401k Plan data: ROLL FORM GROUP 401(K) RETIREMENT SAVINGS PLAN plan

ROLL FORM GROUP 401(K) RETIREMENT SAVINGS PLAN 401k Plan overview

Plan Name	ROLL FORM GROUP 401(K) RETIREMENT SAVINGS PLAN
Plan identification number	001

ROLL FORM GROUP 401(K) RETIREMENT SAVINGS PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) received services of leased employees, as defined in Code section 414(n), during the plan year.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

ROLL FORM GROUP U.S., INC has sponsored the creation of one or more 401k plans.

Company Name: ROLL FORM GROUP U.S., INC

Employer identification number (EIN): 980473981

NAIC Classification: 332900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ROLL FORM GROUP 401(K) RETIREMENT SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2017-01-01 ROSS THOMPSON ROSS THOMPSON 2018-10-15
001 2016-01-01 ROSS THOMPSON ROSS THOMPSON 2017-10-16
001 2015-01-01 STEPHANY GRIMES
001 2014-01-01 JONATHAN ARISTORENAS
001 2014-01-01 JONATHAN ARISTORENAS
001 2013-01-01 JONATHAN ARISTORENAS
001 2012-01-01 NANCY BECKLEY 2013-10-14
001 2011-01-01 GARY C. PANG 2012-08-10
001 2010-01-01 GARY C. PANG 2011-07-06

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2017-01-01	ROSS THOMPSON		ROSS THOMPSON	2018-10-15
001	2016-01-01	ROSS THOMPSON		ROSS THOMPSON	2017-10-16
001	2015-01-01	STEPHANY GRIMES
001	2014-01-01	JONATHAN ARISTORENAS
001	2014-01-01	JONATHAN ARISTORENAS
001	2013-01-01	JONATHAN ARISTORENAS
001	2012-01-01	NANCY BECKLEY	2013-10-14
001	2011-01-01	GARY C. PANG	2012-08-10
001	2010-01-01	GARY C. PANG	2011-07-06

Plan Statistics for ROLL FORM GROUP 401(K) RETIREMENT SAVINGS PLAN

401k plan membership statisitcs for ROLL FORM GROUP 401(K) RETIREMENT SAVINGS PLAN

Measure Date Value
2017: ROLL FORM GROUP 401(K) RETIREMENT SAVINGS PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 226
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 125
Number of retired or separated participants receiving benefits 2017-01-01 9
Number of other retired or separated participants entitled to future benefits 2017-01-01 33
Total of all active and inactive participants 2017-01-01 167
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 167
Number of participants with account balances 2017-01-01 133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: ROLL FORM GROUP 401(K) RETIREMENT SAVINGS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 145
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 215
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 37
Total of all active and inactive participants 2016-01-01 252
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 252
Number of participants with account balances 2016-01-01 182
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: ROLL FORM GROUP 401(K) RETIREMENT SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 125
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 99
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 26
Total of all active and inactive participants 2015-01-01 125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 125
Number of participants with account balances 2015-01-01 91
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: ROLL FORM GROUP 401(K) RETIREMENT SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 110
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 98
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 27
Total of all active and inactive participants 2014-01-01 125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 125
Number of participants with account balances 2014-01-01 81
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: ROLL FORM GROUP 401(K) RETIREMENT SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 134
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 81
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 27
Total of all active and inactive participants 2013-01-01 108
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 108
Number of participants with account balances 2013-01-01 87
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0

Measure	Date	Value
2017: ROLL FORM GROUP 401(K) RETIREMENT SAVINGS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	226
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	125
Number of retired or separated participants receiving benefits	2017-01-01	9
Number of other retired or separated participants entitled to future benefits	2017-01-01	33
Total of all active and inactive participants	2017-01-01	167
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	167
Number of participants with account balances	2017-01-01	133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: ROLL FORM GROUP 401(K) RETIREMENT SAVINGS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	145
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	215
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	37
Total of all active and inactive participants	2016-01-01	252
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	252
Number of participants with account balances	2016-01-01	182
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: ROLL FORM GROUP 401(K) RETIREMENT SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	125
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	99
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	26
Total of all active and inactive participants	2015-01-01	125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	125
Number of participants with account balances	2015-01-01	91
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: ROLL FORM GROUP 401(K) RETIREMENT SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	110
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	98
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	27
Total of all active and inactive participants	2014-01-01	125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	125
Number of participants with account balances	2014-01-01	81
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: ROLL FORM GROUP 401(K) RETIREMENT SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	134
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	81
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	27
Total of all active and inactive participants	2013-01-01	108
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	108
Number of participants with account balances	2013-01-01	87
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0

