401k Plan data: OREGON TILE & MARBLE 401(K) PROFIT SHARING PLAN & TRUST plan

OREGON TILE & MARBLE 401(K) PROFIT SHARING PLAN & TRUST 401k Plan overview

Plan Name	OREGON TILE & MARBLE 401(K) PROFIT SHARING PLAN & TRUST
Plan identification number	001

OREGON TILE & MARBLE 401(K) PROFIT SHARING PLAN & TRUST 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.
Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of 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.

401k Sponsoring company profile

OREGON TILE AND MARBLE has sponsored the creation of one or more 401k plans.

Company Name: OREGON TILE AND MARBLE

Employer identification number (EIN): 930926093

NAIC Classification: 444190
NAIC Description: Other Building Material Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OREGON TILE & MARBLE 401(K) PROFIT SHARING PLAN & TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 VIVIANA MARQUEZ
001 2015-01-01 VIVIANA MARQUEZ
001 2014-01-01 VIVIANA MARQUEZ
001 2013-01-01 VIVIANA MARQUEZ 2014-07-13
001 2012-01-01 MARQUEZ INC 2013-09-13
001 2011-01-01 MARQUEZ INC 2012-10-12
001 2010-01-01 MARQUEZ INC. 2011-09-22
001 2009-01-01 VIVIANA MARQUEZ

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2016-01-01	VIVIANA MARQUEZ
001	2015-01-01	VIVIANA MARQUEZ
001	2014-01-01	VIVIANA MARQUEZ
001	2013-01-01	VIVIANA MARQUEZ	2014-07-13
001	2012-01-01	MARQUEZ INC	2013-09-13
001	2011-01-01	MARQUEZ INC	2012-10-12
001	2010-01-01	MARQUEZ INC.	2011-09-22
001	2009-01-01	VIVIANA MARQUEZ

Plan Statistics for OREGON TILE & MARBLE 401(K) PROFIT SHARING PLAN & TRUST

401k plan membership statisitcs for OREGON TILE & MARBLE 401(K) PROFIT SHARING PLAN & TRUST

Measure Date Value
2016: OREGON TILE & MARBLE 401(K) PROFIT SHARING PLAN & TRUST 2016 401k membership
Total participants, beginning-of-year 2016-01-01 48
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
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 0
Total of all active and inactive participants 2016-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 0
Number of participants with account balances 2016-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: OREGON TILE & MARBLE 401(K) PROFIT SHARING PLAN & TRUST 2015 401k membership
Total participants, beginning-of-year 2015-01-01 45
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 42
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 6
Total of all active and inactive participants 2015-01-01 48
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 48
Number of participants with account balances 2015-01-01 36
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: OREGON TILE & MARBLE 401(K) PROFIT SHARING PLAN & TRUST 2014 401k membership
Total participants, beginning-of-year 2014-01-01 50
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 37
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 8
Total of all active and inactive participants 2014-01-01 45
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 45
Number of participants with account balances 2014-01-01 36
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2009: OREGON TILE & MARBLE 401(K) PROFIT SHARING PLAN & TRUST 2009 401k membership
Total participants, beginning-of-year 2009-01-01 88
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 50
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 31
Total of all active and inactive participants 2009-01-01 81
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 81
Number of participants with account balances 2009-01-01 78
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 14

Measure	Date	Value
2016: OREGON TILE & MARBLE 401(K) PROFIT SHARING PLAN & TRUST 2016 401k membership
Total participants, beginning-of-year	2016-01-01	48
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
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	0
Total of all active and inactive participants	2016-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	0
Number of participants with account balances	2016-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: OREGON TILE & MARBLE 401(K) PROFIT SHARING PLAN & TRUST 2015 401k membership
Total participants, beginning-of-year	2015-01-01	45
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	42
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	6
Total of all active and inactive participants	2015-01-01	48
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	48
Number of participants with account balances	2015-01-01	36
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: OREGON TILE & MARBLE 401(K) PROFIT SHARING PLAN & TRUST 2014 401k membership
Total participants, beginning-of-year	2014-01-01	50
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	37
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	8
Total of all active and inactive participants	2014-01-01	45
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	45
Number of participants with account balances	2014-01-01	36
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2009: OREGON TILE & MARBLE 401(K) PROFIT SHARING PLAN & TRUST 2009 401k membership
Total participants, beginning-of-year	2009-01-01	88
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	50
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	31
Total of all active and inactive participants	2009-01-01	81
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	81
Number of participants with account balances	2009-01-01	78
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	14

