,042
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-01-31	No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-01-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-01-31	$623,042
Total dividends received from registered investment company shares (eg mutual funds)	2020-01-31	$623,042
Was this plan covered by a fidelity bond	2020-01-31	Yes
Value of fidelity bond cover	2020-01-31	$1,000,000
Value of fidelity bond cover	2020-01-31	$1,000,000
If this is an individual account plan, was there a blackout period	2020-01-31	No
If this is an individual account plan, was there a blackout period	2020-01-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-01-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-01-31	No
Were there any nonexempt tranactions with any party-in-interest	2020-01-31	No
Contributions received from participants	2020-01-31	$510,763
Contributions received from participants	2020-01-31	$510,763
Participant contributions at end of year	2020-01-31	$200,685
Participant contributions at end of year	2020-01-31	$200,685
Participant contributions at beginning of year	2020-01-31	$227,079
Participant contributions at beginning of year	2020-01-31	$227,079
Participant contributions at beginning of year	2020-01-31	$14,349
Participant contributions at beginning of year	2020-01-31	$14,349
Assets. Other investments not covered elsewhere at end of year	2020-01-31	$62,003
Assets. Other investments not covered elsewhere at end of year	2020-01-31	$62,003
Assets. Other investments not covered elsewhere at beginning of year	2020-01-31	$56,913
Assets. Other investments not covered elsewhere at beginning of year	2020-01-31	$56,913
Income. Received or receivable in cash from other sources (including rollovers)	2020-01-31	$54,890
Income. Received or receivable in cash from other sources (including rollovers)	2020-01-31	$54,890
Other income not declared elsewhere	2020-01-31	$5,090
Other income not declared elsewhere	2020-01-31	$5,090
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-01-31	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	2020-01-31	No
Value of net income/loss	2020-01-31	$996,915
Value of net income/loss	2020-01-31	$996,915
Value of net assets at end of year (total assets less liabilities)	2020-01-31	$8,665,598
Value of net assets at end of year (total assets less liabilities)	2020-01-31	$8,665,598
Value of net assets at beginning of year (total assets less liabilities)	2020-01-31	$7,668,683
Value of net assets at beginning of year (total assets less liabilities)	2020-01-31	$7,668,683
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-01-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-01-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-01-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-01-31	No
Were any leases to which the plan was party in default or uncollectible	2020-01-31	No
Were any leases to which the plan was party in default or uncollectible	2020-01-31	No
Investment advisory and management fees	2020-01-31	$30,776
Investment advisory and management fees	2020-01-31	$30,776
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-01-31	$8,191,849
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-01-31	$8,191,849
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-01-31	$7,150,639
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-01-31	$7,150,639
Interest on participant loans	2020-01-31	$10,873
Interest on participant loans	2020-01-31	$10,873
Interest earned on other investments	2020-01-31	$2,538
Interest earned on other investments	2020-01-31	$2,538
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-01-31	$207,657
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-01-31	$207,657
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-01-31	$211,814
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-01-31	$211,814
Expenses. Payments to insurance carriers foe the provision of benefits	2020-01-31	$423
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-01-31	$177,028
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-01-31	$177,028
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-01-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-01-31	No
Was there a failure to transmit to the plan any participant contributions	2020-01-31	No
Has the plan failed to provide any benefit when due under the plan	2020-01-31	No
Has the plan failed to provide any benefit when due under the plan	2020-01-31	No
Contributions received in cash from employer	2020-01-31	$180,266
Contributions received in cash from employer	2020-01-31	$180,266
Employer contributions (assets) at end of year	2020-01-31	$3,404
Employer contributions (assets) at beginning of year	2020-01-31	$7,889
Employer contributions (assets) at beginning of year	2020-01-31	$7,889
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-01-31	$533,728
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-01-31	$533,728
Contract administrator fees	2020-01-31	$2,648
Contract administrator fees	2020-01-31	$2,648
Did the plan have assets held for investment	2020-01-31	Yes
Did the plan have assets held for investment	2020-01-31	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	2020-01-31	No
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	2020-01-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-01-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-01-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2020-01-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2020-01-31	Yes
Opinion of an independent qualified public accountant for this plan	2020-01-31	Disclaimer
Opinion of an independent qualified public accountant for this plan	2020-01-31	Disclaimer
Accountancy firm name	2020-01-31	COPELAND BUHL & COMPANY PLLP
Accountancy firm name	2020-01-31	COPELAND BUHL & COMPANY PLLP
Accountancy firm EIN	2020-01-31	411292716
Accountancy firm EIN	2020-01-31	411292716
2019 : HENRYS FOODS, INC. PROFIT SHARING PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-01-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-01-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-01-31	$0
Total income from all sources (including contributions)	2019-01-31	$444,224
Total loss/gain on sale of assets	2019-01-31	$0
Total of all expenses incurred	2019-01-31	$1,725,600
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-01-31	$1,692,471
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-01-31	$675,891
Value of total assets at end of year	2019-01-31	$7,668,683
Value of total assets at beginning of year	2019-01-31	$8,950,059
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-01-31	$33,129
Total interest from all sources	2019-01-31	$15,527
Total dividends received (eg from common stock, registered investment company shares)	2019-01-31	$609,750
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-01-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-01-31	$609,750
Was this plan covered by a fidelity bond	2019-01-31	Yes
Value of fidelity bond cover	2019-01-31	$1,000,000
If this is an individual account plan, was there a blackout period	2019-01-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-01-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-01-31	No
Contributions received from participants	2019-01-31	$475,834
Participant contributions at end of year	2019-01-31	$227,079
Participant contributions at beginning of year	2019-01-31	$214,122
Participant contributions at end of year	2019-01-31	$14,349
Participant contributions at beginning of year	2019-01-31	$0
Assets. Other investments not covered elsewhere at end of year	2019-01-31	$56,913
Assets. Other investments not covered elsewhere at beginning of year	2019-01-31	$61,005
Income. Received or receivable in cash from other sources (including rollovers)	2019-01-31	$32,022
Other income not declared elsewhere	2019-01-31	$-4,092
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-01-31	No
Value of net income/loss	2019-01-31	$-1,281,376
Value of net assets at end of year (total assets less liabilities)	2019-01-31	$7,668,683
Value of net assets at beginning of year (total assets less liabilities)	2019-01-31	$8,950,059
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-01-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-01-31	No
Were any leases to which the plan was party in default or uncollectible	2019-01-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-01-31	$7,150,639
