401k Plan data: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST plan

FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 401k Plan overview

Plan Name	FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST
Plan identification number	501

FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

FORGED COMPONENTS, INC. has sponsored the creation of one or more 401k plans.

Company Name: FORGED COMPONENTS, INC.

Employer identification number (EIN): 760539809

NAIC Classification: 332110

Additional information about FORGED COMPONENTS, INC.

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 1997-04-15

Company Identification Number: 0144116100

Legal Registered Office Address: 14527 SMITH RD

HUMBLE
United States of America (USA)
77396

More information about FORGED COMPONENTS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-04-01 DON C. BRIDGES, JR 2023-08-07
501 2021-04-01 VERONICA DE HOYOS 2023-06-22
501 2020-04-01 DON BRIDGES 2021-09-16
501 2017-09-01 DON BRIDGES
501 2016-09-01 JOE AUGUST
501 2015-09-01 JOE AUGUST
501 2014-09-01 STEPHEN GOODWIN
501 2013-09-01 STEPHEN GOODWIN
501 2012-09-01 STEPHEN GOODWIN
501 2012-07-01 CHRIS STEPHENSON
501 2011-07-01 CHRIS STEPHENSON
501 2009-07-01 JOE AUGUST

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-04-01	DON C. BRIDGES, JR	2023-08-07
501	2021-04-01	VERONICA DE HOYOS	2023-06-22
501	2020-04-01	DON BRIDGES	2021-09-16
501	2017-09-01	DON BRIDGES
501	2016-09-01	JOE AUGUST
501	2015-09-01	JOE AUGUST
501	2014-09-01	STEPHEN GOODWIN
501	2013-09-01	STEPHEN GOODWIN
501	2012-09-01	STEPHEN GOODWIN
501	2012-07-01	CHRIS STEPHENSON
501	2011-07-01	CHRIS STEPHENSON
501	2009-07-01	JOE AUGUST

Plan Statistics for FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST

401k plan membership statisitcs for FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST

Measure Date Value
2022: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2022 401k membership
Total participants, beginning-of-year 2022-04-01 262
Total number of active participants reported on line 7a of the Form 5500 2022-04-01 262
Total of all active and inactive participants 2022-04-01 262
Total participants 2022-04-01 262
2021: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2021 401k membership
Total participants, beginning-of-year 2021-04-01 175
Total number of active participants reported on line 7a of the Form 5500 2021-04-01 175
Total of all active and inactive participants 2021-04-01 175
Total participants 2021-04-01 175
2020: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2020 401k membership
Total participants, beginning-of-year 2020-04-01 274
Total number of active participants reported on line 7a of the Form 5500 2020-04-01 245
Number of retired or separated participants receiving benefits 2020-04-01 0
Number of other retired or separated participants entitled to future benefits 2020-04-01 0
Total of all active and inactive participants 2020-04-01 245
Total participants 2020-04-01 245
2017: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2017 401k membership
Total participants, beginning-of-year 2017-09-01 0
Total number of active participants reported on line 7a of the Form 5500 2017-09-01 0
Number of retired or separated participants receiving benefits 2017-09-01 0
Number of other retired or separated participants entitled to future benefits 2017-09-01 0
Total of all active and inactive participants 2017-09-01 0
2016: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2016 401k membership
Total participants, beginning-of-year 2016-09-01 0
Total number of active participants reported on line 7a of the Form 5500 2016-09-01 0
Number of retired or separated participants receiving benefits 2016-09-01 0
Number of other retired or separated participants entitled to future benefits 2016-09-01 0
Total of all active and inactive participants 2016-09-01 0
2015: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2015 401k membership
Total participants, beginning-of-year 2015-09-01 255
Total number of active participants reported on line 7a of the Form 5500 2015-09-01 0
Number of retired or separated participants receiving benefits 2015-09-01 0
Number of other retired or separated participants entitled to future benefits 2015-09-01 0
Total of all active and inactive participants 2015-09-01 0
2014: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2014 401k membership
Total participants, beginning-of-year 2014-09-01 275
Total number of active participants reported on line 7a of the Form 5500 2014-09-01 250
Number of retired or separated participants receiving benefits 2014-09-01 0
Number of other retired or separated participants entitled to future benefits 2014-09-01 0
Total of all active and inactive participants 2014-09-01 250
2013: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2013 401k membership
Total participants, beginning-of-year 2013-09-01 273
Total number of active participants reported on line 7a of the Form 5500 2013-09-01 261
Total of all active and inactive participants 2013-09-01 261
2012: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2012 401k membership
Total participants, beginning-of-year 2012-09-01 243
Total number of active participants reported on line 7a of the Form 5500 2012-09-01 200
Total of all active and inactive participants 2012-09-01 200
Total participants 2012-09-01 200
Total participants, beginning-of-year 2012-07-01 255
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 258
Total of all active and inactive participants 2012-07-01 258
2011: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2011 401k membership
Total participants, beginning-of-year 2011-07-01 101
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 247
Total of all active and inactive participants 2011-07-01 247
2009: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2009 401k membership
Total participants, beginning-of-year 2009-07-01 116
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 97
Total of all active and inactive participants 2009-07-01 97
Total participants 2009-07-01 97

