401k Plan data: GLASFORMS, INC. RETIREMENT PLAN plan

GLASFORMS, INC. RETIREMENT PLAN 401k Plan overview

Plan Name	GLASFORMS, INC. RETIREMENT PLAN
Plan identification number	001

GLASFORMS, INC. RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Stock bonus
ESOP other than a leveraged ESOP - A completed Schedule E must be attached to a Form 5500 filed for an Employee Stock Ownership Plan (ESOP).
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.

401k Sponsoring company profile

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

Company Name: GLASFORMS, INC.

Employer identification number (EIN): 942498488

NAIC Classification: 812990
NAIC Description: All Other Personal Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GLASFORMS, INC. RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2015-10-01 JOAO JOSE SAN MARTIN
001 2014-10-01 ANA RODRIGUEZ
001 2013-10-01 JASON PETERSON
001 2012-10-01 DANIEL O'BRYON
001 2011-10-01 CINDY CHAMBERS CINDY CHAMBERS 2013-07-15
001 2010-10-01 CINDY CHAMBERS CINDY CHAMBERS 2012-07-11
001 2009-10-01 CINDY CHAMBERS CINDY CHAMBERS 2011-07-14
001 2008-10-01

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2015-10-01	JOAO JOSE SAN MARTIN
001	2014-10-01	ANA RODRIGUEZ
001	2013-10-01	JASON PETERSON
001	2012-10-01	DANIEL O'BRYON
001	2011-10-01	CINDY CHAMBERS	CINDY CHAMBERS	2013-07-15
001	2010-10-01	CINDY CHAMBERS	CINDY CHAMBERS	2012-07-11
001	2009-10-01	CINDY CHAMBERS	CINDY CHAMBERS	2011-07-14
001	2008-10-01

Plan Statistics for GLASFORMS, INC. RETIREMENT PLAN

401k plan membership statisitcs for GLASFORMS, INC. RETIREMENT PLAN

Measure Date Value
2015: GLASFORMS, INC. RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-10-01 205
Total number of active participants reported on line 7a of the Form 5500 2015-10-01 0
Number of retired or separated participants receiving benefits 2015-10-01 0
Number of other retired or separated participants entitled to future benefits 2015-10-01 0
Total of all active and inactive participants 2015-10-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-10-01 0
Total participants 2015-10-01 0
Number of participants with account balances 2015-10-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-10-01 1
2014: GLASFORMS, INC. RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-10-01 224
Total number of active participants reported on line 7a of the Form 5500 2014-10-01 146
Number of retired or separated participants receiving benefits 2014-10-01 0
Number of other retired or separated participants entitled to future benefits 2014-10-01 56
Total of all active and inactive participants 2014-10-01 202
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-10-01 1
Total participants 2014-10-01 203
Number of participants with account balances 2014-10-01 202
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-10-01 15
2013: GLASFORMS, INC. RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-10-01 318
Total number of active participants reported on line 7a of the Form 5500 2013-10-01 174
Number of retired or separated participants receiving benefits 2013-10-01 0
Number of other retired or separated participants entitled to future benefits 2013-10-01 49
Total of all active and inactive participants 2013-10-01 223
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-10-01 1
Total participants 2013-10-01 224
Number of participants with account balances 2013-10-01 222
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-10-01 24
2012: GLASFORMS, INC. RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-10-01 333
Total number of active participants reported on line 7a of the Form 5500 2012-10-01 211
Number of retired or separated participants receiving benefits 2012-10-01 0
Number of other retired or separated participants entitled to future benefits 2012-10-01 106
Total of all active and inactive participants 2012-10-01 317
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-10-01 1
Total participants 2012-10-01 318
Number of participants with account balances 2012-10-01 317
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-10-01 26
2011: GLASFORMS, INC. RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-10-01 281
Total number of active participants reported on line 7a of the Form 5500 2011-10-01 250
Number of retired or separated participants receiving benefits 2011-10-01 0
Number of other retired or separated participants entitled to future benefits 2011-10-01 82
Total of all active and inactive participants 2011-10-01 332
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-10-01 1
Total participants 2011-10-01 333
Number of participants with account balances 2011-10-01 330
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-10-01 6
2010: GLASFORMS, INC. RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-10-01 289
Total number of active participants reported on line 7a of the Form 5500 2010-10-01 182
Number of retired or separated participants receiving benefits 2010-10-01 0
Number of other retired or separated participants entitled to future benefits 2010-10-01 90
Total of all active and inactive participants 2010-10-01 272
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-10-01 2
Total participants 2010-10-01 274
Number of participants with account balances 2010-10-01 271
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-10-01 10
2009: GLASFORMS, INC. RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-10-01 310
Total number of active participants reported on line 7a of the Form 5500 2009-10-01 195
Number of retired or separated participants receiving benefits 2009-10-01 0
Number of other retired or separated participants entitled to future benefits 2009-10-01 87
Total of all active and inactive participants 2009-10-01 282
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-10-01 1
Total participants 2009-10-01 283
Number of participants with account balances 2009-10-01 281
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-10-01 20