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-01-31	$8,303,201
Interest on participant loans	2019-01-31	$11,485
Interest earned on other investments	2019-01-31	$4,042
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-01-31	$211,814
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-01-31	$371,161
Expenses. Payments to insurance carriers foe the provision of benefits	2019-01-31	$423
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-01-31	$-852,852
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-01-31	No
Was there a failure to transmit to the plan any participant contributions	2019-01-31	No
Has the plan failed to provide any benefit when due under the plan	2019-01-31	No
Contributions received in cash from employer	2019-01-31	$168,035
Employer contributions (assets) at end of year	2019-01-31	$7,889
Employer contributions (assets) at beginning of year	2019-01-31	$570
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-01-31	$1,692,048
Contract administrator fees	2019-01-31	$33,129
Did the plan have assets held for investment	2019-01-31	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	2019-01-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-01-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-01-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-01-31	Disclaimer
Accountancy firm name	2019-01-31	COPELAND BUHL & COMPANY PLLP
Accountancy firm EIN	2019-01-31	411292716
2018 : HENRYS FOODS, INC. PROFIT SHARING PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-01-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-01-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-01-31	$0
Total income from all sources (including contributions)	2018-01-31	$1,786,137
Total loss/gain on sale of assets	2018-01-31	$0
Total of all expenses incurred	2018-01-31	$874,295
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-01-31	$824,088
Expenses. Certain deemed distributions of participant loans	2018-01-31	$17,087
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-01-31	$655,551
Value of total assets at end of year	2018-01-31	$8,950,059
Value of total assets at beginning of year	2018-01-31	$8,038,217
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-01-31	$33,120
Total interest from all sources	2018-01-31	$13,466
Total dividends received (eg from common stock, registered investment company shares)	2018-01-31	$432,904
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-01-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-01-31	$432,904
Was this plan covered by a fidelity bond	2018-01-31	Yes
Value of fidelity bond cover	2018-01-31	$1,000,000
If this is an individual account plan, was there a blackout period	2018-01-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-01-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-01-31	No
Contributions received from participants	2018-01-31	$469,071
Participant contributions at end of year	2018-01-31	$214,122
Participant contributions at beginning of year	2018-01-31	$233,374
Participant contributions at end of year	2018-01-31	$0
Participant contributions at beginning of year	2018-01-31	$0
Assets. Other investments not covered elsewhere at end of year	2018-01-31	$61,005
Assets. Other investments not covered elsewhere at beginning of year	2018-01-31	$62,766
Income. Received or receivable in cash from other sources (including rollovers)	2018-01-31	$19,163
Other income not declared elsewhere	2018-01-31	$5,662
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-01-31	No
Value of net income/loss	2018-01-31	$911,842
Value of net assets at end of year (total assets less liabilities)	2018-01-31	$8,950,059
Value of net assets at beginning of year (total assets less liabilities)	2018-01-31	$8,038,217
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-01-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-01-31	No
Were any leases to which the plan was party in default or uncollectible	2018-01-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-01-31	$8,303,201
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-01-31	$7,393,506
Interest on participant loans	2018-01-31	$9,890
Interest earned on other investments	2018-01-31	$3,576
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-01-31	$371,161
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-01-31	$318,299
Expenses. Payments to insurance carriers foe the provision of benefits	2018-01-31	$423
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-01-31	$678,554
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-01-31	No
Was there a failure to transmit to the plan any participant contributions	2018-01-31	No
Has the plan failed to provide any benefit when due under the plan	2018-01-31	No
Contributions received in cash from employer	2018-01-31	$167,317
Employer contributions (assets) at end of year	2018-01-31	$570
Employer contributions (assets) at beginning of year	2018-01-31	$30,272
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-01-31	$823,665
Contract administrator fees	2018-01-31	$33,120
Did the plan have assets held for investment	2018-01-31	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	2018-01-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-01-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-01-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-01-31	Disclaimer
Accountancy firm name	2018-01-31	COPELAND BUHL & COMPANY PLLP
Accountancy firm EIN	2018-01-31	411292716
2017 : HENRYS FOODS, INC. PROFIT SHARING PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-01-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-01-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-01-31	$0
Total income from all sources (including contributions)	2017-01-31	$1,635,318
Total loss/gain on sale of assets	2017-01-31	$0
Total of all expenses incurred	2017-01-31	$781,434
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-01-31	$750,504
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-01-31	$681,798
Value of total assets at end of year	2017-01-31	$8,038,217
Value of total assets at beginning of year	2017-01-31	$7,184,333
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-01-31	$30,930
Total interest from all sources	2017-01-31	$12,019
Total dividends received (eg from common stock, registered investment company shares)	2017-01-31	$473,779
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-01-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-01-31	$473,779
Was this plan covered by a fidelity bond	2017-01-31	Yes
Value of fidelity bond cover	2017-01-31	$1,000,000
If this is an individual account plan, was there a blackout period	2017-01-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-01-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-01-31	No
Contributions received from participants	2017-01-31	$468,831
Participant contributions at end of year	2017-01-31	$233,374
Participant contributions at beginning of year	2017-01-31	$217,789
Participant contributions at end of year	2017-01-31	$0
Participant contributions at beginning of year	2017-01-31	$0
Assets. Other investments not covered elsewhere at end of year	2017-01-31	$62,766
Assets. Other investments not covered elsewhere at beginning of year	2017-01-31	$60,232
Income. Received or receivable in cash from other sources (including rollovers)	2017-01-31	$58,356
Other income not declared elsewhere	2017-01-31	$2,534
Administrative expenses (other) incurred	2017-01-31	$30,930
Total non interest bearing cash at beginning of year	2017-01-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-01-31	No
Value of net income/loss	2017-01-31	$853,884
Value of net assets at end of year (total assets less liabilities)	2017-01-31	$8,038,217
Value of net assets at beginning of year (total assets less liabilities)	2017-01-31	$7,184,333
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-01-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-01-31	No
Were any leases to which the plan was party in default or uncollectible	2017-01-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-01-31	$7,393,506
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-01-31	$6,721,870
Interest on participant loans	2017-01-31	$10,353
Interest earned on other investments	2017-01-31	$1,666
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-01-31	$318,299
