401k Plan data: AMERICAN COVERS, INC. PROFIT SHARING PLAN plan

AMERICAN COVERS, INC. PROFIT SHARING PLAN 401k Plan overview

Plan Name	AMERICAN COVERS, INC. PROFIT SHARING PLAN
Plan identification number	001

AMERICAN COVERS, INC. PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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

AMERICAN COVERS, INC has sponsored the creation of one or more 401k plans.

Company Name: AMERICAN COVERS, INC

Employer identification number (EIN): 870400223

NAIC Classification: 453210
NAIC Description: Office Supplies and Stationery Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AMERICAN COVERS, INC. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2017-01-01
001 2016-01-01 MARK PARADIS
001 2015-01-01 RODD STEUART
001 2014-01-01 RODD STEUART
001 2013-01-01 RODD STEUART
001 2012-01-01 RODD STEUART 2013-07-22
001 2011-01-01 RODD STEUART 2012-06-20
001 2010-01-01 RODD STEUART 2011-04-20 RODD STEUART 2011-04-20

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2017-01-01
001	2016-01-01	MARK PARADIS
001	2015-01-01	RODD STEUART
001	2014-01-01	RODD STEUART
001	2013-01-01	RODD STEUART
001	2012-01-01	RODD STEUART	2013-07-22
001	2011-01-01	RODD STEUART	2012-06-20
001	2010-01-01	RODD STEUART	2011-04-20	RODD STEUART	2011-04-20

Plan Statistics for AMERICAN COVERS, INC. PROFIT SHARING PLAN

401k plan membership statisitcs for AMERICAN COVERS, INC. PROFIT SHARING PLAN

Measure Date Value
2017: AMERICAN COVERS, INC. PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 265
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 0
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 0
Total of all active and inactive participants 2017-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 0
Number of participants with account balances 2017-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: AMERICAN COVERS, INC. PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 261
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 209
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 53
Total of all active and inactive participants 2016-01-01 262
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 1
Total participants 2016-01-01 263
Number of participants with account balances 2016-01-01 229
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 21
2015: AMERICAN COVERS, INC. PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 139
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 230
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 27
Total of all active and inactive participants 2015-01-01 257
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 257
Number of participants with account balances 2015-01-01 207
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: AMERICAN COVERS, INC. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 136
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 113
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 22
Total of all active and inactive participants 2014-01-01 135
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 135
Number of participants with account balances 2014-01-01 125
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 8
2013: AMERICAN COVERS, INC. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 134
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 104
Number of retired or separated participants receiving benefits 2013-01-01 1
Number of other retired or separated participants entitled to future benefits 2013-01-01 27
Total of all active and inactive participants 2013-01-01 132
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 132
Number of participants with account balances 2013-01-01 91
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 2

Measure	Date	Value
2017: AMERICAN COVERS, INC. PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	265
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	0
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	0
Total of all active and inactive participants	2017-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	0
Number of participants with account balances	2017-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: AMERICAN COVERS, INC. PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	261
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	209
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	53
Total of all active and inactive participants	2016-01-01	262
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	1
Total participants	2016-01-01	263
Number of participants with account balances	2016-01-01	229
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	21
2015: AMERICAN COVERS, INC. PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	139
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	230
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	27
Total of all active and inactive participants	2015-01-01	257
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	257
Number of participants with account balances	2015-01-01	207
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: AMERICAN COVERS, INC. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	136
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	113
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	22
Total of all active and inactive participants	2014-01-01	135
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	135
Number of participants with account balances	2014-01-01	125
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	8
2013: AMERICAN COVERS, INC. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	134
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	104
Number of retired or separated participants receiving benefits	2013-01-01	1
Number of other retired or separated participants entitled to future benefits	2013-01-01	27
Total of all active and inactive participants	2013-01-01	132
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	132
Number of participants with account balances	2013-01-01	91
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	2