Financial Data on ROLL FORM GROUP 401(K) RETIREMENT SAVINGS PLAN

Measure	Date	Value
2017 : ROLL FORM GROUP 401(K) RETIREMENT SAVINGS 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	$536,330
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$123,198
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$109,110
Expenses. Certain deemed distributions of participant loans	2017-12-31	$1,058
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$321,778
Value of total assets at end of year	2017-12-31	$1,853,017
Value of total assets at beginning of year	2017-12-31	$1,439,885
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$13,030
Total interest from all sources	2017-12-31	$0
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	$250,000
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	$183,674
Participant contributions at end of year	2017-12-31	$77,314
Participant contributions at beginning of year	2017-12-31	$41,726
Participant contributions at end of year	2017-12-31	$5,793
Participant contributions at beginning of year	2017-12-31	$16,568
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	$413,132
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$1,853,017
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$1,439,885
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 registered invesment companies (eg mutual funds) at end of year	2017-12-31	$1,658,847
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$1,247,285
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$106,982
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$121,473
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$4,163
Net investment gain/loss from pooled separate accounts	2017-12-31	$210,389
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	Yes
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	$138,104
Employer contributions (assets) at end of year	2017-12-31	$4,081
Employer contributions (assets) at beginning of year	2017-12-31	$12,833
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$109,110
Contract administrator fees	2017-12-31	$13,030
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	GODWIN & ASSOCIATES PLLC
Accountancy firm EIN	2017-12-31	621649263
2016 : ROLL FORM GROUP 401(K) RETIREMENT SAVINGS PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$440,634
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$100,089
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$89,828
Expenses. Certain deemed distributions of participant loans	2016-12-31	$7,101
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$356,709
Value of total assets at end of year	2016-12-31	$1,439,885
Value of total assets at beginning of year	2016-12-31	$1,099,340
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$3,160
Total interest from all sources	2016-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$250,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$168,725
Participant contributions at end of year	2016-12-31	$41,726
Participant contributions at beginning of year	2016-12-31	$77,969
Participant contributions at end of year	2016-12-31	$16,568
Participant contributions at beginning of year	2016-12-31	$4,960
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$67,406
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$340,545
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$1,439,885
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$1,099,340
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$1,247,285
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$906,159
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$121,473
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$106,742
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$5,867
Net investment gain/loss from pooled separate accounts	2016-12-31	$78,058
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$120,578
Employer contributions (assets) at end of year	2016-12-31	$12,833
Employer contributions (assets) at beginning of year	2016-12-31	$3,510
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$89,828
Contract administrator fees	2016-12-31	$3,160
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	GODWIN AND ASSOCIATES, PLLC
Accountancy firm EIN	2016-12-31	621649263
2015 : ROLL FORM GROUP 401(K) RETIREMENT SAVINGS PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$188,663
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$127,789
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$127,102
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$197,567
Value of total assets at end of year	2015-12-31	$1,099,340
Value of total assets at beginning of year	2015-12-31	$1,038,466
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$687
Total interest from all sources	2015-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$250,000
If this is an individual account plan, was there a blackout period	2015-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$116,060
Participant contributions at end of year	2015-12-31	$77,969
Participant contributions at beginning of year	2015-12-31	$67,434
Participant contributions at end of year	2015-12-31	$4,960
Participant contributions at beginning of year	2015-12-31	$9,843
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$60,874
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$1,099,340
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$1,038,466
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$906,159
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$845,825
Value of interest in common/collective trusts at beginning of year	2015-12-31	$108,554
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$106,742
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-8,904
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$81,507
Employer contributions (assets) at end of year	2015-12-31	$3,510
Employer contributions (assets) at beginning of year	2015-12-31	$6,810
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$127,102
Contract administrator fees	2015-12-31	$687