Measure	Date	Value
2015: GLASFORMS, INC. RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-10-01	205
Total number of active participants reported on line 7a of the Form 5500	2015-10-01	0
Number of retired or separated participants receiving benefits	2015-10-01	0
Number of other retired or separated participants entitled to future benefits	2015-10-01	0
Total of all active and inactive participants	2015-10-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-10-01	0
Total participants	2015-10-01	0
Number of participants with account balances	2015-10-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-10-01	1
2014: GLASFORMS, INC. RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-10-01	224
Total number of active participants reported on line 7a of the Form 5500	2014-10-01	146
Number of retired or separated participants receiving benefits	2014-10-01	0
Number of other retired or separated participants entitled to future benefits	2014-10-01	56
Total of all active and inactive participants	2014-10-01	202
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-10-01	1
Total participants	2014-10-01	203
Number of participants with account balances	2014-10-01	202
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-10-01	15
2013: GLASFORMS, INC. RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-10-01	318
Total number of active participants reported on line 7a of the Form 5500	2013-10-01	174
Number of retired or separated participants receiving benefits	2013-10-01	0
Number of other retired or separated participants entitled to future benefits	2013-10-01	49
Total of all active and inactive participants	2013-10-01	223
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-10-01	1
Total participants	2013-10-01	224
Number of participants with account balances	2013-10-01	222
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-10-01	24
2012: GLASFORMS, INC. RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-10-01	333
Total number of active participants reported on line 7a of the Form 5500	2012-10-01	211
Number of retired or separated participants receiving benefits	2012-10-01	0
Number of other retired or separated participants entitled to future benefits	2012-10-01	106
Total of all active and inactive participants	2012-10-01	317
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-10-01	1
Total participants	2012-10-01	318
Number of participants with account balances	2012-10-01	317
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-10-01	26
2011: GLASFORMS, INC. RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-10-01	281
Total number of active participants reported on line 7a of the Form 5500	2011-10-01	250
Number of retired or separated participants receiving benefits	2011-10-01	0
Number of other retired or separated participants entitled to future benefits	2011-10-01	82
Total of all active and inactive participants	2011-10-01	332
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-10-01	1
Total participants	2011-10-01	333
Number of participants with account balances	2011-10-01	330
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-10-01	6
2010: GLASFORMS, INC. RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-10-01	289
Total number of active participants reported on line 7a of the Form 5500	2010-10-01	182
Number of retired or separated participants receiving benefits	2010-10-01	0
Number of other retired or separated participants entitled to future benefits	2010-10-01	90
Total of all active and inactive participants	2010-10-01	272
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-10-01	2
Total participants	2010-10-01	274
Number of participants with account balances	2010-10-01	271
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-10-01	10
2009: GLASFORMS, INC. RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-10-01	310
Total number of active participants reported on line 7a of the Form 5500	2009-10-01	195
Number of retired or separated participants receiving benefits	2009-10-01	0
Number of other retired or separated participants entitled to future benefits	2009-10-01	87
Total of all active and inactive participants	2009-10-01	282
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-10-01	1
Total participants	2009-10-01	283
Number of participants with account balances	2009-10-01	281
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-10-01	20