Measure	Date	Value
2022: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2022 401k membership
Total participants, beginning-of-year	2022-04-01	262
Total number of active participants reported on line 7a of the Form 5500	2022-04-01	262
Total of all active and inactive participants	2022-04-01	262
Total participants	2022-04-01	262
2021: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2021 401k membership
Total participants, beginning-of-year	2021-04-01	175
Total number of active participants reported on line 7a of the Form 5500	2021-04-01	175
Total of all active and inactive participants	2021-04-01	175
Total participants	2021-04-01	175
2020: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2020 401k membership
Total participants, beginning-of-year	2020-04-01	274
Total number of active participants reported on line 7a of the Form 5500	2020-04-01	245
Number of retired or separated participants receiving benefits	2020-04-01	0
Number of other retired or separated participants entitled to future benefits	2020-04-01	0
Total of all active and inactive participants	2020-04-01	245
Total participants	2020-04-01	245
2017: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2017 401k membership
Total participants, beginning-of-year	2017-09-01	0
Total number of active participants reported on line 7a of the Form 5500	2017-09-01	0
Number of retired or separated participants receiving benefits	2017-09-01	0
Number of other retired or separated participants entitled to future benefits	2017-09-01	0
Total of all active and inactive participants	2017-09-01	0
2016: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2016 401k membership
Total participants, beginning-of-year	2016-09-01	0
Total number of active participants reported on line 7a of the Form 5500	2016-09-01	0
Number of retired or separated participants receiving benefits	2016-09-01	0
Number of other retired or separated participants entitled to future benefits	2016-09-01	0
Total of all active and inactive participants	2016-09-01	0
2015: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2015 401k membership
Total participants, beginning-of-year	2015-09-01	255
Total number of active participants reported on line 7a of the Form 5500	2015-09-01	0
Number of retired or separated participants receiving benefits	2015-09-01	0
Number of other retired or separated participants entitled to future benefits	2015-09-01	0
Total of all active and inactive participants	2015-09-01	0
2014: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2014 401k membership
Total participants, beginning-of-year	2014-09-01	275
Total number of active participants reported on line 7a of the Form 5500	2014-09-01	250
Number of retired or separated participants receiving benefits	2014-09-01	0
Number of other retired or separated participants entitled to future benefits	2014-09-01	0
Total of all active and inactive participants	2014-09-01	250
2013: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2013 401k membership
Total participants, beginning-of-year	2013-09-01	273
Total number of active participants reported on line 7a of the Form 5500	2013-09-01	261
Total of all active and inactive participants	2013-09-01	261
2012: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2012 401k membership
Total participants, beginning-of-year	2012-09-01	243
Total number of active participants reported on line 7a of the Form 5500	2012-09-01	200
Total of all active and inactive participants	2012-09-01	200
Total participants	2012-09-01	200
Total participants, beginning-of-year	2012-07-01	255
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	258
Total of all active and inactive participants	2012-07-01	258
2011: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2011 401k membership
Total participants, beginning-of-year	2011-07-01	101
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	247
Total of all active and inactive participants	2011-07-01	247
2009: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2009 401k membership
Total participants, beginning-of-year	2009-07-01	116
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	97
Total of all active and inactive participants	2009-07-01	97
Total participants	2009-07-01	97

