401k Plan data: SUEBA USA CORPORATION 401(K) PLAN plan

SUEBA USA CORPORATION 401(K) PLAN 401k Plan overview

Plan Name	SUEBA USA CORPORATION 401(K) PLAN
Plan identification number	001

SUEBA USA CORPORATION 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

SUEBA USA CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: SUEBA USA CORPORATION

Employer identification number (EIN): 760081661

NAIC Classification: 531310

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SUEBA USA CORPORATION 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01 ILEANA SEPULVEDA
001 2016-01-01 ILEANA SEPULVEDA
001 2015-01-01 ILEANA SEPULVEDA 2016-10-10
001 2014-01-01 ILEANA SEPULVEDA 2015-10-05
001 2013-01-01 ILEANA SEPULVEDA 2014-10-09
001 2012-01-01 ILEANA SEPULVEDA 2013-09-16
001 2011-01-01 ILEANA SEPULVEDA 2012-10-02
001 2010-01-01 ILEANA G. SEPULVEDA 2011-09-15

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-01-01
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2017-01-01	ILEANA SEPULVEDA
001	2016-01-01	ILEANA SEPULVEDA
001	2015-01-01	ILEANA SEPULVEDA	2016-10-10
001	2014-01-01	ILEANA SEPULVEDA	2015-10-05
001	2013-01-01	ILEANA SEPULVEDA	2014-10-09
001	2012-01-01	ILEANA SEPULVEDA	2013-09-16
001	2011-01-01	ILEANA SEPULVEDA	2012-10-02
001	2010-01-01	ILEANA G. SEPULVEDA	2011-09-15

Plan Statistics for SUEBA USA CORPORATION 401(K) PLAN

401k plan membership statisitcs for SUEBA USA CORPORATION 401(K) PLAN

Measure Date Value
2022: SUEBA USA CORPORATION 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 101
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 72
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 22
Total of all active and inactive participants 2022-01-01 94
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 94
Number of participants with account balances 2022-01-01 72
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 1
2021: SUEBA USA CORPORATION 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 114
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 76
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 24
Total of all active and inactive participants 2021-01-01 100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 100
Number of participants with account balances 2021-01-01 76
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: SUEBA USA CORPORATION 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 103
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 101
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 12
Total of all active and inactive participants 2020-01-01 113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 113
Number of participants with account balances 2020-01-01 71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: SUEBA USA CORPORATION 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 137
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 94
Number of retired or separated participants receiving benefits 2019-01-01 7
Number of other retired or separated participants entitled to future benefits 2019-01-01 2
Total of all active and inactive participants 2019-01-01 103
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 103
Number of participants with account balances 2019-01-01 56
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 19
2018: SUEBA USA CORPORATION 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 135
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 116
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 18
Total of all active and inactive participants 2018-01-01 134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 134
Number of participants with account balances 2018-01-01 58
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 20
2017: SUEBA USA CORPORATION 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 126
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 114
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 16
Total of all active and inactive participants 2017-01-01 130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 130
Number of participants with account balances 2017-01-01 53
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 15
2016: SUEBA USA CORPORATION 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 127
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 107
Number of retired or separated participants receiving benefits 2016-01-01 1
Number of other retired or separated participants entitled to future benefits 2016-01-01 14
Total of all active and inactive participants 2016-01-01 122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 122
Number of participants with account balances 2016-01-01 55
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 14