Financial Data on AMERICAN COVERS, INC. PROFIT SHARING PLAN

Measure	Date	Value
2017 : AMERICAN COVERS, INC. PROFIT SHARING PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-06-30	$0
Total transfer of assets from this plan	2017-06-30	$5,932,892
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-06-30	$0
Total income from all sources (including contributions)	2017-06-30	$466,203
Total loss/gain on sale of assets	2017-06-30	$0
Total of all expenses incurred	2017-06-30	$306,738
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-06-30	$258,106
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-06-30	$0
Value of total assets at end of year	2017-06-30	$0
Value of total assets at beginning of year	2017-06-30	$5,773,427
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-06-30	$48,632
Total interest from all sources	2017-06-30	$7,824
Total dividends received (eg from common stock, registered investment company shares)	2017-06-30	$43,470
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-06-30	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2017-06-30	$0
Total dividends received from registered investment company shares (eg mutual funds)	2017-06-30	$43,470
Was this plan covered by a fidelity bond	2017-06-30	Yes
Value of fidelity bond cover	2017-06-30	$500,000
If this is an individual account plan, was there a blackout period	2017-06-30	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2017-06-30	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-06-30	No
Value of net income/loss	2017-06-30	$159,465
Value of net assets at end of year (total assets less liabilities)	2017-06-30	$0
Value of net assets at beginning of year (total assets less liabilities)	2017-06-30	$5,773,427
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-06-30	No
Were any leases to which the plan was party in default or uncollectible	2017-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-06-30	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-06-30	$5,443,322
Interest earned on other investments	2017-06-30	$7,824
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-06-30	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-06-30	$330,105
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-06-30	$414,909
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-06-30	No
Was there a failure to transmit to the plan any participant contributions	2017-06-30	No
Has the plan failed to provide any benefit when due under the plan	2017-06-30	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-06-30	$258,106
Contract administrator fees	2017-06-30	$48,632
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	2017-06-30	Yes
Did the plan have assets held for investment	2017-06-30	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	2017-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2017-06-30	Disclaimer
Accountancy firm name	2017-06-30	WSRP, LLC
Accountancy firm EIN	2017-06-30	870517754
2016 : AMERICAN COVERS, INC. PROFIT SHARING 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	$2,676,460
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$378,427
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$325,291
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$2,149,521
Value of total assets at end of year	2016-12-31	$5,773,427
Value of total assets at beginning of year	2016-12-31	$3,475,394
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$53,136
Total interest from all sources	2016-12-31	$5,809
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$143,405
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$143,405
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
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$727,859
Participant contributions at beginning of year	2016-12-31	$11,260
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$1,032,946
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	$2,298,033
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$5,773,427
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$3,475,394
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$5,443,322
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$3,387,454
Interest earned on other investments	2016-12-31	$5,809
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$330,105
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$72,343
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$377,725
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
Contributions received in cash from employer	2016-12-31	$388,716
Employer contributions (assets) at beginning of year	2016-12-31	$4,337
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$325,291
Contract administrator fees	2016-12-31	$53,136
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	WSRP, LLC
Accountancy firm EIN	2016-12-31	870517754
2015 : AMERICAN COVERS, INC. PROFIT SHARING PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$786,160
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$311,910
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$276,741
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$755,571
Value of total assets at end of year	2015-12-31	$3,475,394
Value of total assets at beginning of year	2015-12-31	$3,001,144
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$35,169
Total interest from all sources	2015-12-31	$1,089
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$378,108
Participant contributions at end of year	2015-12-31	$11,260
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$159,961
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$474,250
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$3,475,394
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$3,001,144
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$3,387,454
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$2,953,798
Interest earned on other investments	2015-12-31	$1,089
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$72,343
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$47,346
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$29,500
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$217,502
Employer contributions (assets) at end of year	2015-12-31	$4,337
Employer contributions (assets) at beginning of year	2015-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$276,741
Contract administrator fees	2015-12-31	$35,169
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	2015-12-31	No
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	WSRP, LLC
Accountancy firm EIN	2015-12-31	870517754
2014 : AMERICAN COVERS, INC. PROFIT SHARING PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$4,548
Total income from all sources (including contributions)	2014-12-31	$757,970
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$609,132
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$593,555
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$531,726
Value of total assets at end of year	2014-12-31	$3,001,144
Value of total assets at beginning of year	2014-12-31	$2,856,854
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$15,577
Total interest from all sources	2014-12-31	$217
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$500,000
If this is an individual account plan, was there a blackout period	2014-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$305,165
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$54,883
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$4,548
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$148,838
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$3,001,144
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$2,852,306
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$2,953,798
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$0
Value of interest in pooled separate accounts at end of year	2014-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$2,835,261
Interest earned on other investments	2014-12-31	$217
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$6,499
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$6,499
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$47,346
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$226,027
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$171,678
Employer contributions (assets) at end of year	2014-12-31	$0
Employer contributions (assets) at beginning of year	2014-12-31	$15,094
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$593,555
Contract administrator fees	2014-12-31	$15,577
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2014-12-31	Yes
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	WSRP, LLC
Accountancy firm EIN	2014-12-31	870517754
2013 : AMERICAN COVERS, INC. PROFIT SHARING PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$4,548
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$924,911
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$450,258
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$434,173
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$422,386
Value of total assets at end of year	2013-12-31	$2,856,854
Value of total assets at beginning of year	2013-12-31	$2,377,653
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$16,085
Total interest from all sources	2013-12-31	$6
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$254,236
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$1,805
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-12-31	$4,548
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-12-31	$0
Total non interest bearing cash at end of year	2013-12-31	$0
Total non interest bearing cash at beginning of year	2013-12-31	$4,817
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$474,653
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$2,852,306
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$2,377,653
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in pooled separate accounts at end of year	2013-12-31	$2,835,261
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$2,358,611
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$6,499
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$6,493
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$6,493
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$6
Net investment gain/loss from pooled separate accounts	2013-12-31	$502,519
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Assets. Invements in employer securities at end of year	2013-12-31	$0
Assets. Invements in employer securities at beginning of year	2013-12-31	$0
Contributions received in cash from employer	2013-12-31	$166,345
Employer contributions (assets) at end of year	2013-12-31	$15,094
Employer contributions (assets) at beginning of year	2013-12-31	$7,732
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$434,173
Contract administrator fees	2013-12-31	$16,085
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	WISAN, SMITH, RACKER & PRESCOTT,LLP
Accountancy firm EIN	2013-12-31	870517754

