401k Plan data: AMCHECK NEVADA 401K PLAN plan

AMCHECK NEVADA 401K PLAN 401k Plan overview

Plan Name	AMCHECK NEVADA 401K PLAN
Plan identification number	002

AMCHECK NEVADA 401K PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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

401k Sponsoring company profile

GIRISGEN & KOPOLOW, OD, PC has sponsored the creation of one or more 401k plans.

Company Name: GIRISGEN & KOPOLOW, OD, PC

Employer identification number (EIN): 880484278

NAIC Classification: 621320
NAIC Description: Offices of Optometrists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AMCHECK NEVADA 401K PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2022-01-01
002 2021-01-01
002 2020-01-01
002 2019-01-01
002 2018-01-01
002 2017-01-01 PHIL TISUE
002 2016-01-01 PHIL TISUE 2017-09-05
002 2015-01-01 PHIL TISUE 2016-09-29
002 2014-01-01 PHIL TISUE 2016-08-12
002 2014-01-01 PHIL TISUE 2015-10-09
002 2013-01-01 DEEN GUMERSON 2014-04-02
002 2012-01-01 DEEN GUMERSON 2013-05-24
002 2011-01-01 DEEN GUMERSON 2012-04-18
002 2010-01-01 JASON STANFIELD
002 2009-05-01 JASON STANFIELD

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
002	2022-01-01
002	2021-01-01
002	2020-01-01
002	2019-01-01
002	2018-01-01
002	2017-01-01	PHIL TISUE
002	2016-01-01	PHIL TISUE	2017-09-05
002	2015-01-01	PHIL TISUE	2016-09-29
002	2014-01-01	PHIL TISUE	2016-08-12
002	2014-01-01	PHIL TISUE	2015-10-09
002	2013-01-01	DEEN GUMERSON	2014-04-02
002	2012-01-01	DEEN GUMERSON	2013-05-24
002	2011-01-01	DEEN GUMERSON	2012-04-18
002	2010-01-01	JASON STANFIELD
002	2009-05-01	JASON STANFIELD

Plan Statistics for AMCHECK NEVADA 401K PLAN

401k plan membership statisitcs for AMCHECK NEVADA 401K PLAN

Measure Date Value
2022: AMCHECK NEVADA 401K PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 187
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 175
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 13
Total of all active and inactive participants 2022-01-01 188
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 188
Number of participants with account balances 2022-01-01 61
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: AMCHECK NEVADA 401K PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 178
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 161
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 15
Total of all active and inactive participants 2021-01-01 176
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 176
Number of participants with account balances 2021-01-01 53
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: AMCHECK NEVADA 401K PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 176
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 122
Number of retired or separated participants receiving benefits 2020-01-01 4
Number of other retired or separated participants entitled to future benefits 2020-01-01 21
Total of all active and inactive participants 2020-01-01 147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 147
Number of participants with account balances 2020-01-01 50
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: AMCHECK NEVADA 401K PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 168
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 146
Number of retired or separated participants receiving benefits 2019-01-01 1
Number of other retired or separated participants entitled to future benefits 2019-01-01 14
Total of all active and inactive participants 2019-01-01 161
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 161
Number of participants with account balances 2019-01-01 45
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: AMCHECK NEVADA 401K PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 167
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 147
Number of retired or separated participants receiving benefits 2018-01-01 2
Number of other retired or separated participants entitled to future benefits 2018-01-01 9
Total of all active and inactive participants 2018-01-01 158
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 158
Number of participants with account balances 2018-01-01 44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: AMCHECK NEVADA 401K PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 136
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 136
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 7
Total of all active and inactive participants 2017-01-01 143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 143
Number of participants with account balances 2017-01-01 34
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2010: AMCHECK NEVADA 401K PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 28
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 33
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 3
Total of all active and inactive participants 2010-01-01 36
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 36
Number of participants with account balances 2010-01-01 17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 2
2009: AMCHECK NEVADA 401K PLAN 2009 401k membership
Total participants, beginning-of-year 2009-05-01 26
Total number of active participants reported on line 7a of the Form 5500 2009-05-01 28
Number of retired or separated participants receiving benefits 2009-05-01 0
Number of other retired or separated participants entitled to future benefits 2009-05-01 0
Total of all active and inactive participants 2009-05-01 28
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-05-01 0
Total participants 2009-05-01 28
Number of participants with account balances 2009-05-01 14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-05-01 0