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-01-31	$158,095
Expenses. Payments to insurance carriers foe the provision of benefits	2017-01-31	$422
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-01-31	$465,188
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-01-31	No
Was there a failure to transmit to the plan any participant contributions	2017-01-31	No
Has the plan failed to provide any benefit when due under the plan	2017-01-31	No
Contributions received in cash from employer	2017-01-31	$154,611
Employer contributions (assets) at end of year	2017-01-31	$30,272
Employer contributions (assets) at beginning of year	2017-01-31	$26,347
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-01-31	$750,082
Did the plan have assets held for investment	2017-01-31	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	2017-01-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-01-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-01-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-01-31	Disclaimer
Accountancy firm name	2017-01-31	COPELAND BUHL & COMPANY PLLP
Accountancy firm EIN	2017-01-31	411292716
2016 : HENRYS FOODS, INC. PROFIT SHARING PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-01-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-01-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-01-31	$0
Total income from all sources (including contributions)	2016-01-31	$280,305
Total loss/gain on sale of assets	2016-01-31	$0
Total of all expenses incurred	2016-01-31	$411,292
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-01-31	$382,318
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-01-31	$732,334
Value of total assets at end of year	2016-01-31	$7,184,333
Value of total assets at beginning of year	2016-01-31	$7,315,320
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-01-31	$28,974
Total interest from all sources	2016-01-31	$7,078
Total dividends received (eg from common stock, registered investment company shares)	2016-01-31	$579,002
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-01-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-01-31	$579,002
Was this plan covered by a fidelity bond	2016-01-31	Yes
Value of fidelity bond cover	2016-01-31	$1,000,000
If this is an individual account plan, was there a blackout period	2016-01-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-01-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-01-31	No
Contributions received from participants	2016-01-31	$435,032
Participant contributions at end of year	2016-01-31	$217,789
Participant contributions at beginning of year	2016-01-31	$88,563
Participant contributions at end of year	2016-01-31	$0
Participant contributions at beginning of year	2016-01-31	$1,605
Assets. Other investments not covered elsewhere at end of year	2016-01-31	$60,232
Assets. Other investments not covered elsewhere at beginning of year	2016-01-31	$62,919
Income. Received or receivable in cash from other sources (including rollovers)	2016-01-31	$159,083
Other income not declared elsewhere	2016-01-31	$-394
Total non interest bearing cash at end of year	2016-01-31	$0
Total non interest bearing cash at beginning of year	2016-01-31	$623
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-01-31	No
Value of net income/loss	2016-01-31	$-130,987
Value of net assets at end of year (total assets less liabilities)	2016-01-31	$7,184,333
Value of net assets at beginning of year (total assets less liabilities)	2016-01-31	$7,315,320
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-01-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-01-31	No
Were any leases to which the plan was party in default or uncollectible	2016-01-31	No
Investment advisory and management fees	2016-01-31	$26,233
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-01-31	$6,721,870
Value of interest in pooled separate accounts at beginning of year	2016-01-31	$7,048,113
Interest on participant loans	2016-01-31	$5,635
Interest earned on other investments	2016-01-31	$1,443
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-01-31	$158,095
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-01-31	$81,953
Expenses. Payments to insurance carriers foe the provision of benefits	2016-01-31	$423
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-01-31	$-1,140,480
Net investment gain/loss from pooled separate accounts	2016-01-31	$102,765
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-01-31	No
Was there a failure to transmit to the plan any participant contributions	2016-01-31	No
Has the plan failed to provide any benefit when due under the plan	2016-01-31	No
Contributions received in cash from employer	2016-01-31	$138,219
Employer contributions (assets) at end of year	2016-01-31	$26,347
Employer contributions (assets) at beginning of year	2016-01-31	$31,544
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-01-31	$381,895
Contract administrator fees	2016-01-31	$2,741
Did the plan have assets held for investment	2016-01-31	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	2016-01-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-01-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-01-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-01-31	Disclaimer
Accountancy firm name	2016-01-31	COPELAND BUHL & COMPANY PLLP
Accountancy firm EIN	2016-01-31	411292716
2015 : HENRYS FOODS, INC. PROFIT SHARING PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-01-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-01-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-01-31	$0
Total income from all sources (including contributions)	2015-01-31	$1,006,436
Total loss/gain on sale of assets	2015-01-31	$0
Total of all expenses incurred	2015-01-31	$814,619
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-01-31	$763,234
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-01-31	$612,919
Value of total assets at end of year	2015-01-31	$7,315,320
Value of total assets at beginning of year	2015-01-31	$7,123,503
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-01-31	$51,385
Total interest from all sources	2015-01-31	$3,652
Total dividends received (eg from common stock, registered investment company shares)	2015-01-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-01-31	No
Was this plan covered by a fidelity bond	2015-01-31	Yes
Value of fidelity bond cover	2015-01-31	$1,000,000
If this is an individual account plan, was there a blackout period	2015-01-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-01-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-01-31	No
Contributions received from participants	2015-01-31	$410,563
Participant contributions at end of year	2015-01-31	$88,563
Participant contributions at beginning of year	2015-01-31	$93,525
Participant contributions at end of year	2015-01-31	$1,605
Assets. Other investments not covered elsewhere at end of year	2015-01-31	$62,919
Assets. Other investments not covered elsewhere at beginning of year	2015-01-31	$64,243
Income. Received or receivable in cash from other sources (including rollovers)	2015-01-31	$58,009
Other income not declared elsewhere	2015-01-31	$855
Total non interest bearing cash at end of year	2015-01-31	$623
Total non interest bearing cash at beginning of year	2015-01-31	$272
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-01-31	No
Value of net income/loss	2015-01-31	$191,817
Value of net assets at end of year (total assets less liabilities)	2015-01-31	$7,315,320
Value of net assets at beginning of year (total assets less liabilities)	2015-01-31	$7,123,503
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-01-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-01-31	No
Were any leases to which the plan was party in default or uncollectible	2015-01-31	No
Investment advisory and management fees	2015-01-31	$48,701
Value of interest in pooled separate accounts at end of year	2015-01-31	$7,048,113
Value of interest in pooled separate accounts at beginning of year	2015-01-31	$6,854,629
Interest on participant loans	2015-01-31	$3,652
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-01-31	$81,953
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-01-31	$85,344
Expenses. Payments to insurance carriers foe the provision of benefits	2015-01-31	$423