Financial Data on GLASFORMS, INC. RETIREMENT PLAN

Measure	Date	Value
2016 : GLASFORMS, INC. RETIREMENT PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-06-30	$0
Total transfer of assets from this plan	2016-06-30	$2,163,660
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-06-30	$0
Total income from all sources (including contributions)	2016-06-30	$174,220
Total loss/gain on sale of assets	2016-06-30	$0
Total of all expenses incurred	2016-06-30	$1,207,766
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-06-30	$1,179,318
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-06-30	$0
Value of total assets at end of year	2016-06-30	$0
Value of total assets at beginning of year	2016-06-30	$3,197,206
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-06-30	$28,448
Total interest from all sources	2016-06-30	$8,570
Total dividends received (eg from common stock, registered investment company shares)	2016-06-30	$45,393
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-06-30	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2016-06-30	$0
Total dividends received from registered investment company shares (eg mutual funds)	2016-06-30	$45,393
Was this plan covered by a fidelity bond	2016-06-30	Yes
Value of fidelity bond cover	2016-06-30	$300,000
If this is an individual account plan, was there a blackout period	2016-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2016-06-30	No
Participant contributions at end of year	2016-06-30	$0
Participant contributions at beginning of year	2016-06-30	$321,468
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-06-30	No
Value of net income/loss	2016-06-30	$-1,033,546
Value of net assets at end of year (total assets less liabilities)	2016-06-30	$0
Value of net assets at beginning of year (total assets less liabilities)	2016-06-30	$3,197,206
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-06-30	No
Were any leases to which the plan was party in default or uncollectible	2016-06-30	No
Investment advisory and management fees	2016-06-30	$8,663
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-06-30	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-06-30	$2,750,897
Value of interest in pooled separate accounts at end of year	2016-06-30	$0
Value of interest in pooled separate accounts at beginning of year	2016-06-30	$124,841
Interest on participant loans	2016-06-30	$8,570
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-06-30	$118,806
Net investment gain/loss from pooled separate accounts	2016-06-30	$1,451
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-06-30	No
Was there a failure to transmit to the plan any participant contributions	2016-06-30	No
Has the plan failed to provide any benefit when due under the plan	2016-06-30	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-06-30	$1,179,318
Contract administrator fees	2016-06-30	$19,785
Did the plan have assets held for investment	2016-06-30	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	2016-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-06-30	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2016-06-30	Disclaimer
Accountancy firm name	2016-06-30	PLANTE & MORAN PLLC
Accountancy firm EIN	2016-06-30	381357951
2015 : GLASFORMS, INC. RETIREMENT PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-09-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-09-30	$0
Total income from all sources (including contributions)	2015-09-30	$-33,692
Total loss/gain on sale of assets	2015-09-30	$0
Total of all expenses incurred	2015-09-30	$383,997
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-09-30	$381,497
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-09-30	$0
Value of total assets at end of year	2015-09-30	$3,197,206
Value of total assets at beginning of year	2015-09-30	$3,614,895
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-09-30	$2,500
Total interest from all sources	2015-09-30	$15,013
Total dividends received (eg from common stock, registered investment company shares)	2015-09-30	$47,919
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-09-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-09-30	$47,919
Was this plan covered by a fidelity bond	2015-09-30	Yes
Value of fidelity bond cover	2015-09-30	$3,000,000
If this is an individual account plan, was there a blackout period	2015-09-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-09-30	$0
Were there any nonexempt tranactions with any party-in-interest	2015-09-30	No
Participant contributions at end of year	2015-09-30	$321,468
Participant contributions at beginning of year	2015-09-30	$382,575
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-09-30	No
Value of net income/loss	2015-09-30	$-417,689
Value of net assets at end of year (total assets less liabilities)	2015-09-30	$3,197,206
Value of net assets at beginning of year (total assets less liabilities)	2015-09-30	$3,614,895
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-09-30	No
Were any leases to which the plan was party in default or uncollectible	2015-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-09-30	$2,750,897
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-09-30	$3,140,368
Value of interest in pooled separate accounts at end of year	2015-09-30	$124,841
Value of interest in pooled separate accounts at beginning of year	2015-09-30	$91,952
Interest on participant loans	2015-09-30	$15,013
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-09-30	$-98,636