Financial Data on FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST

Measure	Date	Value
2018 : FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2018 401k financial data
Total income from all sources	2018-08-31	$-17,370
Expenses. Total of all expenses incurred	2018-08-31	$75
Benefits paid (including direct rollovers)	2018-08-31	$75
Total plan assets at end of year	2018-08-31	$0
Total plan assets at beginning of year	2018-08-31	$17,445
Net income (gross income less expenses)	2018-08-31	$-17,445
Net plan assets at end of year (total assets less liabilities)	2018-08-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2018-08-31	$17,445
Total contributions received or receivable from employer(s)	2018-08-31	$-17,370
2017 : FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2017 401k financial data
Total plan liabilities at beginning of year	2017-08-31	$252
Total income from all sources	2017-08-31	$14,762
Expenses. Total of all expenses incurred	2017-08-31	$-2,683
Benefits paid (including direct rollovers)	2017-08-31	$-2,683
Total plan assets at end of year	2017-08-31	$17,445
Total plan assets at beginning of year	2017-08-31	$252
Net income (gross income less expenses)	2017-08-31	$17,445
Net plan assets at end of year (total assets less liabilities)	2017-08-31	$17,445
Net plan assets at beginning of year (total assets less liabilities)	2017-08-31	$0
Total contributions received or receivable from employer(s)	2017-08-31	$14,762
2016 : FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2016 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-08-31	$252
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-08-31	$538,664
Total income from all sources (including contributions)	2016-08-31	$1,035,440
Total of all expenses incurred	2016-08-31	$502,561
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-08-31	$390,242
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-08-31	$1,035,440
Value of total assets at end of year	2016-08-31	$252
Value of total assets at beginning of year	2016-08-31	$5,785
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-08-31	$112,319
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-08-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2016-08-31	$0
Was this plan covered by a fidelity bond	2016-08-31	No
If this is an individual account plan, was there a blackout period	2016-08-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-08-31	No
Contributions received from participants	2016-08-31	$221,498
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2016-08-31	$390,242
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2016-08-31	$252
Administrative expenses (other) incurred	2016-08-31	$112,319
Total non interest bearing cash at beginning of year	2016-08-31	$5,785
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-08-31	No
Value of net income/loss	2016-08-31	$532,879
Value of net assets at end of year (total assets less liabilities)	2016-08-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2016-08-31	$-532,879
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-08-31	No
Were any leases to which the plan was party in default or uncollectible	2016-08-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-08-31	No
Was there a failure to transmit to the plan any participant contributions	2016-08-31	No
Has the plan failed to provide any benefit when due under the plan	2016-08-31	No
Contributions received in cash from employer	2016-08-31	$813,942
Employer contributions (assets) at end of year	2016-08-31	$252
Liabilities. Value of benefit claims payable at beginning of year	2016-08-31	$538,664
Did the plan have assets held for investment	2016-08-31	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	2016-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-08-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-08-31	No
Opinion of an independent qualified public accountant for this plan	2016-08-31	Unqualified
Accountancy firm name	2016-08-31	MOORE, REICHL & BAKER PC
Accountancy firm EIN	2016-08-31	760520230
2015 : FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2015 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-08-31	$538,664
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-08-31	$208,874
Total income from all sources (including contributions)	2015-08-31	$3,199,143
Total of all expenses incurred	2015-08-31	$3,524,103
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-08-31	$3,381,695
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-08-31	$3,199,143
Value of total assets at end of year	2015-08-31	$5,785
Value of total assets at beginning of year	2015-08-31	$955
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-08-31	$142,408
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-08-31	No
Was this plan covered by a fidelity bond	2015-08-31	Yes