Net investment gain/loss from pooled separate accounts	2015-01-31	$389,010
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-01-31	No
Was there a failure to transmit to the plan any participant contributions	2015-01-31	No
Has the plan failed to provide any benefit when due under the plan	2015-01-31	No
Contributions received in cash from employer	2015-01-31	$144,347
Employer contributions (assets) at end of year	2015-01-31	$31,544
Employer contributions (assets) at beginning of year	2015-01-31	$25,490
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-01-31	$762,811
Contract administrator fees	2015-01-31	$2,684
Did the plan have assets held for investment	2015-01-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-01-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-01-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-01-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-01-31	Disclaimer
Accountancy firm name	2015-01-31	COPELAND BUHL & COMPANY PLLP
Accountancy firm EIN	2015-01-31	411292716
2014 : HENRYS FOODS, INC. PROFIT SHARING PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-01-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-01-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-01-31	$239
Total income from all sources (including contributions)	2014-01-31	$1,181,559
Total loss/gain on sale of assets	2014-01-31	$0
Total of all expenses incurred	2014-01-31	$1,700,923
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-01-31	$1,650,403
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-01-31	$502,385
Value of total assets at end of year	2014-01-31	$7,123,503
Value of total assets at beginning of year	2014-01-31	$7,643,106
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-01-31	$50,520
Total interest from all sources	2014-01-31	$5,235
Total dividends received (eg from common stock, registered investment company shares)	2014-01-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-01-31	No
Was this plan covered by a fidelity bond	2014-01-31	Yes
Value of fidelity bond cover	2014-01-31	$1,000,000
If this is an individual account plan, was there a blackout period	2014-01-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-01-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-01-31	No
Contributions received from participants	2014-01-31	$372,134
Participant contributions at end of year	2014-01-31	$93,525
Participant contributions at beginning of year	2014-01-31	$141,757
Assets. Other investments not covered elsewhere at end of year	2014-01-31	$64,243
Assets. Other investments not covered elsewhere at beginning of year	2014-01-31	$530,602
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-01-31	$239
Other income not declared elsewhere	2014-01-31	$7,337
Total non interest bearing cash at end of year	2014-01-31	$272
Total non interest bearing cash at beginning of year	2014-01-31	$6,295
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-01-31	No
Value of net income/loss	2014-01-31	$-519,364
Value of net assets at end of year (total assets less liabilities)	2014-01-31	$7,123,503
Value of net assets at beginning of year (total assets less liabilities)	2014-01-31	$7,642,867
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-01-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-01-31	No
Were any leases to which the plan was party in default or uncollectible	2014-01-31	No
Investment advisory and management fees	2014-01-31	$48,245
Value of interest in pooled separate accounts at end of year	2014-01-31	$6,854,629
Value of interest in pooled separate accounts at beginning of year	2014-01-31	$6,755,910
Interest on participant loans	2014-01-31	$5,235
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-01-31	$85,344
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-01-31	$188,428
Expenses. Payments to insurance carriers foe the provision of benefits	2014-01-31	$580
Net investment gain/loss from pooled separate accounts	2014-01-31	$666,602
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-01-31	No
Was there a failure to transmit to the plan any participant contributions	2014-01-31	No
Has the plan failed to provide any benefit when due under the plan	2014-01-31	No
Contributions received in cash from employer	2014-01-31	$130,251
Employer contributions (assets) at end of year	2014-01-31	$25,490
Employer contributions (assets) at beginning of year	2014-01-31	$20,114
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-01-31	$1,649,823
Contract administrator fees	2014-01-31	$2,275
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	2014-01-31	No
Did the plan have assets held for investment	2014-01-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-01-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-01-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-01-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-01-31	Disclaimer
Accountancy firm name	2014-01-31	COPELAND BUHL & COMPANY PLLP
Accountancy firm EIN	2014-01-31	411292716
2013 : HENRYS FOODS, INC. PROFIT SHARING PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-01-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-01-31	$239
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-01-31	$0
Total income from all sources (including contributions)	2013-01-31	$1,238,501
Total loss/gain on sale of assets	2013-01-31	$0
Total of all expenses incurred	2013-01-31	$747,312
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-01-31	$698,925
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-01-31	$520,220
Value of total assets at end of year	2013-01-31	$7,643,106
Value of total assets at beginning of year	2013-01-31	$7,151,678
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-01-31	$48,387
Total interest from all sources	2013-01-31	$5,609
Total dividends received (eg from common stock, registered investment company shares)	2013-01-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-01-31	No
Administrative expenses professional fees incurred	2013-01-31	$2,066
Was this plan covered by a fidelity bond	2013-01-31	Yes
Value of fidelity bond cover	2013-01-31	$1,000,000
If this is an individual account plan, was there a blackout period	2013-01-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-01-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-01-31	No
Contributions received from participants	2013-01-31	$377,438
Participant contributions at end of year	2013-01-31	$141,757
Participant contributions at beginning of year	2013-01-31	$116,239
Assets. Other investments not covered elsewhere at end of year	2013-01-31	$530,602
Assets. Other investments not covered elsewhere at beginning of year	2013-01-31	$902,712
Income. Received or receivable in cash from other sources (including rollovers)	2013-01-31	$19,003
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-01-31	$239
Other income not declared elsewhere	2013-01-31	$12,762
Total non interest bearing cash at end of year	2013-01-31	$6,295
Total non interest bearing cash at beginning of year	2013-01-31	$688
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-01-31	No
Value of net income/loss	2013-01-31	$491,189
Value of net assets at end of year (total assets less liabilities)	2013-01-31	$7,642,867
Value of net assets at beginning of year (total assets less liabilities)	2013-01-31	$7,151,678
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-01-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-01-31	No
Were any leases to which the plan was party in default or uncollectible	2013-01-31	No
Investment advisory and management fees	2013-01-31	$26,895
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-01-31	$6,755,910
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-01-31	$5,957,485
Interest on participant loans	2013-01-31	$5,609
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-01-31	$188,428
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-01-31	$153,771
Expenses. Payments to insurance carriers foe the provision of benefits	2013-01-31	$580
Net investment gain/loss from pooled separate accounts	2013-01-31	$699,910
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-01-31	No
Was there a failure to transmit to the plan any participant contributions	2013-01-31	No
Has the plan failed to provide any benefit when due under the plan	2013-01-31	No
Contributions received in cash from employer	2013-01-31	$123,779
