401k Plan data: GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN plan

GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN 401k Plan overview

Plan Name	GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN
Plan identification number	001

GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN Benefits

401k Plan Type	Defined Contribution Pension
Plan Features/Benefits	Profit-sharing 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. Plan not intended to be qualified - A plan not intended to be qualified under Code sections 401, 403, or 408.

401k Sponsoring company profile

GRUPO CARMELO has sponsored the creation of one or more 401k plans.

Company Name: GRUPO CARMELO

Employer identification number (EIN): 660288317

NAIC Classification: 327300

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2015-01-01 BRENDA L. HERNANDEZ RODRIGUEZ
001 2014-01-01 MELBA FIGUEROA PADILLA
001 2014-01-01 MELBA FIGUEROA PADILLA
001 2014-01-01 JOSE A. FERNANDEZ
001 2013-01-01 MELBA FIGUEROA PADILLA
001 2012-01-01 MELBA FIGUEROA PADILLA
001 2011-01-01 BRENDA HERNANDEZ RODRIGUEZ
001 2009-01-01 BRENDA HERNANDEZ RODRIGUEZ

Plan id#	Filing Submission Date	Name of Administrator
001	2015-01-01	BRENDA L. HERNANDEZ RODRIGUEZ
001	2014-01-01	MELBA FIGUEROA PADILLA
001	2014-01-01	MELBA FIGUEROA PADILLA
001	2014-01-01	JOSE A. FERNANDEZ
001	2013-01-01	MELBA FIGUEROA PADILLA
001	2012-01-01	MELBA FIGUEROA PADILLA
001	2011-01-01	BRENDA HERNANDEZ RODRIGUEZ
001	2009-01-01	BRENDA HERNANDEZ RODRIGUEZ

Plan Statistics for GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN

401k plan membership statisitcs for GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN

Measure Date Value
2015: GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 156
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 156
Number of retired or separated participants receiving benefits 2015-01-01 4
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 160
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 160
Number of participants with account balances 2015-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
Number of employers contributing to the scheme 2015-01-01 3
2014: GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 156
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 156
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 156
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 156
Number of participants with account balances 2014-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
Number of employers contributing to the scheme 2014-01-01 3
2013: GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 151
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 156
Number of retired or separated participants receiving benefits 2013-01-01 11
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 167
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 167
Number of participants with account balances 2013-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
Number of employers contributing to the scheme 2013-01-01 3
2012: GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 175
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 151
Number of retired or separated participants receiving benefits 2012-01-01 8
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 159
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 159
Number of participants with account balances 2012-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
Number of employers contributing to the scheme 2012-01-01 3
2011: GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 185
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 175
Number of retired or separated participants receiving benefits 2011-01-01 13
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 188
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 188
Number of participants with account balances 2011-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
Number of employers contributing to the scheme 2011-01-01 3
2009: GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 164
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 153
Number of retired or separated participants receiving benefits 2009-01-01 16
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 169
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 1
Total participants 2009-01-01 170
Number of participants with account balances 2009-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0
Number of employers contributing to the scheme 2009-01-01 3

Measure	Date	Value
2015: GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	156
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	156
Number of retired or separated participants receiving benefits	2015-01-01	4
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	160
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	160
Number of participants with account balances	2015-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
Number of employers contributing to the scheme	2015-01-01	3
2014: GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	156
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	156
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	156
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	156
Number of participants with account balances	2014-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
Number of employers contributing to the scheme	2014-01-01	3
2013: GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	151
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	156
Number of retired or separated participants receiving benefits	2013-01-01	11
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	167
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	167
Number of participants with account balances	2013-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
Number of employers contributing to the scheme	2013-01-01	3
2012: GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	175
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	151
Number of retired or separated participants receiving benefits	2012-01-01	8
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	159
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	159
Number of participants with account balances	2012-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
Number of employers contributing to the scheme	2012-01-01	3
2011: GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	185
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	175
Number of retired or separated participants receiving benefits	2011-01-01	13
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	188
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	188
Number of participants with account balances	2011-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
Number of employers contributing to the scheme	2011-01-01	3
2009: GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	164
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	153
Number of retired or separated participants receiving benefits	2009-01-01	16
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	169
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	1
Total participants	2009-01-01	170
Number of participants with account balances	2009-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0
Number of employers contributing to the scheme	2009-01-01	3