Measure	Date	Value
2022: AMCHECK NEVADA 401K PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	187
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	175
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	13
Total of all active and inactive participants	2022-01-01	188
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	188
Number of participants with account balances	2022-01-01	61
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: AMCHECK NEVADA 401K PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	178
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	161
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	15
Total of all active and inactive participants	2021-01-01	176
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	176
Number of participants with account balances	2021-01-01	53
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: AMCHECK NEVADA 401K PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	176
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	122
Number of retired or separated participants receiving benefits	2020-01-01	4
Number of other retired or separated participants entitled to future benefits	2020-01-01	21
Total of all active and inactive participants	2020-01-01	147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	147
Number of participants with account balances	2020-01-01	50
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: AMCHECK NEVADA 401K PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	168
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	146
Number of retired or separated participants receiving benefits	2019-01-01	1
Number of other retired or separated participants entitled to future benefits	2019-01-01	14
Total of all active and inactive participants	2019-01-01	161
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	161
Number of participants with account balances	2019-01-01	45
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: AMCHECK NEVADA 401K PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	167
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	147
Number of retired or separated participants receiving benefits	2018-01-01	2
Number of other retired or separated participants entitled to future benefits	2018-01-01	9
Total of all active and inactive participants	2018-01-01	158
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	158
Number of participants with account balances	2018-01-01	44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: AMCHECK NEVADA 401K PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	136
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	136
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	7
Total of all active and inactive participants	2017-01-01	143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	143
Number of participants with account balances	2017-01-01	34
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2010: AMCHECK NEVADA 401K PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	28
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	33
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	3
Total of all active and inactive participants	2010-01-01	36
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	36
Number of participants with account balances	2010-01-01	17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	2
2009: AMCHECK NEVADA 401K PLAN 2009 401k membership
Total participants, beginning-of-year	2009-05-01	26
Total number of active participants reported on line 7a of the Form 5500	2009-05-01	28
Number of retired or separated participants receiving benefits	2009-05-01	0
Number of other retired or separated participants entitled to future benefits	2009-05-01	0
Total of all active and inactive participants	2009-05-01	28
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-05-01	0
Total participants	2009-05-01	28
Number of participants with account balances	2009-05-01	14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-05-01	0