Value of fidelity bond cover	2015-08-31	$500,000
If this is an individual account plan, was there a blackout period	2015-08-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-08-31	No
Contributions received from participants	2015-08-31	$449,217
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2015-08-31	$3,381,695
Administrative expenses (other) incurred	2015-08-31	$142,408
Total non interest bearing cash at end of year	2015-08-31	$5,785
Total non interest bearing cash at beginning of year	2015-08-31	$955
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-08-31	No
Value of net income/loss	2015-08-31	$-324,960
Value of net assets at end of year (total assets less liabilities)	2015-08-31	$-532,879
Value of net assets at beginning of year (total assets less liabilities)	2015-08-31	$-207,919
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-08-31	No
Were any leases to which the plan was party in default or uncollectible	2015-08-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-08-31	No
Was there a failure to transmit to the plan any participant contributions	2015-08-31	No
Has the plan failed to provide any benefit when due under the plan	2015-08-31	No
Contributions received in cash from employer	2015-08-31	$2,749,926
Liabilities. Value of benefit claims payable at end of year	2015-08-31	$538,664
Liabilities. Value of benefit claims payable at beginning of year	2015-08-31	$208,874
Did the plan have assets held for investment	2015-08-31	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	2015-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-08-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-08-31	No
Opinion of an independent qualified public accountant for this plan	2015-08-31	Unqualified
Accountancy firm name	2015-08-31	MOORE, REICHL & BAKER PC
Accountancy firm EIN	2015-08-31	760520230
2014 : FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-08-31	$208,874
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-08-31	$103,615
Total income from all sources (including contributions)	2014-08-31	$1,936,296
Total of all expenses incurred	2014-08-31	$2,040,713
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-08-31	$1,891,546
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-08-31	$1,936,296
Value of total assets at end of year	2014-08-31	$955
Value of total assets at beginning of year	2014-08-31	$113
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-08-31	$149,167
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-08-31	No
Was this plan covered by a fidelity bond	2014-08-31	Yes
Value of fidelity bond cover	2014-08-31	$500,000
If this is an individual account plan, was there a blackout period	2014-08-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-08-31	No
Contributions received from participants	2014-08-31	$367,803
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2014-08-31	$1,891,546
Administrative expenses (other) incurred	2014-08-31	$149,167
Total non interest bearing cash at end of year	2014-08-31	$955
Total non interest bearing cash at beginning of year	2014-08-31	$113
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-08-31	No
Value of net income/loss	2014-08-31	$-104,417
Value of net assets at end of year (total assets less liabilities)	2014-08-31	$-207,919
Value of net assets at beginning of year (total assets less liabilities)	2014-08-31	$-103,502
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-08-31	No
Were any leases to which the plan was party in default or uncollectible	2014-08-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-08-31	No
Was there a failure to transmit to the plan any participant contributions	2014-08-31	No
Has the plan failed to provide any benefit when due under the plan	2014-08-31	No
Contributions received in cash from employer	2014-08-31	$1,568,493
Liabilities. Value of benefit claims payable at end of year	2014-08-31	$208,874
Liabilities. Value of benefit claims payable at beginning of year	2014-08-31	$103,615
Did the plan have assets held for investment	2014-08-31	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	2014-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-08-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-08-31	No
Opinion of an independent qualified public accountant for this plan	2014-08-31	Unqualified
Accountancy firm name	2014-08-31	MOORE, REICHL & BAKER PC
Accountancy firm EIN	2014-08-31	760520230
2013 : FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-08-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-08-31	$103,615
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-08-31	$109,879
Total income from all sources (including contributions)	2013-08-31	$963,117
Total loss/gain on sale of assets	2013-08-31	$0
Total of all expenses incurred	2013-08-31	$964,309
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-08-31	$858,746