Net investment gain/loss from pooled separate accounts	2015-09-30	$2,012
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-09-30	No
Was there a failure to transmit to the plan any participant contributions	2015-09-30	No
Has the plan failed to provide any benefit when due under the plan	2015-09-30	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-09-30	$381,497
Contract administrator fees	2015-09-30	$2,500
Did the plan have assets held for investment	2015-09-30	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	2015-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-09-30	No
Opinion of an independent qualified public accountant for this plan	2015-09-30	Unqualified
Accountancy firm name	2015-09-30	PLANTE & MORAN PLLC
Accountancy firm EIN	2015-09-30	381357951
2014 : GLASFORMS, INC. RETIREMENT PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-09-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-09-30	$1,171
Total income from all sources (including contributions)	2014-09-30	$490,725
Total loss/gain on sale of assets	2014-09-30	$0
Total of all expenses incurred	2014-09-30	$2,457,771
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-09-30	$2,448,303
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-09-30	$33,329
Value of total assets at end of year	2014-09-30	$3,614,895
Value of total assets at beginning of year	2014-09-30	$5,583,112
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-09-30	$9,468
Total interest from all sources	2014-09-30	$15,825
Total dividends received (eg from common stock, registered investment company shares)	2014-09-30	$77,627
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-09-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-09-30	$77,627
Administrative expenses professional fees incurred	2014-09-30	$3,768
Was this plan covered by a fidelity bond	2014-09-30	Yes
Value of fidelity bond cover	2014-09-30	$300,000
If this is an individual account plan, was there a blackout period	2014-09-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-09-30	$0
Were there any nonexempt tranactions with any party-in-interest	2014-09-30	No
Participant contributions at end of year	2014-09-30	$382,575
Participant contributions at beginning of year	2014-09-30	$381,963
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-09-30	$0
Administrative expenses (other) incurred	2014-09-30	$2,500
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-09-30	No
Value of net income/loss	2014-09-30	$-1,967,046
Value of net assets at end of year (total assets less liabilities)	2014-09-30	$3,614,895
Value of net assets at beginning of year (total assets less liabilities)	2014-09-30	$5,581,941
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-09-30	No
Were any leases to which the plan was party in default or uncollectible	2014-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-09-30	$3,140,368
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-09-30	$5,150,153
Value of interest in pooled separate accounts at end of year	2014-09-30	$91,952
Value of interest in pooled separate accounts at beginning of year	2014-09-30	$50,996
Interest on participant loans	2014-09-30	$15,825
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-09-30	$362,604
Net investment gain/loss from pooled separate accounts	2014-09-30	$1,340
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-09-30	No
Was there a failure to transmit to the plan any participant contributions	2014-09-30	No
Has the plan failed to provide any benefit when due under the plan	2014-09-30	No
Assets. Invements in employer securities at beginning of year	2014-09-30	$0
Contributions received in cash from employer	2014-09-30	$33,329
Employer contributions (assets) at beginning of year	2014-09-30	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-09-30	$2,448,303
Contract administrator fees	2014-09-30	$3,200
Assets. Corporate common stocks other than exployer securities at beginning of year	2014-09-30	$0
Liabilities. Value of benefit claims payable at end of year	2014-09-30	$0
Liabilities. Value of benefit claims payable at beginning of year	2014-09-30	$1,171
Did the plan have assets held for investment	2014-09-30	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	2014-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-09-30	No
Opinion of an independent qualified public accountant for this plan	2014-09-30	Unqualified
Accountancy firm name	2014-09-30	PLANTE & MORAN PLLC
Accountancy firm EIN	2014-09-30	381357951
2013 : GLASFORMS, INC. RETIREMENT PLAN 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2013-09-30	$605,962
Total unrealized appreciation/depreciation of assets	2013-09-30	$605,962
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-09-30	$1,171
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-09-30	$8,286
Total income from all sources (including contributions)	2013-09-30	$825,368
Total loss/gain on sale of assets	2013-09-30	$0
Total of all expenses incurred	2013-09-30	$142,535
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-09-30	$127,883
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-09-30	$0
Value of total assets at end of year	2013-09-30	$5,583,112
Value of total assets at beginning of year	2013-09-30	$4,907,394
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-09-30	$14,652
Total interest from all sources	2013-09-30	$17,444
Total dividends received (eg from common stock, registered investment company shares)	2013-09-30	$2,917
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-09-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-09-30	$372