Employer contributions (assets) at end of year	2013-01-31	$20,114
Employer contributions (assets) at beginning of year	2013-01-31	$20,783
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-01-31	$698,345
Contract administrator fees	2013-01-31	$19,426
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	2013-01-31	No
Did the plan have assets held for investment	2013-01-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-01-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-01-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-01-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-01-31	Disclaimer
Accountancy firm name	2013-01-31	COPELAND BUHL & COMPANY PLLP
Accountancy firm EIN	2013-01-31	411292716
2012 : HENRYS FOODS, INC. PROFIT SHARING PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-01-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-01-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-01-31	$0
Total income from all sources (including contributions)	2012-01-31	$630,385
Total loss/gain on sale of assets	2012-01-31	$0
Total of all expenses incurred	2012-01-31	$753,555
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-01-31	$748,509
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-01-31	$489,977
Value of total assets at end of year	2012-01-31	$7,151,678
Value of total assets at beginning of year	2012-01-31	$7,274,848
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-01-31	$5,046
Total interest from all sources	2012-01-31	$7,341
Total dividends received (eg from common stock, registered investment company shares)	2012-01-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-01-31	No
Was this plan covered by a fidelity bond	2012-01-31	Yes
Value of fidelity bond cover	2012-01-31	$1,000,000
If this is an individual account plan, was there a blackout period	2012-01-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-01-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-01-31	No
Contributions received from participants	2012-01-31	$367,816
Participant contributions at end of year	2012-01-31	$116,239
Participant contributions at beginning of year	2012-01-31	$167,262
Participant contributions at beginning of year	2012-01-31	$79
Assets. Other investments not covered elsewhere at end of year	2012-01-31	$902,712
Assets. Other investments not covered elsewhere at beginning of year	2012-01-31	$821,369
Income. Received or receivable in cash from other sources (including rollovers)	2012-01-31	$352
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-01-31	$2
Other income not declared elsewhere	2012-01-31	$87,712
Administrative expenses (other) incurred	2012-01-31	$1,890
Total non interest bearing cash at end of year	2012-01-31	$688
Total non interest bearing cash at beginning of year	2012-01-31	$357
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-01-31	No
Value of net income/loss	2012-01-31	$-123,170
Value of net assets at end of year (total assets less liabilities)	2012-01-31	$7,151,678
Value of net assets at beginning of year (total assets less liabilities)	2012-01-31	$7,274,848
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-01-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-01-31	No
Were any leases to which the plan was party in default or uncollectible	2012-01-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-01-31	$5,957,485
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-01-31	$6,118,343
Interest on participant loans	2012-01-31	$6,514
Interest earned on other investments	2012-01-31	$827
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-01-31	$153,771
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-01-31	$151,978
Expenses. Payments to insurance carriers foe the provision of benefits	2012-01-31	$87,063
Net investment gain/loss from pooled separate accounts	2012-01-31	$45,355
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-01-31	No
Was there a failure to transmit to the plan any participant contributions	2012-01-31	No
Has the plan failed to provide any benefit when due under the plan	2012-01-31	No
Contributions received in cash from employer	2012-01-31	$121,809
Employer contributions (assets) at end of year	2012-01-31	$20,783
Employer contributions (assets) at beginning of year	2012-01-31	$15,458
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-01-31	$661,446
Contract administrator fees	2012-01-31	$3,156
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	2012-01-31	No
Did the plan have assets held for investment	2012-01-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-01-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-01-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-01-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-01-31	Disclaimer
Accountancy firm name	2012-01-31	COPELAND BUHL & COMPANY PLLP
Accountancy firm EIN	2012-01-31	411292716
2011 : HENRYS FOODS, INC. PROFIT SHARING PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-01-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-01-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-01-31	$3,229
Total income from all sources (including contributions)	2011-01-31	$1,397,093
Total loss/gain on sale of assets	2011-01-31	$0
Total of all expenses incurred	2011-01-31	$161,100
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-01-31	$156,012
Value of total corrective distributions	2011-01-31	$983
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-01-31	$479,915
Value of total assets at end of year	2011-01-31	$7,274,848
Value of total assets at beginning of year	2011-01-31	$6,042,084
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-01-31	$4,105
Total interest from all sources	2011-01-31	$10,260
Total dividends received (eg from common stock, registered investment company shares)	2011-01-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-01-31	No
Was this plan covered by a fidelity bond	2011-01-31	Yes
Value of fidelity bond cover	2011-01-31	$1,000,000
If this is an individual account plan, was there a blackout period	2011-01-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-01-31	No
Contributions received from participants	2011-01-31	$363,599
Participant contributions at end of year	2011-01-31	$167,262
Participant contributions at beginning of year	2011-01-31	$153,684
Participant contributions at end of year	2011-01-31	$79
Participant contributions at beginning of year	2011-01-31	$12,958
Assets. Other investments not covered elsewhere at end of year	2011-01-31	$821,369
Assets. Other investments not covered elsewhere at beginning of year	2011-01-31	$730,681
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-01-31	$2
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-01-31	$22
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-01-31	$3,229
Other income not declared elsewhere	2011-01-31	$90,688
Administrative expenses (other) incurred	2011-01-31	$1,250
Total non interest bearing cash at end of year	2011-01-31	$357
Total non interest bearing cash at beginning of year	2011-01-31	$6,374
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-01-31	No
Value of net income/loss	2011-01-31	$1,235,993
Value of net assets at end of year (total assets less liabilities)	2011-01-31	$7,274,848
Value of net assets at beginning of year (total assets less liabilities)	2011-01-31	$6,038,855
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-01-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-01-31	No
Were any leases to which the plan was party in default or uncollectible	2011-01-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-01-31	$6,118,343
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-01-31	$4,971,029
Interest on participant loans	2011-01-31	$7,515
Interest earned on other investments	2011-01-31	$2,745
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-01-31	$151,978
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-01-31	$148,394
Expenses. Payments to insurance carriers foe the provision of benefits	2011-01-31	$59,132
Net investment gain/loss from pooled separate accounts	2011-01-31	$816,230
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-01-31	No
Was there a failure to transmit to the plan any participant contributions	2011-01-31	Yes
Has the plan failed to provide any benefit when due under the plan	2011-01-31	No
Contributions received in cash from employer	2011-01-31	$116,316