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-08-31	$963,117
Value of total assets at end of year	2013-08-31	$113
Value of total assets at beginning of year	2013-08-31	$7,569
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-08-31	$105,563
Total interest from all sources	2013-08-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2013-08-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-08-31	No
Was this plan covered by a fidelity bond	2013-08-31	Yes
Value of fidelity bond cover	2013-08-31	$500,000
If this is an individual account plan, was there a blackout period	2013-08-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-08-31	No
Contributions received from participants	2013-08-31	$257,981
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2013-08-31	$858,746
Administrative expenses (other) incurred	2013-08-31	$105,563
Total non interest bearing cash at end of year	2013-08-31	$113
Total non interest bearing cash at beginning of year	2013-08-31	$7,569
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-08-31	No
Value of net income/loss	2013-08-31	$-1,192
Value of net assets at end of year (total assets less liabilities)	2013-08-31	$-103,502
Value of net assets at beginning of year (total assets less liabilities)	2013-08-31	$-102,310
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-08-31	No
Were any leases to which the plan was party in default or uncollectible	2013-08-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-08-31	No
Was there a failure to transmit to the plan any participant contributions	2013-08-31	No
Has the plan failed to provide any benefit when due under the plan	2013-08-31	No
Contributions received in cash from employer	2013-08-31	$705,136
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2013-08-31	No
Liabilities. Value of benefit claims payable at end of year	2013-08-31	$103,615
Liabilities. Value of benefit claims payable at beginning of year	2013-08-31	$109,879
Did the plan have assets held for investment	2013-08-31	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	2013-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-08-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-08-31	No
Opinion of an independent qualified public accountant for this plan	2013-08-31	Unqualified
Accountancy firm name	2013-08-31	MOORE, REICHL & BAKER PC
Accountancy firm EIN	2013-08-31	760520230
2012 : FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-08-31	$109,879
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-08-31	$88,351
Total income from all sources (including contributions)	2012-08-31	$125,143
Total of all expenses incurred	2012-08-31	$174,227
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-08-31	$151,314
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-08-31	$125,143
Value of total assets at end of year	2012-08-31	$7,569
Value of total assets at beginning of year	2012-08-31	$35,125
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-08-31	$22,913
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-08-31	No
Was this plan covered by a fidelity bond	2012-08-31	No
If this is an individual account plan, was there a blackout period	2012-08-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-08-31	No
Contributions received from participants	2012-08-31	$54,108
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2012-08-31	$151,314
Administrative expenses (other) incurred	2012-08-31	$22,913
Total non interest bearing cash at end of year	2012-08-31	$7,569
Total non interest bearing cash at beginning of year	2012-08-31	$35,125
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-08-31	No
Value of net income/loss	2012-08-31	$-49,084
Value of net assets at end of year (total assets less liabilities)	2012-08-31	$-102,310
Value of net assets at beginning of year (total assets less liabilities)	2012-08-31	$-53,226
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-08-31	No
Were any leases to which the plan was party in default or uncollectible	2012-08-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-08-31	No
Was there a failure to transmit to the plan any participant contributions	2012-08-31	No
Has the plan failed to provide any benefit when due under the plan	2012-08-31	No
Contributions received in cash from employer	2012-08-31	$71,035
Liabilities. Value of benefit claims payable at end of year	2012-08-31	$109,879
Liabilities. Value of benefit claims payable at beginning of year	2012-08-31	$88,351
Did the plan have assets held for investment	2012-08-31	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	2012-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-08-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-08-31	No
Opinion of an independent qualified public accountant for this plan	2012-08-31	Unqualified
Accountancy firm name	2012-08-31	MOORE, REICHL & BAKER PC
