401k Plan data: AIS 401(K) PLAN plan

AIS 401(K) PLAN 401k Plan overview

Plan Name	AIS 401(K) PLAN
Plan identification number	002

AIS 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
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

BOND PHARMACY, INC. has sponsored the creation of one or more 401k plans.

Company Name: BOND PHARMACY, INC.

Employer identification number (EIN): 640913966

NAIC Classification: 446110
NAIC Description: Pharmacies and Drug Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AIS 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2022-01-01 JULIA DOUCETTE 2023-10-09
002 2021-01-01
002 2020-01-01
002 2019-01-01
002 2018-01-01
002 2017-01-01 JULIA DOUCETTE
002 2016-01-01 JULIA DOUCETTE JULIA DOUCETTE 2017-10-13
002 2015-01-01 JULIA DOUCETTE 2017-10-13 JULIA DOUCETTE 2017-10-13
002 2015-01-01 JULIA DOUCETTE 2016-05-05 JULIA DOUCETTE 2016-05-05
002 2014-01-01 JULIA DOUCETTE 2015-07-15 JULIA DOUCETTE 2015-07-15
002 2013-01-01 CHARLES R BELL JR 2014-02-25 CHARLES R BELL JR 2014-02-25
002 2012-01-01 CHUCK BELL 2013-02-13 CHUCK BELL 2013-02-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2022-01-01	JULIA DOUCETTE	2023-10-09
002	2021-01-01
002	2020-01-01
002	2019-01-01
002	2018-01-01
002	2017-01-01	JULIA DOUCETTE
002	2016-01-01	JULIA DOUCETTE		JULIA DOUCETTE	2017-10-13
002	2015-01-01	JULIA DOUCETTE	2017-10-13	JULIA DOUCETTE	2017-10-13
002	2015-01-01	JULIA DOUCETTE	2016-05-05	JULIA DOUCETTE	2016-05-05
002	2014-01-01	JULIA DOUCETTE	2015-07-15	JULIA DOUCETTE	2015-07-15
002	2013-01-01	CHARLES R BELL JR	2014-02-25	CHARLES R BELL JR	2014-02-25
002	2012-01-01	CHUCK BELL	2013-02-13	CHUCK BELL	2013-02-13

Plan Statistics for AIS 401(K) PLAN

401k plan membership statisitcs for AIS 401(K) PLAN

Measure Date Value
2022: AIS 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 838
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 573
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 297
Total of all active and inactive participants 2022-01-01 870
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 870
Number of participants with account balances 2022-01-01 870
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 59
2021: AIS 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 722
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 542
Number of retired or separated participants receiving benefits 2021-01-01 28
Number of other retired or separated participants entitled to future benefits 2021-01-01 206
Total of all active and inactive participants 2021-01-01 776
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 776
Number of participants with account balances 2021-01-01 776
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 51
2020: AIS 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 562
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 497
Number of retired or separated participants receiving benefits 2020-01-01 26
Number of other retired or separated participants entitled to future benefits 2020-01-01 141
Total of all active and inactive participants 2020-01-01 664
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 664
Number of participants with account balances 2020-01-01 664
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: AIS 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 402
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 355
Number of retired or separated participants receiving benefits 2019-01-01 33
Number of other retired or separated participants entitled to future benefits 2019-01-01 101
Total of all active and inactive participants 2019-01-01 489
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 489
Number of participants with account balances 2019-01-01 489
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 32
2018: AIS 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 299
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 276
Number of retired or separated participants receiving benefits 2018-01-01 21
Number of other retired or separated participants entitled to future benefits 2018-01-01 73
Total of all active and inactive participants 2018-01-01 370
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 370
Number of participants with account balances 2018-01-01 369
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: AIS 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 177
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 231
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 33
Total of all active and inactive participants 2017-01-01 264
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 264
Number of participants with account balances 2017-01-01 263
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 16
2016: AIS 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 134
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 128
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 28
Total of all active and inactive participants 2016-01-01 156
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 156
Number of participants with account balances 2016-01-01 156
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 9