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2015-12-31	Yes
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	GODWIN AND ASSOCIATES, PLLC
Accountancy firm EIN	2015-12-31	621649263
2014 : ROLL FORM GROUP 401(K) RETIREMENT SAVINGS PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$255,607
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$142,009
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$137,974
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$207,043
Value of total assets at end of year	2014-12-31	$1,039,715
Value of total assets at beginning of year	2014-12-31	$926,117
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$4,035
Total interest from all sources	2014-12-31	$2,094
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$14,050
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$14,050
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$250,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$121,054
Participant contributions at end of year	2014-12-31	$68,683
Participant contributions at beginning of year	2014-12-31	$44,683
Participant contributions at end of year	2014-12-31	$9,843
Participant contributions at beginning of year	2014-12-31	$9,841
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$113,598
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$1,039,715
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$926,117
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$845,825
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$760,514
Interest on participant loans	2014-12-31	$2,094
Value of interest in common/collective trusts at end of year	2014-12-31	$108,554
Value of interest in common/collective trusts at beginning of year	2014-12-31	$104,833
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$31,586
Net investment gain or loss from common/collective trusts	2014-12-31	$834
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$85,989
Employer contributions (assets) at end of year	2014-12-31	$6,810
Employer contributions (assets) at beginning of year	2014-12-31	$6,246
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$137,974
Contract administrator fees	2014-12-31	$4,035
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	GODWIN AND ASSOCIATES, PLLC
Accountancy firm EIN	2014-12-31	621649263
2013 : ROLL FORM GROUP 401(K) RETIREMENT SAVINGS PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$348,109
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$105,450
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$100,995
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$240,690
Value of total assets at end of year	2013-12-31	$926,117
Value of total assets at beginning of year	2013-12-31	$683,458
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$4,455
Total interest from all sources	2013-12-31	$1,659
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$11,372
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-12-31	$11,372
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$250,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$141,610
Participant contributions at end of year	2013-12-31	$44,683
Participant contributions at beginning of year	2013-12-31	$33,065
Participant contributions at end of year	2013-12-31	$9,841
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$242,659
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$926,117
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$683,458
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$760,514
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$603,508
Interest on participant loans	2013-12-31	$1,659
Value of interest in common/collective trusts at end of year	2013-12-31	$104,833
Value of interest in common/collective trusts at beginning of year	2013-12-31	$46,885
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$93,695
Net investment gain or loss from common/collective trusts	2013-12-31	$693
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$99,080
Employer contributions (assets) at end of year	2013-12-31	$6,246
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$100,995
Contract administrator fees	2013-12-31	$4,455
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	No
Opinion of an independent qualified public accountant for this plan	2013-12-31	Unqualified
Accountancy firm name	2013-12-31	GODWIN AND ASSOCIATES, PLLC
Accountancy firm EIN	2013-12-31	621649263

Form 5500 Responses for ROLL FORM GROUP 401(K) RETIREMENT SAVINGS PLAN

2017: ROLL FORM GROUP 401(K) RETIREMENT SAVINGS 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
2016: ROLL FORM GROUP 401(K) RETIREMENT SAVINGS PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: ROLL FORM GROUP 401(K) RETIREMENT SAVINGS PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: ROLL FORM GROUP 401(K) RETIREMENT SAVINGS PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	Yes
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 – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: ROLL FORM GROUP 401(K) RETIREMENT SAVINGS PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

RM 86282-5

Policy instance

Insurance contract or identification number	RM 86282-5
Number of Individuals Covered	133
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $462
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 $222
Insurance broker organization code?	3
Insurance broker name	JOSEPH L DILEO

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

RM 86282-5

Policy instance

Insurance contract or identification number	RM 86282-5
Number of Individuals Covered	91
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $10,951
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	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
Commission paid to Insurance Broker	USD $5,456
Insurance broker organization code?	3
Insurance broker name	JOSEPH L DILEO

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Company Name:	ROLL FORM GROUP U.S., INC
Employer identification number (EIN):	980473981
NAIC Classification:	332900