Accountancy firm EIN	2012-08-31	760520230
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-06-30	$88,351
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-06-30	$61,525
Total income from all sources (including contributions)	2012-06-30	$591,509
Total of all expenses incurred	2012-06-30	$583,210
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-06-30	$480,616
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-06-30	$591,509
Value of total assets at end of year	2012-06-30	$35,125
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-06-30	$102,594
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-06-30	No
Was this plan covered by a fidelity bond	2012-06-30	No
If this is an individual account plan, was there a blackout period	2012-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2012-06-30	No
Contributions received from participants	2012-06-30	$232,486
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2012-06-30	$480,616
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-06-30	$78
Administrative expenses (other) incurred	2012-06-30	$102,594
Total non interest bearing cash at end of year	2012-06-30	$35,125
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-06-30	No
Value of net income/loss	2012-06-30	$8,299
Value of net assets at end of year (total assets less liabilities)	2012-06-30	$-53,226
Value of net assets at beginning of year (total assets less liabilities)	2012-06-30	$-61,525
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-06-30	No
Were any leases to which the plan was party in default or uncollectible	2012-06-30	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-06-30	No
Was there a failure to transmit to the plan any participant contributions	2012-06-30	No
Has the plan failed to provide any benefit when due under the plan	2012-06-30	No
Contributions received in cash from employer	2012-06-30	$359,023
Liabilities. Value of benefit claims payable at end of year	2012-06-30	$88,351
Liabilities. Value of benefit claims payable at beginning of year	2012-06-30	$61,447
Did the plan have assets held for investment	2012-06-30	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	2012-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-06-30	No
Opinion of an independent qualified public accountant for this plan	2012-06-30	Unqualified
Accountancy firm name	2012-06-30	MOORE, REICHL & BAKER PC
Accountancy firm EIN	2012-06-30	760520230
2011 : FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-06-30	$61,525
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-06-30	$53,564
Total income from all sources (including contributions)	2011-06-30	$584,918
Total of all expenses incurred	2011-06-30	$606,624
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-06-30	$536,605
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-06-30	$584,918
Value of total assets at end of year	2011-06-30	$0
Value of total assets at beginning of year	2011-06-30	$13,745
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-06-30	$70,019
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-06-30	No
Was this plan covered by a fidelity bond	2011-06-30	No
If this is an individual account plan, was there a blackout period	2011-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2011-06-30	No
Contributions received from participants	2011-06-30	$101,999
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2011-06-30	$536,605
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-06-30	$78
Administrative expenses (other) incurred	2011-06-30	$70,019
Total non interest bearing cash at beginning of year	2011-06-30	$13,745
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-06-30	No
Value of net income/loss	2011-06-30	$-21,706
Value of net assets at end of year (total assets less liabilities)	2011-06-30	$-61,525
Value of net assets at beginning of year (total assets less liabilities)	2011-06-30	$-39,819
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-06-30	No
Were any leases to which the plan was party in default or uncollectible	2011-06-30	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-06-30	No
Was there a failure to transmit to the plan any participant contributions	2011-06-30	No
Has the plan failed to provide any benefit when due under the plan	2011-06-30	No
Contributions received in cash from employer	2011-06-30	$482,919
Liabilities. Value of benefit claims payable at end of year	2011-06-30	$61,447
Liabilities. Value of benefit claims payable at beginning of year	2011-06-30	$53,564
Did the plan have assets held for investment	2011-06-30	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	2011-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-06-30	No
Opinion of an independent qualified public accountant for this plan	2011-06-30	Unqualified
Accountancy firm name	2011-06-30	MOORE, REICHL & BAKER PC
Accountancy firm EIN	2011-06-30	760520230