Employer contributions (assets) at end of year	2011-01-31	$15,458
Employer contributions (assets) at beginning of year	2011-01-31	$18,942
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-01-31	$96,880
Contract administrator fees	2011-01-31	$2,855
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	2011-01-31	No
Did the plan have assets held for investment	2011-01-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-01-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-01-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-01-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-01-31	Disclaimer
Accountancy firm name	2011-01-31	COPELAND BUHL & COMPANY PLLP
Accountancy firm EIN	2011-01-31	411292716

Form 5500 Responses for HENRYS FOODS, INC. PROFIT SHARING PLAN

2022: HENRYS FOODS, INC. PROFIT SHARING PLAN 2022 form 5500 responses
2022-02-01	Type of plan entity	Single employer plan
2022-02-01	Submission has been amended	No
2022-02-01	This submission is the final filing	No
2022-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-02-01	Plan is a collectively bargained plan	No
2022-02-01	Plan funding arrangement – Insurance	Yes
2022-02-01	Plan funding arrangement – Trust	Yes
2022-02-01	Plan benefit arrangement – Insurance	Yes
2022-02-01	Plan benefit arrangement - Trust	Yes
2021: HENRYS FOODS, INC. PROFIT SHARING PLAN 2021 form 5500 responses
2021-02-01	Type of plan entity	Single employer plan
2021-02-01	Submission has been amended	No
2021-02-01	This submission is the final filing	No
2021-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-02-01	Plan is a collectively bargained plan	No
2021-02-01	Plan funding arrangement – Insurance	Yes
2021-02-01	Plan funding arrangement – Trust	Yes
2021-02-01	Plan benefit arrangement – Insurance	Yes
2021-02-01	Plan benefit arrangement - Trust	Yes
2020: HENRYS FOODS, INC. PROFIT SHARING PLAN 2020 form 5500 responses
2020-02-01	Type of plan entity	Single employer plan
2020-02-01	Submission has been amended	No
2020-02-01	This submission is the final filing	No
2020-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-02-01	Plan is a collectively bargained plan	No
2020-02-01	Plan funding arrangement – Insurance	Yes
2020-02-01	Plan funding arrangement – Trust	Yes
2020-02-01	Plan benefit arrangement – Insurance	Yes
2020-02-01	Plan benefit arrangement - Trust	Yes
2019: HENRYS FOODS, INC. PROFIT SHARING PLAN 2019 form 5500 responses
2019-02-01	Type of plan entity	Single employer plan
2019-02-01	Submission has been amended	No
2019-02-01	This submission is the final filing	No
2019-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-02-01	Plan is a collectively bargained plan	No
2019-02-01	Plan funding arrangement – Insurance	Yes
2019-02-01	Plan funding arrangement – Trust	Yes
2019-02-01	Plan benefit arrangement – Insurance	Yes
2019-02-01	Plan benefit arrangement - Trust	Yes
2018: HENRYS FOODS, INC. PROFIT SHARING PLAN 2018 form 5500 responses
2018-02-01	Type of plan entity	Single employer plan
2018-02-01	Submission has been amended	No
2018-02-01	This submission is the final filing	No
2018-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-02-01	Plan is a collectively bargained plan	No
2018-02-01	Plan funding arrangement – Insurance	Yes
2018-02-01	Plan funding arrangement – Trust	Yes
2018-02-01	Plan benefit arrangement – Insurance	Yes
2018-02-01	Plan benefit arrangement - Trust	Yes
2017: HENRYS FOODS, INC. PROFIT SHARING PLAN 2017 form 5500 responses
2017-02-01	Type of plan entity	Single employer plan
2017-02-01	Submission has been amended	No
2017-02-01	This submission is the final filing	No
2017-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-02-01	Plan is a collectively bargained plan	No
2017-02-01	Plan funding arrangement – Insurance	Yes
2017-02-01	Plan funding arrangement – Trust	Yes
2017-02-01	Plan benefit arrangement – Insurance	Yes
2017-02-01	Plan benefit arrangement - Trust	Yes
2016: HENRYS FOODS, INC. PROFIT SHARING PLAN 2016 form 5500 responses
2016-02-01	Type of plan entity	Single employer plan
2016-02-01	Submission has been amended	No
2016-02-01	This submission is the final filing	No
2016-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-02-01	Plan is a collectively bargained plan	No
2016-02-01	Plan funding arrangement – Insurance	Yes
2016-02-01	Plan funding arrangement – Trust	Yes
2016-02-01	Plan benefit arrangement – Insurance	Yes
2016-02-01	Plan benefit arrangement - Trust	Yes
2015: HENRYS FOODS, INC. PROFIT SHARING PLAN 2015 form 5500 responses
2015-02-01	Type of plan entity	Single employer plan
2015-02-01	Submission has been amended	No
2015-02-01	This submission is the final filing	No
2015-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-02-01	Plan is a collectively bargained plan	No
2015-02-01	Plan funding arrangement – Insurance	Yes
2015-02-01	Plan funding arrangement – Trust	Yes
2015-02-01	Plan benefit arrangement – Insurance	Yes
2015-02-01	Plan benefit arrangement - Trust	Yes
2014: HENRYS FOODS, INC. PROFIT SHARING PLAN 2014 form 5500 responses
2014-02-01	Type of plan entity	Single employer plan
2014-02-01	Submission has been amended	No
2014-02-01	This submission is the final filing	No
2014-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-02-01	Plan is a collectively bargained plan	No
2014-02-01	Plan funding arrangement – Insurance	Yes
2014-02-01	Plan funding arrangement – Trust	Yes
2014-02-01	Plan benefit arrangement – Insurance	Yes
2014-02-01	Plan benefit arrangement - Trust	Yes
2013: HENRYS FOODS, INC. PROFIT SHARING PLAN 2013 form 5500 responses
2013-02-01	Type of plan entity	Single employer plan
2013-02-01	Submission has been amended	No
2013-02-01	This submission is the final filing	No
2013-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-02-01	Plan is a collectively bargained plan	No
2013-02-01	Plan funding arrangement – Insurance	Yes
2013-02-01	Plan funding arrangement – Trust	Yes
2013-02-01	Plan benefit arrangement – Insurance	Yes
2013-02-01	Plan benefit arrangement - Trust	Yes
2012: HENRYS FOODS, INC. PROFIT SHARING PLAN 2012 form 5500 responses
2012-02-01	Type of plan entity	Single employer plan
2012-02-01	Submission has been amended	No
2012-02-01	This submission is the final filing	No
2012-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-02-01	Plan is a collectively bargained plan	No
2012-02-01	Plan funding arrangement – Insurance	Yes
2012-02-01	Plan funding arrangement – Trust	Yes
2012-02-01	Plan benefit arrangement – Insurance	Yes
2012-02-01	Plan benefit arrangement - Trust	Yes
2011: HENRYS FOODS, INC. PROFIT SHARING PLAN 2011 form 5500 responses
2011-02-01	Type of plan entity	Single employer plan
2011-02-01	Submission has been amended	No
2011-02-01	This submission is the final filing	No
2011-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-02-01	Plan is a collectively bargained plan	No
2011-02-01	Plan funding arrangement – Insurance	Yes
2011-02-01	Plan funding arrangement – Trust	Yes
2011-02-01	Plan benefit arrangement – Insurance	Yes
2011-02-01	Plan benefit arrangement - Trust	Yes
2009: HENRYS FOODS, INC. PROFIT SHARING PLAN 2009 form 5500 responses
2009-02-01	Type of plan entity	Single employer plan
2009-02-01	Submission has been amended	No
2009-02-01	This submission is the final filing	No
2009-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-02-01	Plan is a collectively bargained plan	No
2009-02-01	Plan funding arrangement – Insurance	Yes
2009-02-01	Plan funding arrangement – Trust	Yes
2009-02-01	Plan benefit arrangement – Insurance	Yes
2009-02-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	E1834255
Policy instance	2
Insurance contract or identification number E1834255 Number of Individuals Covered 1 Insurance policy start date 2022-02-01 Insurance policy end date 2023-01-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? Yes 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 No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Other information about contract INDIVIDUAL ANNUITIES
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	372539-01
Policy instance	1
Insurance contract or identification number 372539-01 Number of Individuals Covered 7 Insurance policy start date 2022-02-01 Insurance policy end date 2023-01-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number	1982322,1982343
Policy instance	3