Form 5500 Responses for AMERICAN COVERS, INC. PROFIT SHARING PLAN

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

Insurance Providers Used on plan

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

809209

Policy instance

Insurance contract or identification number	809209
Number of Individuals Covered	0
Insurance policy start date	2016-01-01
Insurance policy end date	2017-06-30
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	1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

809209

Policy instance

Insurance contract or identification number	809209
Number of Individuals Covered	257
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
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?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

86929

Policy instance

Insurance contract or identification number	86929
Number of Individuals Covered	0
Insurance policy start date	2014-01-01
Insurance policy end date	2014-07-28
Total amount of commissions paid to insurance broker	USD $8,148
Total amount of fees paid to insurance company	USD $883
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,148
Insurance broker organization code?	3
Amount paid for insurance broker fees	883
Additional information about fees paid to insurance broker	TPA COMPENSATION TPA FEES PAID
Insurance broker name	ROCKY MOUNTAIN EMPLOYEE BENEFITS

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

809209

Policy instance

Insurance contract or identification number	809209
Number of Individuals Covered	135
Insurance policy start date	2014-07-28
Insurance policy end date	2014-12-31
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?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

86929

Policy instance

Insurance contract or identification number	86929
Number of Individuals Covered	91
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $13,392
Total amount of fees paid to insurance company	USD $1,716
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,907
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	FINANCIAL ADVISOR
Insurance broker organization code?	3
Insurance broker name	ROCKY MOUNTAIN EMPLOYEE BENEFITS, I

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Company Name:	AMERICAN COVERS, INC
Employer identification number (EIN):	870400223
NAIC Classification:	453210
NAIC Description:	Office Supplies and Stationery Stores