Financial Data on GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN

Measure	Date	Value
2015 : GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$1,827
Total income from all sources (including contributions)	2015-12-31	$22,459
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$210,724
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$210,724
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$89,095
Value of total assets at end of year	2015-12-31	$3,178,984
Value of total assets at beginning of year	2015-12-31	$3,369,076
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$0
Total interest from all sources	2015-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	No
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2015-12-31	$0
Minimum employer required contribution for this plan year	2015-12-31	$0
Amount contributed by the employer to the plan for this plan year	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$89,095
Participant contributions at end of year	2015-12-31	$5,333
Participant contributions at beginning of year	2015-12-31	$11,979
Assets. Other investments not covered elsewhere at end of year	2015-12-31	$2,933,052
Assets. Other investments not covered elsewhere at beginning of year	2015-12-31	$3,035,987
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$1,827
Total non interest bearing cash at end of year	2015-12-31	$0
Total non interest bearing cash at beginning of year	2015-12-31	$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	2015-12-31	No
Value of net income/loss	2015-12-31	$-188,265
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$3,178,984
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$3,367,249
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$132,584
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$214,378
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$214,378
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$108,015
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$104,905
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-66,636
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Employer contributions (assets) at end of year	2015-12-31	$0
Employer contributions (assets) at beginning of year	2015-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$210,724
Liabilities. Value of benefit claims payable at end of year	2015-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2015-12-31	$1,827
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	AQUINO, DE CORDOVA & ALFARO & CO.
Accountancy firm EIN	2015-12-31	660546032
2014 : GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$1,827
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$10,115
Total income from all sources (including contributions)	2014-12-31	$242,151
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$156,465
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$156,465
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$96,619
Value of total assets at end of year	2014-12-31	$3,369,076
Value of total assets at beginning of year	2014-12-31	$3,291,678
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$0
Total interest from all sources	2014-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	No
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2014-12-31	$0
Minimum employer required contribution for this plan year	2014-12-31	$0
Amount contributed by the employer to the plan for this plan year	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$96,619
Participant contributions at end of year	2014-12-31	$11,979
Participant contributions at beginning of year	2014-12-31	$14,267
Assets. Other investments not covered elsewhere at end of year	2014-12-31	$3,035,987
Assets. Other investments not covered elsewhere at beginning of year	2014-12-31	$2,933,527
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$1,827
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$10,115
Total non interest bearing cash at end of year	2014-12-31	$0
Total non interest bearing cash at beginning of year	2014-12-31	$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	2014-12-31	No
Value of net income/loss	2014-12-31	$85,686
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$3,367,249
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$3,281,563
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$214,378
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$216,209
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$216,209
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$104,905
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$117,560
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$145,532
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Employer contributions (assets) at end of year	2014-12-31	$0
Employer contributions (assets) at beginning of year	2014-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$156,465
Liabilities. Value of benefit claims payable at end of year	2014-12-31	$1,827
Liabilities. Value of benefit claims payable at beginning of year	2014-12-31	$10,115
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	AQUINO, DE CORDOVA & ALFARO & CO.
Accountancy firm EIN	2014-12-31	660546032
2013 : GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$10,115
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$566,241
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$272,471
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$272,471
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$112,061
Value of total assets at end of year	2013-12-31	$3,291,678
Value of total assets at beginning of year	2013-12-31	$2,987,793
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$0
Total interest from all sources	2013-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	No
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2013-12-31	$0
Minimum employer required contribution for this plan year	2013-12-31	$0
Amount contributed by the employer to the plan for this plan year	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$112,061
Participant contributions at end of year	2013-12-31	$14,267
Participant contributions at beginning of year	2013-12-31	$6,946
Assets. Other investments not covered elsewhere at end of year	2013-12-31	$2,933,527
Assets. Other investments not covered elsewhere at beginning of year	2013-12-31	$2,613,395
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$10,115
Total non interest bearing cash at end of year	2013-12-31	$0
Total non interest bearing cash at beginning of year	2013-12-31	$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	2013-12-31	No
Value of net income/loss	2013-12-31	$293,770
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$3,281,563
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$2,987,793
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$216,209
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$240,157
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$240,157
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$117,560
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$127,295
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$454,180
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Employer contributions (assets) at end of year	2013-12-31	$0
Employer contributions (assets) at beginning of year	2013-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$272,471
Liabilities. Value of benefit claims payable at end of year	2013-12-31	$10,115
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	AQUINO, DE CORDOVA, ALFARO & CO
Accountancy firm EIN	2013-12-31	660546032
2012 : GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$355,050
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$95,886
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$95,886
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$114,556
Value of total assets at end of year	2012-12-31	$2,987,793
Value of total assets at beginning of year	2012-12-31	$2,728,629
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$0
Total interest from all sources	2012-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	No
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2012-12-31	$0
Minimum employer required contribution for this plan year	2012-12-31	$0
Amount contributed by the employer to the plan for this plan year	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$114,556
Participant contributions at end of year	2012-12-31	$6,946
Participant contributions at beginning of year	2012-12-31	$16,684
Assets. Other investments not covered elsewhere at end of year	2012-12-31	$2,613,395
Assets. Other investments not covered elsewhere at beginning of year	2012-12-31	$2,392,344
Total non interest bearing cash at end of year	2012-12-31	$0
Total non interest bearing cash at beginning of year	2012-12-31	$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	2012-12-31	No
Value of net income/loss	2012-12-31	$259,164
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$2,987,793
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$2,728,629
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$240,157
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$239,342
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$239,342
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$127,295
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$80,259
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$240,494
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$0
Employer contributions (assets) at end of year	2012-12-31	$0
Employer contributions (assets) at beginning of year	2012-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$95,886
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	AQUINO, DE CORDOVA, ALFARO & CO
Accountancy firm EIN	2012-12-31	660546032
2011 : GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$36,077
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$210,955
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$210,955
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$116,692
Value of total assets at end of year	2011-12-31	$2,728,629
Value of total assets at beginning of year	2011-12-31	$2,903,507
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$0
Total interest from all sources	2011-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	No
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2011-12-31	$0
Minimum employer required contribution for this plan year	2011-12-31	$0
Amount contributed by the employer to the plan for this plan year	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$116,692
Participant contributions at end of year	2011-12-31	$16,684
Participant contributions at beginning of year	2011-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2011-12-31	$2,392,344
Assets. Other investments not covered elsewhere at beginning of year	2011-12-31	$2,593,808
Total non interest bearing cash at end of year	2011-12-31	$0
Total non interest bearing cash at beginning of year	2011-12-31	$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	2011-12-31	No
Value of net income/loss	2011-12-31	$-174,878
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$2,728,629
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$2,903,507
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$239,342
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$212,255
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$212,255
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$80,259
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$87,690
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-80,615
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$0
Employer contributions (assets) at end of year	2011-12-31	$0
Employer contributions (assets) at beginning of year	2011-12-31	$9,754
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$210,955
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	AQUINO, DE CORDOVA, ALFARO & CO. LL
Accountancy firm EIN	2011-12-31	660546032
2010 : GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$428,850
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$393,385
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$393,385
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$169,293
Value of total assets at end of year	2010-12-31	$2,903,507
Value of total assets at beginning of year	2010-12-31	$2,868,042
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$0
Total interest from all sources	2010-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	No
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2010-12-31	$0
Minimum employer required contribution for this plan year	2010-12-31	$38,389
Amount contributed by the employer to the plan for this plan year	2010-12-31	$38,389
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$130,904
Participant contributions at end of year	2010-12-31	$0
Participant contributions at beginning of year	2010-12-31	$10,034
Assets. Other investments not covered elsewhere at end of year	2010-12-31	$2,593,808
Assets. Other investments not covered elsewhere at beginning of year	2010-12-31	$2,554,141
Total non interest bearing cash at end of year	2010-12-31	$0
Total non interest bearing cash at beginning of year	2010-12-31	$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	2010-12-31	No
Value of net income/loss	2010-12-31	$35,465
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$2,903,507
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$2,868,042
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$212,255
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$209,233
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$209,233
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$87,690
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$83,894
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$259,557
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$38,389
Employer contributions (assets) at end of year	2010-12-31	$9,754
Employer contributions (assets) at beginning of year	2010-12-31	$10,740
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$393,385
Did the plan have assets held for investment	2010-12-31	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	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	AQUINO, DE CORDOVA, ALFARO & CO., L
Accountancy firm EIN	2010-12-31	660546032
2009 : GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2009-12-31	$0
Minimum employer required contribution for this plan year	2009-12-31	$145,820
Amount contributed by the employer to the plan for this plan year	2009-12-31	$145,820