Measure	Date	Value
2022: SUEBA USA CORPORATION 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	101
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	72
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	22
Total of all active and inactive participants	2022-01-01	94
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	94
Number of participants with account balances	2022-01-01	72
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	1
2021: SUEBA USA CORPORATION 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	114
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	76
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	24
Total of all active and inactive participants	2021-01-01	100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	100
Number of participants with account balances	2021-01-01	76
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: SUEBA USA CORPORATION 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	103
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	101
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	12
Total of all active and inactive participants	2020-01-01	113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	113
Number of participants with account balances	2020-01-01	71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: SUEBA USA CORPORATION 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	137
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	94
Number of retired or separated participants receiving benefits	2019-01-01	7
Number of other retired or separated participants entitled to future benefits	2019-01-01	2
Total of all active and inactive participants	2019-01-01	103
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	103
Number of participants with account balances	2019-01-01	56
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	19
2018: SUEBA USA CORPORATION 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	135
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	116
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	18
Total of all active and inactive participants	2018-01-01	134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	134
Number of participants with account balances	2018-01-01	58
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	20
2017: SUEBA USA CORPORATION 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	126
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	114
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	16
Total of all active and inactive participants	2017-01-01	130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	130
Number of participants with account balances	2017-01-01	53
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	15
2016: SUEBA USA CORPORATION 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	127
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	107
Number of retired or separated participants receiving benefits	2016-01-01	1
Number of other retired or separated participants entitled to future benefits	2016-01-01	14
Total of all active and inactive participants	2016-01-01	122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	122
Number of participants with account balances	2016-01-01	55
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	14