Measure	Date	Value
2022: AIS 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	838
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	573
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	297
Total of all active and inactive participants	2022-01-01	870
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	870
Number of participants with account balances	2022-01-01	870
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	59
2021: AIS 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	722
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	542
Number of retired or separated participants receiving benefits	2021-01-01	28
Number of other retired or separated participants entitled to future benefits	2021-01-01	206
Total of all active and inactive participants	2021-01-01	776
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	776
Number of participants with account balances	2021-01-01	776
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	51
2020: AIS 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	562
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	497
Number of retired or separated participants receiving benefits	2020-01-01	26
Number of other retired or separated participants entitled to future benefits	2020-01-01	141
Total of all active and inactive participants	2020-01-01	664
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	664
Number of participants with account balances	2020-01-01	664
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: AIS 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	402
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	355
Number of retired or separated participants receiving benefits	2019-01-01	33
Number of other retired or separated participants entitled to future benefits	2019-01-01	101
Total of all active and inactive participants	2019-01-01	489
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	489
Number of participants with account balances	2019-01-01	489
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	32
2018: AIS 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	299
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	276
Number of retired or separated participants receiving benefits	2018-01-01	21
Number of other retired or separated participants entitled to future benefits	2018-01-01	73
Total of all active and inactive participants	2018-01-01	370
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	370
Number of participants with account balances	2018-01-01	369
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: AIS 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	177
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	231
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	33
Total of all active and inactive participants	2017-01-01	264
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	264
Number of participants with account balances	2017-01-01	263
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	16
2016: AIS 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	134
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	128
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	28
Total of all active and inactive participants	2016-01-01	156
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	156
Number of participants with account balances	2016-01-01	156
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	9