Financial Data on AMCHECK NEVADA 401K PLAN

Measure	Date	Value
2022 : AMCHECK NEVADA 401K PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-133,057
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$84,598
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$72,682
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$372,610
Value of total assets at end of year	2022-12-31	$2,901,568
Value of total assets at beginning of year	2022-12-31	$3,119,223
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$11,916
Total interest from all sources	2022-12-31	$2,666
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$385,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$304,287
Participant contributions at end of year	2022-12-31	$63,158
Participant contributions at beginning of year	2022-12-31	$63,369
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$5,090
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-217,655
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$2,901,568
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$3,119,223
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in pooled separate accounts at end of year	2022-12-31	$2,834,619
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$3,055,854
Interest on participant loans	2022-12-31	$2,666
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-12-31	$3,791
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-12-31	$0
Net investment gain/loss from pooled separate accounts	2022-12-31	$-508,333
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$63,233
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$72,682
Contract administrator fees	2022-12-31	$11,916
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	TEMPLETON & COMPANY, LLP
Accountancy firm EIN	2022-12-31	141918990
2021 : AMCHECK NEVADA 401K PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$613,571
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$172,823
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$129,892
Expenses. Certain deemed distributions of participant loans	2021-12-31	$23,406
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$239,420
Value of total assets at end of year	2021-12-31	$3,119,223
Value of total assets at beginning of year	2021-12-31	$2,678,475
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$19,525
Total interest from all sources	2021-12-31	$1,616
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$300,000
If this is an individual account plan, was there a blackout period	2021-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$216,986
Participant contributions at end of year	2021-12-31	$63,369
Participant contributions at beginning of year	2021-12-31	$51,310
Participant contributions at end of year	2021-12-31	$0
Participant contributions at beginning of year	2021-12-31	$4,736
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Income. Non cash contributions	2021-12-31	$22,434
Value of net income/loss	2021-12-31	$440,748
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$3,119,223
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$2,678,475
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in pooled separate accounts at end of year	2021-12-31	$3,055,854
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$2,589,213
Interest on participant loans	2021-12-31	$1,616
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$1,212
Net investment gain/loss from pooled separate accounts	2021-12-31	$372,535
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Employer contributions (assets) at end of year	2021-12-31	$0
Employer contributions (assets) at beginning of year	2021-12-31	$32,004
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$129,892
Contract administrator fees	2021-12-31	$19,525
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	2021-12-31	Yes
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	TEMPLETON & COMPANY, LLP
Accountancy firm EIN	2021-12-31	141918990
2020 : AMCHECK NEVADA 401K PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$545,618
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$300,159
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$290,762
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$200,131
Value of total assets at end of year	2020-12-31	$2,678,475
Value of total assets at beginning of year	2020-12-31	$2,433,016
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$9,397
Total interest from all sources	2020-12-31	$2,115
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$168,127
Participant contributions at end of year	2020-12-31	$51,310
Participant contributions at beginning of year	2020-12-31	$49,484
Participant contributions at end of year	2020-12-31	$4,736
Participant contributions at beginning of year	2020-12-31	$6,315
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$245,459
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$2,678,475
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$2,433,016
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in pooled separate accounts at end of year	2020-12-31	$2,589,213
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$2,334,591
Interest on participant loans	2020-12-31	$2,100
Interest earned on other investments	2020-12-31	$15
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$1,212
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$766
Net investment gain/loss from pooled separate accounts	2020-12-31	$343,372
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$32,004
Employer contributions (assets) at end of year	2020-12-31	$32,004
Employer contributions (assets) at beginning of year	2020-12-31	$41,860
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$290,762
Contract administrator fees	2020-12-31	$9,397
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Unqualified
Accountancy firm name	2020-12-31	COULTER & JUSTUS
Accountancy firm EIN	2020-12-31	621532536
2019 : AMCHECK NEVADA 401K PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$1,031,949
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$181,875
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$167,552
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$629,227
Value of total assets at end of year	2019-12-31	$2,433,016
Value of total assets at beginning of year	2019-12-31	$1,582,942
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$14,323
Total interest from all sources	2019-12-31	$2,827
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$228,995
Participant contributions at end of year	2019-12-31	$49,484
Participant contributions at beginning of year	2019-12-31	$52,025
Participant contributions at end of year	2019-12-31	$6,315
Participant contributions at beginning of year	2019-12-31	$8,376
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$358,372
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$850,074
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$2,433,016
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$1,582,942
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in pooled separate accounts at end of year	2019-12-31	$2,334,591
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$1,476,490
Interest on participant loans	2019-12-31	$2,819
Interest earned on other investments	2019-12-31	$8
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$766
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$331
Net investment gain/loss from pooled separate accounts	2019-12-31	$399,895
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$41,860
Employer contributions (assets) at end of year	2019-12-31	$41,860
Employer contributions (assets) at beginning of year	2019-12-31	$45,720
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$167,552
Contract administrator fees	2019-12-31	$14,323
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	COULTER & JUSTUS
Accountancy firm EIN	2019-12-31	621532536
2018 : AMCHECK NEVADA 401K PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$202,318
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$76,130
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$65,778
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$325,240
Value of total assets at end of year	2018-12-31	$1,582,942
Value of total assets at beginning of year	2018-12-31	$1,456,754
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$10,352
Total interest from all sources	2018-12-31	$1,452
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$500,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$257,381
Participant contributions at end of year	2018-12-31	$52,025
Participant contributions at beginning of year	2018-12-31	$9,091
Participant contributions at end of year	2018-12-31	$8,376
Participant contributions at beginning of year	2018-12-31	$9,173
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$22,139
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$126,188
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$1,582,942
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$1,456,754
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in pooled separate accounts at end of year	2018-12-31	$1,476,490
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$1,397,526
Interest on participant loans	2018-12-31	$1,424
Interest earned on other investments	2018-12-31	$28
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$331
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$2,357
Net investment gain/loss from pooled separate accounts	2018-12-31	$-124,374
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$45,720
Employer contributions (assets) at end of year	2018-12-31	$45,720
Employer contributions (assets) at beginning of year	2018-12-31	$38,607
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$65,778
Contract administrator fees	2018-12-31	$10,352
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2018-12-31	No
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	COULTER & JUSTUS
Accountancy firm EIN	2018-12-31	621532536
2017 : AMCHECK NEVADA 401K PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$464,866
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$178,214
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$165,641
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$237,952
Value of total assets at end of year	2017-12-31	$1,456,754
Value of total assets at beginning of year	2017-12-31	$1,170,102
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$12,573
Total interest from all sources	2017-12-31	$424
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$500,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$199,345
Participant contributions at end of year	2017-12-31	$9,091
Participant contributions at beginning of year	2017-12-31	$1,338
Participant contributions at end of year	2017-12-31	$9,173
Participant contributions at beginning of year	2017-12-31	$7,750
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$286,652
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$1,456,754
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$1,170,102
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in pooled separate accounts at end of year	2017-12-31	$1,397,526
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$1,112,209
Interest on participant loans	2017-12-31	$393
Interest earned on other investments	2017-12-31	$31
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$2,357
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$2,369
Net investment gain/loss from pooled separate accounts	2017-12-31	$226,490
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$38,607
Employer contributions (assets) at end of year	2017-12-31	$38,607
Employer contributions (assets) at beginning of year	2017-12-31	$46,436
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$165,641
Contract administrator fees	2017-12-31	$12,573
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2017-12-31	No
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	COULTER & JUSTUS
Accountancy firm EIN	2017-12-31	621532536
2010 : AMCHECK NEVADA 401K PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$280,845
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$122,965
Expenses. Total of all expenses incurred	2010-12-31	$0
Benefits paid (including direct rollovers)	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$424,067
Total plan assets at beginning of year	2010-12-31	$20,257
Value of fidelity bond covering the plan	2010-12-31	$100,000
Total contributions received or receivable from participants	2010-12-31	$88,986
Expenses. Other expenses not covered elsewhere	2010-12-31	$0
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$23,244
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$122,965
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$424,067
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$20,257
Assets. Value of participant loans	2010-12-31	$20,265
Total contributions received or receivable from employer(s)	2010-12-31	$10,735
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : AMCHECK NEVADA 401K PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for AMCHECK NEVADA 401K PLAN