Financial Data on SUEBA USA CORPORATION 401(K) PLAN

Measure	Date	Value
2022 : SUEBA USA CORPORATION 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	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$125
Total income from all sources (including contributions)	2022-12-31	$-643,436
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$180,155
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$174,009
Expenses. Certain deemed distributions of participant loans	2022-12-31	$1,523
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$632,621
Value of total assets at end of year	2022-12-31	$5,682,527
Value of total assets at beginning of year	2022-12-31	$6,506,243
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$4,623
Total interest from all sources	2022-12-31	$2,061
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$372,786
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$372,786
Administrative expenses professional fees incurred	2022-12-31	$4,623
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	$423,546
Participant contributions at end of year	2022-12-31	$145,309
Participant contributions at beginning of year	2022-12-31	$33,914
Participant contributions at beginning of year	2022-12-31	$14,867
Other income not declared elsewhere	2022-12-31	$5,428
Liabilities. Value of operating payables at beginning of year	2022-12-31	$125
Total non interest bearing cash at end of year	2022-12-31	$209
Total non interest bearing cash at beginning of year	2022-12-31	$987
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	$-823,591
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$5,682,527
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$6,506,118
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	$5,078,959
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$6,087,448
Income. Interest from loans (other than to participants)	2022-12-31	$2,047
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-12-31	$1,591
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2022-12-31	$14
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$456,459
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$359,366
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-1,656,332
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	$209,075
Employer contributions (assets) at beginning of year	2022-12-31	$9,661
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$174,009
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	LAPORTE, APAC
Accountancy firm EIN	2022-12-31	722018864
2021 : SUEBA USA CORPORATION 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	$125
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$1,533,913
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$79,724
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$66,799
Value of total corrective distributions	2021-12-31	$10,061
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$729,624
Value of total assets at end of year	2021-12-31	$6,506,243
Value of total assets at beginning of year	2021-12-31	$5,051,929
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$2,864
Total interest from all sources	2021-12-31	$2,453
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$65,368
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	$65,368
Administrative expenses professional fees incurred	2021-12-31	$2,864
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	$476,357
Participant contributions at end of year	2021-12-31	$33,914
Participant contributions at beginning of year	2021-12-31	$53,691
Participant contributions at end of year	2021-12-31	$14,867
Participant contributions at beginning of year	2021-12-31	$1,083
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$21,946
Other income not declared elsewhere	2021-12-31	$4,765
Liabilities. Value of operating payables at end of year	2021-12-31	$125
Total non interest bearing cash at end of year	2021-12-31	$987
Total non interest bearing cash at beginning of year	2021-12-31	$62,286
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	$1,454,189
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$6,506,118
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$5,051,929
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$6,087,448
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$4,727,059
Interest on participant loans	2021-12-31	$2,453
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2021-12-31	$118
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2021-12-31	$118
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$359,366
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$204,394
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$731,703
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	Yes
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	$231,321
Employer contributions (assets) at end of year	2021-12-31	$9,661
Employer contributions (assets) at beginning of year	2021-12-31	$3,298
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$66,799
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	LAPORTE, APAC
Accountancy firm EIN	2021-12-31	722018864
2020 : SUEBA USA CORPORATION 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	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$1,620,517
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$762,667
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$688,379
Expenses. Certain deemed distributions of participant loans	2020-12-31	$907
Value of total corrective distributions	2020-12-31	$69,955
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$714,907
Value of total assets at end of year	2020-12-31	$5,051,929
Value of total assets at beginning of year	2020-12-31	$4,194,079
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$3,426
Total interest from all sources	2020-12-31	$3,009
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$74,257
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	$74,257
Administrative expenses professional fees incurred	2020-12-31	$3,426
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	Yes
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	$485,017
Participant contributions at end of year	2020-12-31	$53,691
Participant contributions at beginning of year	2020-12-31	$60,538
Participant contributions at end of year	2020-12-31	$1,083
Other income not declared elsewhere	2020-12-31	$7,248
Total non interest bearing cash at end of year	2020-12-31	$62,286
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	$857,850
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$5,051,929
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$4,194,079
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	$4,727,059
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$4,058,206
Interest on participant loans	2020-12-31	$3,009
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-12-31	$118
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$204,394
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$75,335
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$812,725
Net investment gain/loss from pooled separate accounts	2020-12-31	$8,371
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	$229,890
Employer contributions (assets) at end of year	2020-12-31	$3,298
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$688,379
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2020-12-31	Yes
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	LAPORTE, APAC
Accountancy firm EIN	2020-12-31	722018864
2019 : SUEBA USA CORPORATION 401(K) PLAN 2019 401k financial data
Unrealized appreciation/depreciation of real estate assets	2019-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2019-12-31	$0
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Expenses. Interest paid	2019-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$1,059,261
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$863,353
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$812,279
Expenses. Certain deemed distributions of participant loans	2019-12-31	$0
Value of total corrective distributions	2019-12-31	$47,582
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$307,516
Value of total assets at end of year	2019-12-31	$4,194,079
Value of total assets at beginning of year	2019-12-31	$3,998,171
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$3,492
Total income from rents	2019-12-31	$0
Total interest from all sources	2019-12-31	$12,852
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
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$0
Assets. Real estate other than employer real property at end of year	2019-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2019-12-31	$0
Administrative expenses professional fees incurred	2019-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2019-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2019-12-31	$0
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	Yes
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	$307,516
Participant contributions at end of year	2019-12-31	$60,538
Participant contributions at beginning of year	2019-12-31	$30,266
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2019-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2019-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2019-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$0