Financial Data on AIS 401(K) PLAN

Measure	Date	Value
2022 : AIS 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$1,342
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$5,639
Total income from all sources (including contributions)	2022-12-31	$303,798
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$2,271,737
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$2,122,993
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$4,468,031
Value of total assets at end of year	2022-12-31	$20,050,658
Value of total assets at beginning of year	2022-12-31	$22,022,894
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$148,744
Total interest from all sources	2022-12-31	$2,746
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Administrative expenses professional fees incurred	2022-12-31	$144,744
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$2,700,129
Participant contributions at end of year	2022-12-31	$230
Participant contributions at beginning of year	2022-12-31	$75
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$215,183
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2022-12-31	$1,342
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2022-12-31	$5,639
Other income not declared elsewhere	2022-12-31	$6,168
Administrative expenses (other) incurred	2022-12-31	$4,000
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-1,967,939
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$20,049,316
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$22,017,255
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$0
Interest earned on other investments	2022-12-31	$2,746
Value of interest in common/collective trusts at end of year	2022-12-31	$19,636,031
Value of interest in common/collective trusts at beginning of year	2022-12-31	$21,787,194
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$414,191
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$232,436
Net investment gain/loss from pooled separate accounts	2022-12-31	$-4,173,147
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$1,552,719
Employer contributions (assets) at end of year	2022-12-31	$206
Employer contributions (assets) at beginning of year	2022-12-31	$3,189
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$2,122,993
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	FORVIS, LLP
Accountancy firm EIN	2022-12-31	440160260
2021 : AIS 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$5,639
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$44
Total income from all sources (including contributions)	2021-12-31	$7,824,561
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$1,402,708
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$1,289,492
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$4,889,958
Value of total assets at end of year	2021-12-31	$22,022,894
Value of total assets at beginning of year	2021-12-31	$15,595,446
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$113,216
Total interest from all sources	2021-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$6,237
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$6,237
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$2,648,711
Participant contributions at end of year	2021-12-31	$75
Participant contributions at beginning of year	2021-12-31	$75
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$815,541
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2021-12-31	$5,639
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2021-12-31	$44
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$6,421,853
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$22,017,255
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$15,595,402
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Investment advisory and management fees	2021-12-31	$55,380
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$3,590,654
Value of interest in common/collective trusts at end of year	2021-12-31	$21,787,194
Value of interest in common/collective trusts at beginning of year	2021-12-31	$11,499,549
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$232,436
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$240,334
Net investment gain/loss from pooled separate accounts	2021-12-31	$2,928,366
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$1,425,706
Employer contributions (assets) at end of year	2021-12-31	$3,189
Employer contributions (assets) at beginning of year	2021-12-31	$264,834
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$1,289,492
Contract administrator fees	2021-12-31	$57,836
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	FORVIS, LLP
Accountancy firm EIN	2021-12-31	440160260
2020 : AIS 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$44
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$5,826,849
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$872,875
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$870,375
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$3,771,134
Value of total assets at end of year	2020-12-31	$15,595,446
Value of total assets at beginning of year	2020-12-31	$10,641,428
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$2,500
Total interest from all sources	2020-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$156,878
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$156,878
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$2,147,501
Participant contributions at end of year	2020-12-31	$75
Participant contributions at beginning of year	2020-12-31	$73
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$132,038
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2020-12-31	$44
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-12-31	$0
Total non interest bearing cash at end of year	2020-12-31	$0
Total non interest bearing cash at beginning of year	2020-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$4,953,974
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$15,595,402
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$10,641,428
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$3,590,654
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$0
Value of interest in pooled separate accounts at end of year	2020-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$10,130,568
Value of interest in common/collective trusts at end of year	2020-12-31	$11,499,549
Value of interest in common/collective trusts at beginning of year	2020-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$240,334
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$108,417
Net investment gain/loss from pooled separate accounts	2020-12-31	$1,898,837
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$1,491,595
Employer contributions (assets) at end of year	2020-12-31	$264,834
Employer contributions (assets) at beginning of year	2020-12-31	$402,370
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$870,375
Contract administrator fees	2020-12-31	$2,500
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	DIXON HUGHES GOODMAN
Accountancy firm EIN	2020-12-31	560747981
2019 : AIS 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$143
Total income from all sources (including contributions)	2019-12-31	$4,514,182
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$744,739
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$742,889
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$2,849,233
Value of total assets at end of year	2019-12-31	$10,641,428
Value of total assets at beginning of year	2019-12-31	$6,872,128
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$1,850
Total interest from all sources	2019-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$1,532,549
Participant contributions at end of year	2019-12-31	$73
Participant contributions at beginning of year	2019-12-31	$65
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$39,681
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$143
Other income not declared elsewhere	2019-12-31	$610
Total non interest bearing cash at end of year	2019-12-31	$0
Total non interest bearing cash at beginning of year	2019-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$3,769,443
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$10,641,428
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$6,871,985
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in pooled separate accounts at end of year	2019-12-31	$10,130,568
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$6,261,272
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$108,417
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$316,012
Net investment gain/loss from pooled separate accounts	2019-12-31	$1,664,339
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$1,277,003
Employer contributions (assets) at end of year	2019-12-31	$402,370
Employer contributions (assets) at beginning of year	2019-12-31	$294,779
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$742,889
Contract administrator fees	2019-12-31	$1,850
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	DIXON HUGHES GOODMAN
Accountancy firm EIN	2019-12-31	560747981
2018 : AIS 401(K) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$143
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$121
Total income from all sources (including contributions)	2018-12-31	$1,579,156
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$620,264
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$618,964
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$2,074,096
Value of total assets at end of year	2018-12-31	$6,872,128
Value of total assets at beginning of year	2018-12-31	$5,913,214
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$1,300
Total interest from all sources	2018-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$500,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$1,031,270
Participant contributions at end of year	2018-12-31	$65
Participant contributions at beginning of year	2018-12-31	$14,563
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$118,290
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2018-12-31	$143
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2018-12-31	$121
Total non interest bearing cash at end of year	2018-12-31	$0
Total non interest bearing cash at beginning of year	2018-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$958,892
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$6,871,985
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$5,913,093
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in pooled separate accounts at end of year	2018-12-31	$6,261,272
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$5,436,149
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$316,012
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$256,778
Net investment gain/loss from pooled separate accounts	2018-12-31	$-494,940
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$924,536
Employer contributions (assets) at end of year	2018-12-31	$294,779
Employer contributions (assets) at beginning of year	2018-12-31	$205,724
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$618,964
Contract administrator fees	2018-12-31	$1,300
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	DIXON HUGHES GOODMAN
Accountancy firm EIN	2018-12-31	560747981
2017 : AIS 401(K) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total transfer of assets to this plan	2017-12-31	$1,375,778
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$121
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$2,252,979
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$379,144
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$379,144
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$1,650,326
Value of total assets at end of year	2017-12-31	$5,913,214
Value of total assets at beginning of year	2017-12-31	$2,663,480
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$0
Total interest from all sources	2017-12-31	$73
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$500,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$741,709
Participant contributions at end of year	2017-12-31	$14,563
Participant contributions at beginning of year	2017-12-31	$5,087
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$275,991
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2017-12-31	$121
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2017-12-31	$0
Total non interest bearing cash at end of year	2017-12-31	$0
Total non interest bearing cash at beginning of year	2017-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$1,873,835
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$5,913,093
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$2,663,480
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in pooled separate accounts at end of year	2017-12-31	$5,436,149
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$2,520,482
Interest on participant loans	2017-12-31	$73
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$256,778
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$0
Net investment gain/loss from pooled separate accounts	2017-12-31	$602,580
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$632,626
Employer contributions (assets) at end of year	2017-12-31	$205,724
Employer contributions (assets) at beginning of year	2017-12-31	$137,911
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$379,144
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	DIXON HUGHES GOODMAN
Accountancy firm EIN	2017-12-31	560747981
2016 : AIS 401(K) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$205
Total income from all sources (including contributions)	2016-12-31	$1,042,011
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$39,995
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$39,995
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$873,965
Value of total assets at end of year	2016-12-31	$2,663,480
Value of total assets at beginning of year	2016-12-31	$1,661,669
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$0
Total interest from all sources	2016-12-31	$1,536
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$455,335
Participant contributions at end of year	2016-12-31	$5,087
Participant contributions at beginning of year	2016-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2016-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2016-12-31	$205
Other income not declared elsewhere	2016-12-31	$197
Administrative expenses (other) incurred	2016-12-31	$0
Total non interest bearing cash at end of year	2016-12-31	$0
Total non interest bearing cash at beginning of year	2016-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$1,002,016
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$2,663,480
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$1,661,464
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in pooled separate accounts at end of year	2016-12-31	$2,520,482
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$1,558,140
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-12-31	$1,536
Net investment gain/loss from pooled separate accounts	2016-12-31	$166,313
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$418,630
Employer contributions (assets) at end of year	2016-12-31	$137,911
Employer contributions (assets) at beginning of year	2016-12-31	$103,529
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$39,995
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	DIXON HUGHES GOODMAN
Accountancy firm EIN	2016-12-31	560747981