2022: AMCHECK NEVADA 401K PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: AMCHECK NEVADA 401K PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: AMCHECK NEVADA 401K PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: AMCHECK NEVADA 401K PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: AMCHECK NEVADA 401K PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: AMCHECK NEVADA 401K PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2010: AMCHECK NEVADA 401K PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: AMCHECK NEVADA 401K PLAN 2009 form 5500 responses
2009-05-01	Type of plan entity	Single employer plan
2009-05-01	First time form 5500 has been submitted	Yes
2009-05-01	Submission has been amended	No
2009-05-01	This submission is the final filing	No
2009-05-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2009-05-01	Plan is a collectively bargained plan	No
2009-05-01	Plan funding arrangement – Insurance	Yes
2009-05-01	Plan funding arrangement – Trust	Yes
2009-05-01	Plan benefit arrangement – Insurance	Yes
2009-05-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

659AB

Policy instance

Insurance contract or identification number	659AB
Number of Individuals Covered	64
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $9,880
Total amount of fees paid to insurance company	USD $2,801
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,880
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	SALES AND BASE COMMISSIONS
Insurance broker organization code?	4

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

931061-855

Policy instance

Insurance contract or identification number	931061-855
Number of Individuals Covered	161
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $11,295
Total amount of fees paid to insurance company	USD $686
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,295
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

659AB

Policy instance

Insurance contract or identification number	659AB
Number of Individuals Covered	63
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

931061-00855

Policy instance

Insurance contract or identification number	931061-00855
Number of Individuals Covered	147
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $8,893
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,893
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

931061-00855

Policy instance

Insurance contract or identification number	931061-00855
Number of Individuals Covered	161
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $11,515
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,561
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

931061-00855

Policy instance

Insurance contract or identification number	931061-00855
Number of Individuals Covered	158
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,910
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,910
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

931061-00855

Policy instance

Insurance contract or identification number	931061-00855
Number of Individuals Covered	167
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $5,093
Total amount of fees paid to insurance company	USD $537
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,093
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	0
Insurance broker organization code?	3
Insurance broker name	TAG RESOURCES, LLC

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

Policy contract number

86461

Policy instance

Insurance contract or identification number	86461
Number of Individuals Covered	17
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $7,181
Total amount of fees paid to insurance company	USD $2,149
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,181
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3
Amount paid for insurance broker fees	2149
Insurance broker name	ASPEN PENSION ADMINISTRATORS INC

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Company Name:	GIRISGEN & KOPOLOW, OD, PC
Employer identification number (EIN):	880484278
NAIC Classification:	621320
NAIC Description:	Offices of Optometrists