Administrative expenses professional fees incurred	2013-09-30	$10,868
Was this plan covered by a fidelity bond	2013-09-30	Yes
Value of fidelity bond cover	2013-09-30	$300,000
If this is an individual account plan, was there a blackout period	2013-09-30	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-09-30	$0
Were there any nonexempt tranactions with any party-in-interest	2013-09-30	No
Participant contributions at end of year	2013-09-30	$381,963
Participant contributions at beginning of year	2013-09-30	$218,467
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-09-30	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-09-30	$900
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-09-30	No
Value of net income/loss	2013-09-30	$682,833
Value of net assets at end of year (total assets less liabilities)	2013-09-30	$5,581,941
Value of net assets at beginning of year (total assets less liabilities)	2013-09-30	$4,899,108
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-09-30	No
Were any leases to which the plan was party in default or uncollectible	2013-09-30	No
Investment advisory and management fees	2013-09-30	$1,144
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-09-30	$5,150,153
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-09-30	$143,929
Value of interest in pooled separate accounts at end of year	2013-09-30	$50,996
Value of interest in pooled separate accounts at beginning of year	2013-09-30	$0
Interest on participant loans	2013-09-30	$10,779
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-09-30	$6,665
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-09-30	$199,045
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-09-30	No
Was there a failure to transmit to the plan any participant contributions	2013-09-30	No
Has the plan failed to provide any benefit when due under the plan	2013-09-30	No
Assets. Invements in employer securities at end of year	2013-09-30	$0
Assets. Invements in employer securities at beginning of year	2013-09-30	$4,200,779
Employer contributions (assets) at end of year	2013-09-30	$0
Employer contributions (assets) at beginning of year	2013-09-30	$300,000
Income. Dividends from common stock	2013-09-30	$2,545
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-09-30	$127,883
Contract administrator fees	2013-09-30	$2,640
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2013-09-30	Yes
Assets. Corporate common stocks other than exployer securities at end of year	2013-09-30	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2013-09-30	$44,219
Liabilities. Value of benefit claims payable at end of year	2013-09-30	$1,171
Liabilities. Value of benefit claims payable at beginning of year	2013-09-30	$7,386
Did the plan have assets held for investment	2013-09-30	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	2013-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-09-30	No
Opinion of an independent qualified public accountant for this plan	2013-09-30	Unqualified
Accountancy firm name	2013-09-30	PLANTE & MORAN PLLC
Accountancy firm EIN	2013-09-30	381357951
2012 : GLASFORMS, INC. RETIREMENT PLAN 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2012-09-30	$1,138,383
Total unrealized appreciation/depreciation of assets	2012-09-30	$1,138,383
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-09-30	$8,286
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-09-30	$46,438
Total income from all sources (including contributions)	2012-09-30	$1,446,077
Total loss/gain on sale of assets	2012-09-30	$0
Total of all expenses incurred	2012-09-30	$30,242
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-09-30	$30,032
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-09-30	$300,000
Value of total assets at end of year	2012-09-30	$4,907,394
Value of total assets at beginning of year	2012-09-30	$3,529,711
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-09-30	$210
Total interest from all sources	2012-09-30	$5,764
Total dividends received (eg from common stock, registered investment company shares)	2012-09-30	$1,308
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-09-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-09-30	$109
Was this plan covered by a fidelity bond	2012-09-30	Yes
Value of fidelity bond cover	2012-09-30	$300,000
If this is an individual account plan, was there a blackout period	2012-09-30	No
Were there any nonexempt tranactions with any party-in-interest	2012-09-30	No
Participant contributions at end of year	2012-09-30	$218,467
Participant contributions at beginning of year	2012-09-30	$108,861
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-09-30	$900
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-09-30	$5,931
Other income not declared elsewhere	2012-09-30	$3
Administrative expenses (other) incurred	2012-09-30	$70
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-09-30	No
Value of net income/loss	2012-09-30	$1,415,835
Value of net assets at end of year (total assets less liabilities)	2012-09-30	$4,899,108
Value of net assets at beginning of year (total assets less liabilities)	2012-09-30	$3,483,273
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-09-30	No
Were any leases to which the plan was party in default or uncollectible	2012-09-30	No
Investment advisory and management fees	2012-09-30	$140
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-09-30	$143,929
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-09-30	$104,226