Form 5500 Responses for AIS 401(K) PLAN

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

Insurance Providers Used on plan

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

Policy contract number

944164-01

Policy instance

Insurance contract or identification number	944164-01
Number of Individuals Covered	26
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
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

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

Policy contract number

944164-01

Policy instance

Insurance contract or identification number	944164-01
Number of Individuals Covered	21
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
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

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

Policy contract number

944164-01

Policy instance

Insurance contract or identification number	944164-01
Number of Individuals Covered	24
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $790
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
Commission paid to Insurance Broker	USD $790
Insurance broker organization code?	3

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

Policy contract number

944164-01

Policy instance

Insurance contract or identification number	944164-01
Number of Individuals Covered	469
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $40,272
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
Commission paid to Insurance Broker	USD $40,272
Insurance broker organization code?	3

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

Policy contract number

944164-01

Policy instance

Insurance contract or identification number	944164-01
Number of Individuals Covered	357
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $31,818
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
Commission paid to Insurance Broker	USD $31,818
Insurance broker organization code?	3

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

Policy contract number

944164-01

Policy instance

Insurance contract or identification number	944164-01
Number of Individuals Covered	257
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $17,815
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
Commission paid to Insurance Broker	USD $17,815
Insurance broker organization code?	3
Insurance broker name	JOHN CORRERO

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Company Name:	BOND PHARMACY, INC.
Employer identification number (EIN):	640913966
NAIC Classification:	446110
NAIC Description:	Pharmacies and Drug Stores