Form 5500 Responses for FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST

2022: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2022 form 5500 responses
2022-04-01	Type of plan entity	Single employer plan
2022-04-01	Submission has been amended	No
2022-04-01	This submission is the final filing	No
2022-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-04-01	Plan is a collectively bargained plan	No
2022-04-01	Plan funding arrangement – Insurance	Yes
2022-04-01	Plan benefit arrangement – Insurance	Yes
2021: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2021 form 5500 responses
2021-04-01	Type of plan entity	Single employer plan
2021-04-01	Submission has been amended	No
2021-04-01	This submission is the final filing	No
2021-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-04-01	Plan is a collectively bargained plan	No
2021-04-01	Plan funding arrangement – Insurance	Yes
2021-04-01	Plan benefit arrangement – Insurance	Yes
2020: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2020 form 5500 responses
2020-04-01	Type of plan entity	Single employer plan
2020-04-01	First time form 5500 has been submitted	Yes
2020-04-01	Submission has been amended	No
2020-04-01	This submission is the final filing	No
2020-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-04-01	Plan is a collectively bargained plan	No
2020-04-01	Plan funding arrangement – Insurance	Yes
2020-04-01	Plan benefit arrangement – Insurance	Yes
2017: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2017 form 5500 responses
2017-09-01	Type of plan entity	Single employer plan
2017-09-01	This submission is the final filing	Yes
2017-09-01	Plan funding arrangement – Trust	Yes
2017-09-01	Plan benefit arrangement - Trust	Yes
2016: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2016 form 5500 responses
2016-09-01	Type of plan entity	Single employer plan
2016-09-01	Plan funding arrangement – Trust	Yes
2016-09-01	Plan benefit arrangement - Trust	Yes
2015: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2015 form 5500 responses
2015-09-01	Type of plan entity	Single employer plan
2015-09-01	Plan funding arrangement – Trust	Yes
2015-09-01	Plan benefit arrangement - Trust	Yes
2014: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2014 form 5500 responses
2014-09-01	Type of plan entity	Single employer plan
2014-09-01	Plan funding arrangement – Trust	Yes
2014-09-01	Plan benefit arrangement - Trust	Yes
2013: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2013 form 5500 responses
2013-09-01	Type of plan entity	Single employer plan
2013-09-01	Plan funding arrangement – Trust	Yes
2013-09-01	Plan benefit arrangement - Trust	Yes
2012: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2012 form 5500 responses
2012-09-01	Type of plan entity	Single employer plan
2012-09-01	Submission has been amended	No
2012-09-01	This submission is the final filing	No
2012-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-09-01	Plan is a collectively bargained plan	No
2012-09-01	Plan funding arrangement – Trust	Yes
2012-09-01	Plan benefit arrangement - Trust	Yes
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2012-07-01	Plan funding arrangement – Trust	Yes
2012-07-01	Plan benefit arrangement - Trust	Yes
2011: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Plan funding arrangement – Trust	Yes
2011-07-01	Plan benefit arrangement - Trust	Yes
2009: FORGED COMPONENTS EMPLOYEE BENEFIT PLAN TRUST 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	Plan funding arrangement – Trust	Yes
2009-07-01	Plan benefit arrangement – Insurance	Yes
2009-07-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

0629494

Policy instance

Insurance contract or identification number	0629494
Number of Individuals Covered	187
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $153,879
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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $955,682
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $153,879
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

BCM005722

Policy instance

Insurance contract or identification number	BCM005722
Number of Individuals Covered	9
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $4,299
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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $31,403
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,299
Insurance broker organization code?	3

THE HARTFORD (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

890873G

Policy instance

Insurance contract or identification number	890873G
Number of Individuals Covered	262
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $14,874
Total amount of fees paid to insurance company	USD $487
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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ADD
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $91,666
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,874
Amount paid for insurance broker fees	487
Additional information about fees paid to insurance broker	BONUS PAID
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

BCM0055723

Policy instance

Insurance contract or identification number	BCM0055723
Number of Individuals Covered	14
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $3,821
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?	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
Welfare Benefit Premiums Paid to Carrier	USD $30,570
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

0069494

Policy instance

Insurance contract or identification number	0069494
Number of Individuals Covered	177
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $2,600
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?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $818,435
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,600
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

890873G

Policy instance

Insurance contract or identification number	890873G
Number of Individuals Covered	242
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $15,282
Total amount of fees paid to insurance company	USD $166
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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ADD
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $94,455
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,282
Amount paid for insurance broker fees	166
Additional information about fees paid to insurance broker	BONUS PAID
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

BCM005722

Policy instance

Insurance contract or identification number	BCM005722
Number of Individuals Covered	9
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $2,044
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?	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
Welfare Benefit Premiums Paid to Carrier	USD $16,355
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

BCM00572-4

Policy instance

Insurance contract or identification number	BCM00572-4
Number of Individuals Covered	28
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $6,710
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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $67,646
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,710
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

890873G

Policy instance

Insurance contract or identification number	890873G
Number of Individuals Covered	247
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $16,060
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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ADD
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $100,415
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,060
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

0629494

Policy instance

Insurance contract or identification number	0629494
Number of Individuals Covered	162
Insurance policy start date	2020-04-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $11,234
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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $113,675
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,234
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00629494

Policy instance

Insurance contract or identification number	00629494
Number of Individuals Covered	175
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $142,019
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?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $730,745
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $142,019
Insurance broker organization code?	3

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Company Name:	FORGED COMPONENTS, INC.
Employer identification number (EIN):	760539809
NAIC Classification:	332110

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	1997-04-15
Company Identification Number:	0144116100
Legal Registered Office Address:	14527 SMITH RD HUMBLE United States of America (USA) 77396