Interest on participant loans	2012-09-30	$5,764
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-09-30	$619
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-09-30	Yes
Was there a failure to transmit to the plan any participant contributions	2012-09-30	No
Has the plan failed to provide any benefit when due under the plan	2012-09-30	No
Assets. Invements in employer securities at end of year	2012-09-30	$4,200,779
Assets. Invements in employer securities at beginning of year	2012-09-30	$2,980,156
Contributions received in cash from employer	2012-09-30	$300,000
Employer contributions (assets) at end of year	2012-09-30	$300,000
Employer contributions (assets) at beginning of year	2012-09-30	$300,000
Income. Dividends from common stock	2012-09-30	$1,199
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-09-30	$30,032
Assets. Corporate common stocks other than exployer securities at end of year	2012-09-30	$44,219
Assets. Corporate common stocks other than exployer securities at beginning of year	2012-09-30	$36,468
Liabilities. Value of benefit claims payable at end of year	2012-09-30	$7,386
Liabilities. Value of benefit claims payable at beginning of year	2012-09-30	$40,507
Did the plan have assets held for investment	2012-09-30	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	2012-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-09-30	No
Opinion of an independent qualified public accountant for this plan	2012-09-30	Unqualified
Accountancy firm name	2012-09-30	MILLER, KAPLAN, ARASE & COMPANY,LLP
Accountancy firm EIN	2012-09-30	952036255
2011 : GLASFORMS, INC. RETIREMENT PLAN 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2011-09-30	$1,142,137
Total unrealized appreciation/depreciation of assets	2011-09-30	$1,142,137
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-09-30	$46,438
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-09-30	$3
Total income from all sources (including contributions)	2011-09-30	$1,447,681
Total loss/gain on sale of assets	2011-09-30	$0
Total of all expenses incurred	2011-09-30	$203,413
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-09-30	$203,308
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-09-30	$300,000
Value of total assets at end of year	2011-09-30	$3,529,711
Value of total assets at beginning of year	2011-09-30	$2,239,008
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-09-30	$105
Total interest from all sources	2011-09-30	$4,902
Total dividends received (eg from common stock, registered investment company shares)	2011-09-30	$1,163
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-09-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-09-30	$60
Was this plan covered by a fidelity bond	2011-09-30	Yes
Value of fidelity bond cover	2011-09-30	$300,000
If this is an individual account plan, was there a blackout period	2011-09-30	No
Were there any nonexempt tranactions with any party-in-interest	2011-09-30	No
Participant contributions at end of year	2011-09-30	$108,861
Participant contributions at beginning of year	2011-09-30	$122,417
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-09-30	$5,931
Administrative expenses (other) incurred	2011-09-30	$105
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-09-30	No
Value of net income/loss	2011-09-30	$1,244,268
Value of net assets at end of year (total assets less liabilities)	2011-09-30	$3,483,273
Value of net assets at beginning of year (total assets less liabilities)	2011-09-30	$2,239,005
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-09-30	No
Were any leases to which the plan was party in default or uncollectible	2011-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-09-30	$104,226
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-09-30	$1,650
Interest on participant loans	2011-09-30	$4,902
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-09-30	$60,453
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-09-30	$60,453
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-09-30	$-521
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-09-30	Yes
Was there a failure to transmit to the plan any participant contributions	2011-09-30	No
Has the plan failed to provide any benefit when due under the plan	2011-09-30	No
Assets. Invements in employer securities at end of year	2011-09-30	$2,980,156
Assets. Invements in employer securities at beginning of year	2011-09-30	$1,837,423
Contributions received in cash from employer	2011-09-30	$300,000
Employer contributions (assets) at end of year	2011-09-30	$300,000
Employer contributions (assets) at beginning of year	2011-09-30	$180,000
Income. Dividends from common stock	2011-09-30	$1,103
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-09-30	$203,308
Assets. Corporate common stocks other than exployer securities at end of year	2011-09-30	$36,468
Assets. Corporate common stocks other than exployer securities at beginning of year	2011-09-30	$37,065
Liabilities. Value of benefit claims payable at end of year	2011-09-30	$40,507
Liabilities. Value of benefit claims payable at beginning of year	2011-09-30	$3
Did the plan have assets held for investment	2011-09-30	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	2011-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-09-30	No
Opinion of an independent qualified public accountant for this plan	2011-09-30	Unqualified
Accountancy firm name	2011-09-30	MILLER, KAPLAN, ARASE & COMPANY,LLP
Accountancy firm EIN	2011-09-30	952036255