Assets. Loans (other than to participants) at end of year	2019-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2019-12-31	$0
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	$0
Other income not declared elsewhere	2019-12-31	$0
Administrative expenses (other) incurred	2019-12-31	$106
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
Income. Non cash contributions	2019-12-31	$0
Value of net income/loss	2019-12-31	$195,908
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$4,194,079
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$3,998,171
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
Assets. partnership/joint venture interests at end of year	2019-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2019-12-31	$0
Investment advisory and management fees	2019-12-31	$3,386
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$0
Value of interest in pooled separate accounts at end of year	2019-12-31	$4,058,206
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$3,146,389
Interest on participant loans	2019-12-31	$4,051
Income. Interest from loans (other than to participants)	2019-12-31	$0
Interest earned on other investments	2019-12-31	$8,801
Income. Interest from US Government securities	2019-12-31	$0
Income. Interest from corporate debt instruments	2019-12-31	$0
Value of interest in master investment trust accounts at end of year	2019-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2019-12-31	$0
Value of interest in common/collective trusts at end of year	2019-12-31	$0
Value of interest in common/collective trusts at beginning of year	2019-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$0
Assets. Value of investments in 103.12 investment entities at end of year	2019-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2019-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$75,335
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$821,516
Expenses. Payments to insurance carriers foe the provision of benefits	2019-12-31	$0
Asset value of US Government securities at end of year	2019-12-31	$0
Asset value of US Government securities at beginning of year	2019-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$0
Net investment gain/loss from pooled separate accounts	2019-12-31	$738,893
Net investment gain or loss from common/collective trusts	2019-12-31	$0
Net gain/loss from 103.12 investment entities	2019-12-31	$0
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
Assets. Invements in employer securities at end of year	2019-12-31	$0
Assets. Invements in employer securities at beginning of year	2019-12-31	$0
Assets. Value of employer real property at end of year	2019-12-31	$0
Assets. Value of employer real property at beginning of year	2019-12-31	$0
Contributions received in cash from employer	2019-12-31	$0
Employer contributions (assets) at end of year	2019-12-31	$0
Employer contributions (assets) at beginning of year	2019-12-31	$0
Income. Dividends from preferred stock	2019-12-31	$0
Income. Dividends from common stock	2019-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$812,279
Asset. Corporate debt instrument preferred debt at end of year	2019-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2019-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2019-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2019-12-31	$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2019-12-31	Yes
Assets. Corporate common stocks other than exployer securities at end of year	2019-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2019-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2019-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2019-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2019-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2019-12-31	$0
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
Aggregate proceeds on sale of assets	2019-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2019-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2019-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2019-12-31	$0
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	LAPORTE, APAC
Accountancy firm EIN	2019-12-31	722018864
2018 : SUEBA USA CORPORATION 401(K) PLAN 2018 401k financial data
Unrealized appreciation/depreciation of real estate assets	2018-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2018-12-31	$0
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Expenses. Interest paid	2018-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$71,854
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$16,704
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$11,342
Expenses. Certain deemed distributions of participant loans	2018-12-31	$0
Value of total corrective distributions	2018-12-31	$2,132
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$272,694
Value of total assets at end of year	2018-12-31	$3,998,171
Value of total assets at beginning of year	2018-12-31	$3,943,021
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$3,230
Total income from rents	2018-12-31	$0
Total interest from all sources	2018-12-31	$10,115
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
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$0
Assets. Real estate other than employer real property at end of year	2018-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2018-12-31	$0
Administrative expenses professional fees incurred	2018-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2018-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2018-12-31	$0
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	$272,694
Participant contributions at end of year	2018-12-31	$30,266
Participant contributions at beginning of year	2018-12-31	$23,892
Participant contributions at end of year	2018-12-31	$0
Participant contributions at beginning of year	2018-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2018-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2018-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2018-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2018-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2018-12-31	$0
Assets. Loans (other than to participants) at end of year	2018-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2018-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2018-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2018-12-31	$0
Other income not declared elsewhere	2018-12-31	$104
Administrative expenses (other) incurred	2018-12-31	$0
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
Income. Non cash contributions	2018-12-31	$0
Value of net income/loss	2018-12-31	$55,150
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$3,998,171
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$3,943,021
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
Assets. partnership/joint venture interests at end of year	2018-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2018-12-31	$0
Investment advisory and management fees	2018-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$0
Value of interest in pooled separate accounts at end of year	2018-12-31	$3,146,389
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$3,139,141
Interest on participant loans	2018-12-31	$1,233
Income. Interest from loans (other than to participants)	2018-12-31	$0
Interest earned on other investments	2018-12-31	$8,882
Income. Interest from US Government securities	2018-12-31	$0
Income. Interest from corporate debt instruments	2018-12-31	$0
Value of interest in master investment trust accounts at end of year	2018-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2018-12-31	$0
Value of interest in common/collective trusts at end of year	2018-12-31	$0
Value of interest in common/collective trusts at beginning of year	2018-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-31	$0
Assets. Value of investments in 103.12 investment entities at end of year	2018-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2018-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$821,516
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$779,988
Expenses. Payments to insurance carriers foe the provision of benefits	2018-12-31	$0
Asset value of US Government securities at end of year	2018-12-31	$0
Asset value of US Government securities at beginning of year	2018-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$0
Net investment gain/loss from pooled separate accounts	2018-12-31	$-211,059
Net investment gain or loss from common/collective trusts	2018-12-31	$0
Net gain/loss from 103.12 investment entities	2018-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Assets. Invements in employer securities at end of year	2018-12-31	$0
Assets. Invements in employer securities at beginning of year	2018-12-31	$0
Assets. Value of employer real property at end of year	2018-12-31	$0
Assets. Value of employer real property at beginning of year	2018-12-31	$0
Contributions received in cash from employer	2018-12-31	$0
Employer contributions (assets) at end of year	2018-12-31	$0
Employer contributions (assets) at beginning of year	2018-12-31	$0