Form 5500 Responses for GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN

2015: GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Multi-employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	Yes
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Multi-employer plan
2014-01-01	Submission has been amended	Yes
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	Yes
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Multi-employer plan
2013-01-01	Submission has been amended	Yes
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	Yes
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Multi-employer plan
2012-01-01	Submission has been amended	Yes
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	Yes
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Multi-employer plan
2011-01-01	Submission has been amended	Yes
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	Yes
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: GRUPO CARMELO 1165(E) SAVINGS AND INVESTMENT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Multi-employer plan
2009-01-01	Submission has been amended	Yes
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	Yes
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

063-00936

Policy instance

Insurance contract or identification number	063-00936
Number of Individuals Covered	156
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $735
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?	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 $735
Insurance broker organization code?	3
Insurance broker name	FAIRBRIDGE CAPITAL MARKETS

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

Policy contract number

063-00936

Policy instance

Insurance contract or identification number	063-00936
Number of Individuals Covered	156
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $792
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?	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 $792
Insurance broker organization code?	3
Insurance broker name	FAIRBRIDGE CAPITAL MARKETS

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

Policy contract number

063-00936

Policy instance

Insurance contract or identification number	063-00936
Number of Individuals Covered	156
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $794
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?	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 $794
Insurance broker organization code?	3
Insurance broker name	GAP-B2-AA1B CONSULTIVA SECURITIES

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

Policy contract number

063-00936

Policy instance

Insurance contract or identification number	063-00936
Number of Individuals Covered	151
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $806
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?	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 $806
Insurance broker organization code?	3
Insurance broker name	GAP-B2-AA1B CONSULTIVA SECURITIES

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

Policy contract number

063-00936

Policy instance

Insurance contract or identification number	063-00936
Number of Individuals Covered	175
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $620
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?	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

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

Policy contract number

063-00936

Policy instance

Insurance contract or identification number	063-00936
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $541
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?	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 $541
Insurance broker organization code?	3
Insurance broker name	GAP-B2-AA1B CONSULTIVA SECURITIES

Potentially related plans

GRUPO CARMELO SAVINGS AND INVESTMENT PLAN [EIN = 660532348]

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Company Name:	GRUPO CARMELO
Employer identification number (EIN):	660288317
NAIC Classification:	327300