Form 5500 Responses for GLASFORMS, INC. RETIREMENT PLAN

2015: GLASFORMS, INC. RETIREMENT PLAN 2015 form 5500 responses
2015-10-01	Type of plan entity	Single employer plan
2015-10-01	Submission has been amended	No
2015-10-01	This submission is the final filing	Yes
2015-10-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2015-10-01	Plan is a collectively bargained plan	No
2015-10-01	Plan funding arrangement – Insurance	Yes
2015-10-01	Plan funding arrangement – Trust	Yes
2015-10-01	Plan benefit arrangement - Trust	Yes
2014: GLASFORMS, INC. RETIREMENT PLAN 2014 form 5500 responses
2014-10-01	Type of plan entity	Single employer plan
2014-10-01	Submission has been amended	No
2014-10-01	This submission is the final filing	No
2014-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-10-01	Plan is a collectively bargained plan	No
2014-10-01	Plan funding arrangement – Insurance	Yes
2014-10-01	Plan funding arrangement – Trust	Yes
2014-10-01	Plan benefit arrangement - Trust	Yes
2013: GLASFORMS, INC. RETIREMENT PLAN 2013 form 5500 responses
2013-10-01	Type of plan entity	Single employer plan
2013-10-01	Submission has been amended	No
2013-10-01	This submission is the final filing	No
2013-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-10-01	Plan is a collectively bargained plan	No
2013-10-01	Plan funding arrangement – Insurance	Yes
2013-10-01	Plan funding arrangement – Trust	Yes
2013-10-01	Plan benefit arrangement - Trust	Yes
2012: GLASFORMS, INC. RETIREMENT PLAN 2012 form 5500 responses
2012-10-01	Type of plan entity	Single employer plan
2012-10-01	Submission has been amended	No
2012-10-01	This submission is the final filing	No
2012-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-10-01	Plan is a collectively bargained plan	No
2012-10-01	Plan funding arrangement – Insurance	Yes
2012-10-01	Plan funding arrangement – Trust	Yes
2012-10-01	Plan benefit arrangement - Trust	Yes
2011: GLASFORMS, INC. RETIREMENT PLAN 2011 form 5500 responses
2011-10-01	Type of plan entity	Single employer plan
2011-10-01	Submission has been amended	No
2011-10-01	This submission is the final filing	No
2011-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-10-01	Plan is a collectively bargained plan	No
2011-10-01	Plan funding arrangement – Trust	Yes
2011-10-01	Plan benefit arrangement - Trust	Yes
2010: GLASFORMS, INC. RETIREMENT PLAN 2010 form 5500 responses
2010-10-01	Type of plan entity	Single employer plan
2010-10-01	Submission has been amended	No
2010-10-01	This submission is the final filing	No
2010-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-10-01	Plan is a collectively bargained plan	No
2010-10-01	Plan funding arrangement – Trust	Yes
2010-10-01	Plan benefit arrangement - Trust	Yes
2009: GLASFORMS, INC. RETIREMENT PLAN 2009 form 5500 responses
2009-10-01	Type of plan entity	Single employer plan
2009-10-01	Submission has been amended	No
2009-10-01	This submission is the final filing	No
2009-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-10-01	Plan is a collectively bargained plan	No
2009-10-01	Plan funding arrangement – Trust	Yes
2009-10-01	Plan benefit arrangement - Trust	Yes
2008: GLASFORMS, INC. RETIREMENT PLAN 2008 form 5500 responses
2008-10-01	Type of plan entity	Single employer plan
2008-10-01	Submission has been amended	No
2008-10-01	This submission is the final filing	No
2008-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-10-01	Plan is a collectively bargained plan	No

Insurance Providers Used on plan

NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )

Policy contract number

31505

Policy instance

Insurance contract or identification number	31505
Number of Individuals Covered	0
Insurance policy start date	2015-10-01
Insurance policy end date	2016-06-30
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

NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )

Policy contract number

31505

Policy instance

Insurance contract or identification number	31505
Number of Individuals Covered	202
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
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

NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )

Policy contract number

30500

Policy instance

Insurance contract or identification number	30500
Number of Individuals Covered	0
Insurance policy start date	2013-10-01
Insurance policy end date	2013-11-21
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

NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )

Policy contract number

31505

Policy instance

Insurance contract or identification number	31505
Number of Individuals Covered	222
Insurance policy start date	2013-11-21
Insurance policy end date	2014-09-30
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

NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )

Policy contract number

30500

Policy instance

Insurance contract or identification number	30500
Number of Individuals Covered	317
Insurance policy start date	2013-06-06
Insurance policy end date	2013-09-30
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

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Company Name:	GLASFORMS, INC.
Employer identification number (EIN):	942498488
NAIC Classification:	812990
NAIC Description:	All Other Personal Services