Insurance contract or identification number 1982322,1982343 Number of Individuals Covered 2 Insurance policy start date 2021-02-01 Insurance policy end date 2022-01-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 1 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 No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $0 Insurance broker organization code? 7
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	E1834255
Policy instance	2
Insurance contract or identification number E1834255 Number of Individuals Covered 1 Insurance policy start date 2021-02-01 Insurance policy end date 2022-01-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? Yes 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 No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Other information about contract INDIVIDUAL ANNUITIES
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	372539
Policy instance	1
Insurance contract or identification number 372539 Number of Individuals Covered 7 Insurance policy start date 2021-02-01 Insurance policy end date 2022-01-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number	1982322,1982343
Policy instance	3
Insurance contract or identification number 1982322,1982343 Number of Individuals Covered 2 Insurance policy start date 2020-02-01 Insurance policy end date 2021-01-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 1 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 No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $0 Insurance broker organization code? 7
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	372539
Policy instance	1
Insurance contract or identification number 372539 Number of Individuals Covered 6 Insurance policy start date 2020-02-01 Insurance policy end date 2021-01-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	E1834255
Policy instance	2
Insurance contract or identification number E1834255 Number of Individuals Covered 1 Insurance policy start date 2020-02-01 Insurance policy end date 2021-01-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? Yes 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 No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Other information about contract INDIVIDUAL ANNUITIES
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	372539
Policy instance	1
Insurance contract or identification number 372539 Number of Individuals Covered 5 Insurance policy start date 2019-02-01 Insurance policy end date 2020-01-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	E1834255
Policy instance	2
Insurance contract or identification number E1834255 Number of Individuals Covered 1 Insurance policy start date 2019-02-01 Insurance policy end date 2020-01-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? Yes 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 No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Other information about contract INDIVIDUAL ANNUITIES
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number	1982322,1982343
Policy instance	3
Insurance contract or identification number 1982322,1982343 Number of Individuals Covered 2 Insurance policy start date 2019-02-01 Insurance policy end date 2020-01-31 Total amount of commissions paid to insurance broker USD $13 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 1 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 No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $13 Insurance broker organization code? 7
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	E1834255
Policy instance	2
Insurance contract or identification number E1834255 Number of Individuals Covered 1 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $470 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? Yes 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 No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Other information about contract INDIVIDUAL ANNUITIES Commission paid to Insurance Broker USD $470 Amount paid for insurance broker fees 0 Insurance broker organization code? 3
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	372539
Policy instance	1
Insurance contract or identification number 372539 Number of Individuals Covered 5 Insurance policy start date 2018-02-01 Insurance policy end date 2019-01-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number	1982322,1982343
Policy instance	3
Insurance contract or identification number 1982322,1982343 Number of Individuals Covered 2 Insurance policy start date 2018-02-01 Insurance policy end date 2019-01-31 Total amount of commissions paid to insurance broker USD $13 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 1 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 No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $13 Amount paid for insurance broker fees 0 Insurance broker organization code? 7
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number	1982322,1982343
Policy instance	3
Insurance contract or identification number 1982322,1982343 Number of Individuals Covered 2 Insurance policy start date 2017-02-01 Insurance policy end date 2018-01-31 Total amount of commissions paid to insurance broker USD $13 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 1 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 No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $13 Insurance broker organization code? 7 Insurance broker name E DENNIS ZAHRBOCK
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	E1834255
Policy instance	2
Insurance contract or identification number E1834255 Number of Individuals Covered 1 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $505 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? Yes 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 No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Other information about contract INDIVIDUAL ANNUITIES Commission paid to Insurance Broker USD $505 Insurance broker organization code? 3 Insurance broker name SARAH K KAELBERER
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	372539
Policy instance	1
Insurance contract or identification number 372539 Number of Individuals Covered 6 Insurance policy start date 2017-02-01 Insurance policy end date 2018-01-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	372539
Policy instance	1
Insurance contract or identification number 372539 Number of Individuals Covered 5 Insurance policy start date 2015-02-01 Insurance policy end date 2016-01-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number	1982322
Policy instance	4
Insurance contract or identification number 1982322 Number of Individuals Covered 2 Insurance policy start date 2015-02-01 Insurance policy end date 2016-01-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? Yes 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 No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number	29801
Policy instance	2
Insurance contract or identification number 29801 Number of Individuals Covered 0 Insurance policy start date 2015-02-01 Insurance policy end date 2016-01-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $4,797 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? Yes Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 4347 Additional information about fees paid to insurance broker INVESTMENT MANAGER/ADVISER Insurance broker organization code? 7 Insurance broker name B & E PENSION ADVISERS, INC
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	E1833731,4255
Policy instance	3
Insurance contract or identification number E1833731,4255 Number of Individuals Covered 2 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $551 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? Yes 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 No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $551 Insurance broker organization code? 3 Insurance broker name SARAH K KAELBERER
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	E1833731,4255
Policy instance	2
Insurance contract or identification number E1833731,4255 Number of Individuals Covered 3 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $617 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? Yes 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 No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $617 Insurance broker organization code? 3 Insurance broker name SARAH K KAELBERER