Financial Data on OREGON TILE & MARBLE 401(K) PROFIT SHARING PLAN & TRUST

Measure	Date	Value
2016 : OREGON TILE & MARBLE 401(K) PROFIT SHARING PLAN & TRUST 2016 401k financial data
Transfers to/from the plan	2016-07-25	$0
Total plan liabilities at end of year	2016-07-25	$0
Total plan liabilities at beginning of year	2016-07-25	$0
Total income from all sources	2016-07-25	$326,454
Expenses. Total of all expenses incurred	2016-07-25	$5,839,016
Benefits paid (including direct rollovers)	2016-07-25	$5,823,338
Total plan assets at end of year	2016-07-25	$0
Total plan assets at beginning of year	2016-07-25	$5,512,562
Value of fidelity bond covering the plan	2016-07-25	$500,000
Total contributions received or receivable from participants	2016-07-25	$57,733
Expenses. Other expenses not covered elsewhere	2016-07-25	$0
Contributions received from other sources (not participants or employers)	2016-07-25	$10,285
Other income received	2016-07-25	$226,988
Noncash contributions received	2016-07-25	$0
Net income (gross income less expenses)	2016-07-25	$-5,512,562
Net plan assets at end of year (total assets less liabilities)	2016-07-25	$0
Net plan assets at beginning of year (total assets less liabilities)	2016-07-25	$5,512,562
Total contributions received or receivable from employer(s)	2016-07-25	$31,448
Value of certain deemed distributions of participant loans	2016-07-25	$0
Value of corrective distributions	2016-07-25	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-07-25	$15,678
2015 : OREGON TILE & MARBLE 401(K) PROFIT SHARING PLAN & TRUST 2015 401k financial data
Transfers to/from the plan	2015-12-31	$0
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$203,650
Expenses. Total of all expenses incurred	2015-12-31	$235,968
Benefits paid (including direct rollovers)	2015-12-31	$223,110
Total plan assets at end of year	2015-12-31	$5,512,562
Total plan assets at beginning of year	2015-12-31	$5,544,880
Value of fidelity bond covering the plan	2015-12-31	$500,000
Total contributions received or receivable from participants	2015-12-31	$142,664
Expenses. Other expenses not covered elsewhere	2015-12-31	$0
Contributions received from other sources (not participants or employers)	2015-12-31	$77
Other income received	2015-12-31	$-9,640
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$-32,318
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$5,512,562
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$5,544,880
Total contributions received or receivable from employer(s)	2015-12-31	$70,549
Value of certain deemed distributions of participant loans	2015-12-31	$0
Value of corrective distributions	2015-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$12,858
2014 : OREGON TILE & MARBLE 401(K) PROFIT SHARING PLAN & TRUST 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total plan liabilities at end of year	2014-12-31	$0
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$546,595
Expenses. Total of all expenses incurred	2014-12-31	$89,893
Benefits paid (including direct rollovers)	2014-12-31	$81,569
Total plan assets at end of year	2014-12-31	$5,544,880
Total plan assets at beginning of year	2014-12-31	$5,088,178
Value of fidelity bond covering the plan	2014-12-31	$500,000
Total contributions received or receivable from participants	2014-12-31	$124,446
Expenses. Other expenses not covered elsewhere	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$360,211
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$456,702
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$5,544,880
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$5,088,178
Total contributions received or receivable from employer(s)	2014-12-31	$61,938
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$8,324
2009 : OREGON TILE & MARBLE 401(K) PROFIT SHARING PLAN & TRUST 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 OREGON TILE & MARBLE 401(K) PROFIT SHARING PLAN & TRUST

2016: OREGON TILE & MARBLE 401(K) PROFIT SHARING PLAN & TRUST 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	Yes
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: OREGON TILE & MARBLE 401(K) PROFIT SHARING PLAN & TRUST 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 – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: OREGON TILE & MARBLE 401(K) PROFIT SHARING PLAN & TRUST 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
2009: OREGON TILE & MARBLE 401(K) PROFIT SHARING PLAN & TRUST 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

92273

Policy instance

Insurance contract or identification number	92273
Number of Individuals Covered	0
Insurance policy start date	2014-01-01
Insurance policy end date	2014-07-31
Total amount of commissions paid to insurance broker	USD $7,609
Total amount of fees paid to insurance company	USD $1,303
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 $5,373
Amount paid for insurance broker fees	0
Insurance broker name	SOUTHEASTERNEMPLOYEEBENEFITSERVICES

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Company Name:	OREGON TILE AND MARBLE
Employer identification number (EIN):	930926093
NAIC Classification:	444190
NAIC Description:	Other Building Material Dealers