Income. Dividends from preferred stock	2018-12-31	$0
Income. Dividends from common stock	2018-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$11,342
Asset. Corporate debt instrument preferred debt at end of year	2018-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2018-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2018-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2018-12-31	$0
Contract administrator fees	2018-12-31	$3,230
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2018-12-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2018-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2018-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2018-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2018-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2018-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2018-12-31	$0
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
Aggregate proceeds on sale of assets	2018-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2018-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2018-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2018-12-31	$0
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	LAPORTE, APAC
Accountancy firm EIN	2018-12-31	722018864
2017 : SUEBA USA CORPORATION 401(K) PLAN 2017 401k financial data
Unrealized appreciation/depreciation of real estate assets	2017-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2017-12-31	$0
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Expenses. Interest paid	2017-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$724,866
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$152,377
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$144,185
Expenses. Certain deemed distributions of participant loans	2017-12-31	$0
Value of total corrective distributions	2017-12-31	$5,542
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$252,912
Value of total assets at end of year	2017-12-31	$3,943,021
Value of total assets at beginning of year	2017-12-31	$3,370,532
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$2,650
Total income from rents	2017-12-31	$0
Total interest from all sources	2017-12-31	$8,941
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
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$0
Assets. Real estate other than employer real property at end of year	2017-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2017-12-31	$0
Administrative expenses professional fees incurred	2017-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2017-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2017-12-31	$0
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	$252,912
Participant contributions at end of year	2017-12-31	$23,892
Participant contributions at beginning of year	2017-12-31	$13,710
Participant contributions at end of year	2017-12-31	$0
Participant contributions at beginning of year	2017-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2017-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2017-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2017-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2017-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2017-12-31	$0
Assets. Loans (other than to participants) at end of year	2017-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2017-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2017-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2017-12-31	$0
Other income not declared elsewhere	2017-12-31	$0
Administrative expenses (other) incurred	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
Income. Non cash contributions	2017-12-31	$0
Value of net income/loss	2017-12-31	$572,489
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$3,943,021
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$3,370,532
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
Assets. partnership/joint venture interests at end of year	2017-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2017-12-31	$0
Investment advisory and management fees	2017-12-31	$2,650
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$0
Value of interest in pooled separate accounts at end of year	2017-12-31	$3,139,141
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$2,665,814
Interest on participant loans	2017-12-31	$926
Income. Interest from loans (other than to participants)	2017-12-31	$0
Interest earned on other investments	2017-12-31	$8,015
Income. Interest from US Government securities	2017-12-31	$0
Income. Interest from corporate debt instruments	2017-12-31	$0
Value of interest in master investment trust accounts at end of year	2017-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2017-12-31	$0
Value of interest in common/collective trusts at end of year	2017-12-31	$0
Value of interest in common/collective trusts at beginning of year	2017-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-12-31	$0
Assets. Value of investments in 103.12 investment entities at end of year	2017-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2017-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$779,988
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$691,008
Expenses. Payments to insurance carriers foe the provision of benefits	2017-12-31	$0
Asset value of US Government securities at end of year	2017-12-31	$0
Asset value of US Government securities at beginning of year	2017-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$0
Net investment gain/loss from pooled separate accounts	2017-12-31	$463,013
Net investment gain or loss from common/collective trusts	2017-12-31	$0
Net gain/loss from 103.12 investment entities	2017-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Assets. Invements in employer securities at end of year	2017-12-31	$0
Assets. Invements in employer securities at beginning of year	2017-12-31	$0
Assets. Value of employer real property at end of year	2017-12-31	$0
Assets. Value of employer real property at beginning of year	2017-12-31	$0
Contributions received in cash from employer	2017-12-31	$0
Employer contributions (assets) at end of year	2017-12-31	$0
Employer contributions (assets) at beginning of year	2017-12-31	$0
Income. Dividends from preferred stock	2017-12-31	$0
Income. Dividends from common stock	2017-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$144,185
Asset. Corporate debt instrument preferred debt at end of year	2017-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2017-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2017-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2017-12-31	$0
Contract administrator fees	2017-12-31	$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2017-12-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2017-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2017-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2017-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2017-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2017-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2017-12-31	$0
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
Aggregate proceeds on sale of assets	2017-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2017-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2017-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2017-12-31	$0
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	LAPORTE, APAC
Accountancy firm EIN	2017-12-31	722018864
2016 : SUEBA USA CORPORATION 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	$0
Total income from all sources (including contributions)	2016-12-31	$441,684
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$53,174
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$51,508
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$230,515
Value of total assets at end of year	2016-12-31	$3,370,532
Value of total assets at beginning of year	2016-12-31	$2,982,022
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$1,666
Total interest from all sources	2016-12-31	$1,490
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$8,586
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$8,586
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$230,515
Participant contributions at end of year	2016-12-31	$13,710
Participant contributions at beginning of year	2016-12-31	$75,136
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	$388,510
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$3,370,532
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$2,982,022
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
Investment advisory and management fees	2016-12-31	$1,666
Value of interest in pooled separate accounts at end of year	2016-12-31	$2,665,814
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$2,142,261
Interest on participant loans	2016-12-31	$1,490
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$691,008
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$764,625
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$201,093
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$51,508
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2016-12-31	No
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	LAPORTE APAC
Accountancy firm EIN	2016-12-31	722018864