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number	1982322
Policy instance	3
Insurance contract or identification number 1982322 Number of Individuals Covered 2 Insurance policy start date 2014-02-01 Insurance policy end date 2015-01-31 Total amount of commissions paid to insurance broker USD $20 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? Yes 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 No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $20 Insurance broker organization code? 3 Insurance broker name E. DENNIS ZAHRBOCK
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number	29801
Policy instance	1
Insurance contract or identification number 29801 Number of Individuals Covered 173 Insurance policy start date 2014-02-01 Insurance policy end date 2015-01-31 Total amount of commissions paid to insurance broker USD $3,533 Total amount of fees paid to insurance company USD $52,267 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? Yes Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 50117 Additional information about fees paid to insurance broker INVESTMENT MANAGER/ADVISER Insurance broker organization code? 7 Commission paid to Insurance Broker USD $3,533 Insurance broker name B & E PENSION ADVISERS, INC
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number	1982322
Policy instance	4
Insurance contract or identification number 1982322 Insurance policy start date 2013-02-01 Insurance policy end date 2014-01-31 Total amount of commissions paid to insurance broker USD $20 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? Yes 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 No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $20 Insurance broker organization code? 3 Insurance broker name E. DENNIS ZAHRBOCK
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	P03158
Policy instance	2
Insurance contract or identification number P03158 Number of Individuals Covered 1 Insurance policy start date 2013-02-01 Insurance policy end date 2014-01-31 Total amount of commissions paid to insurance broker USD $906 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? Yes 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 No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $906 Insurance broker organization code? 3 Insurance broker name EXECUTIVE INSURANCE AGENCY
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number	29801
Policy instance	1
Insurance contract or identification number 29801 Number of Individuals Covered 161 Insurance policy start date 2013-02-01 Insurance policy end date 2014-01-31 Total amount of commissions paid to insurance broker USD $3,520 Total amount of fees paid to insurance company USD $51,204 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? Yes Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 49529 Additional information about fees paid to insurance broker INVESTMENT MANAGER/ADVISER Insurance broker organization code? 7 Commission paid to Insurance Broker USD $3,520 Insurance broker name B & E PENSION ADVISERS, INC
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	E1833731,4255
Policy instance	3
Insurance contract or identification number E1833731,4255 Number of Individuals Covered 2 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $561 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $561 Insurance broker organization code? 3 Insurance broker name SARAH K KAELBERER
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	P03158
Policy instance	2
Insurance contract or identification number P03158 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $2,242 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? Yes 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 No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Commission paid to Insurance Broker USD $1,368 Insurance broker organization code? 3 Insurance broker name E DENNIS ZAHRBOCK
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number	29801
Policy instance	1
Insurance contract or identification number 29801 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $22,676 Total amount of fees paid to insurance company USD $29,352 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? Yes Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Amount paid for insurance broker fees 27286 Additional information about fees paid to insurance broker INVESTMENT MANAGER/ADVISER Insurance broker organization code? 7 Commission paid to Insurance Broker USD $22,676 Insurance broker name B & E PENSION ADVISERS, INC
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	E1833731,4255
Policy instance	3
Insurance contract or identification number E1833731,4255 Number of Individuals Covered 2 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $556 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $556 Insurance broker organization code? 3 Insurance broker name SARAH K KAELBERER
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number	1982322
Policy instance	4
Insurance contract or identification number 1982322 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $17 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? Yes 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 No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Commission paid to Insurance Broker USD $17 Insurance broker organization code? 3 Insurance broker name E. DENNIS ZAHRBOCK
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number	1982322
Policy instance	4
Insurance contract or identification number 1982322 Number of Individuals Covered 3 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $17 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? Yes 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 No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number	29801
Policy instance	2
Insurance contract or identification number 29801 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $48,171 Total amount of fees paid to insurance company USD $1,890 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? Yes Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	P03158
Policy instance	1
Insurance contract or identification number P03158 Number of Individuals Covered 2 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $2,242 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? Yes 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 No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	E1833730
Policy instance	3
Insurance contract or identification number E1833730 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with 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 No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	P03158
Policy instance	1
Insurance contract or identification number P03158 Number of Individuals Covered 2 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $2,343 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? Yes 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 No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Commission paid to Insurance Broker USD $1,757 Insurance broker organization code? 3 Insurance broker name EXECUTIVE INSURANCE AGENCY
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	E1833730
Policy instance	3
Insurance contract or identification number E1833730 Number of Individuals Covered 3 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with 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 No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Commission paid to Insurance Broker USD $0 Insurance broker organization code? 3 Insurance broker name SARAH K KAELBERER
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number	29801
Policy instance	2
Insurance contract or identification number 29801 Number of Individuals Covered 177 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $40,061 Total amount of fees paid to insurance company USD $1,250 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? Yes Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Commission paid to Insurance Broker USD $37,206 Insurance broker organization code? 3 Amount paid for insurance broker fees 1250 Additional information about fees paid to insurance broker FEES Insurance broker name B & E PENSION ADVISERS, INC

Potentially related plans

• HENRYS FOODS, INC 401(K) RETIREMENT PLAN [EIN = 042459051]