Form 5500 Responses for SUEBA USA CORPORATION 401(K) PLAN

2022: SUEBA USA CORPORATION 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: SUEBA USA CORPORATION 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: SUEBA USA CORPORATION 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: SUEBA USA CORPORATION 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 benefit arrangement – Insurance	Yes
2018: SUEBA USA CORPORATION 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 benefit arrangement – Insurance	Yes
2017: SUEBA USA CORPORATION 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 benefit arrangement – Insurance	Yes
2016: SUEBA USA CORPORATION 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 benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )

Policy contract number

GA-64248

Policy instance

Insurance contract or identification number	GA-64248
Number of Individuals Covered	24
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?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )

Policy contract number

GA-64248

Policy instance

Insurance contract or identification number	GA-64248
Number of Individuals Covered	24
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with 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?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

91557-01

Policy instance

Insurance contract or identification number	91557-01
Number of Individuals Covered	0
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,012
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 $1,012
Insurance broker organization code?	3

PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )

Policy contract number

GA-64248

Policy instance

Insurance contract or identification number	GA-64248
Number of Individuals Covered	15
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with 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?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

91557-01

Policy instance

Insurance contract or identification number	91557-01
Number of Individuals Covered	56
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $10,437
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 $10,437
Insurance broker organization code?	3

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

Policy contract number

91557-01

Policy instance

Insurance contract or identification number	91557-01
Number of Individuals Covered	58
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $10,231
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 $10,231
Insurance broker organization code?	3

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

Policy contract number

91557-01

Policy instance

Insurance contract or identification number	91557-01
Number of Individuals Covered	53
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $8,894
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 $8,894
Insurance broker organization code?	3
Insurance broker name	USI SOUTHWEST INC

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Company Name:	SUEBA USA CORPORATION
Employer identification number (EIN):	760081661
NAIC Classification:	531310