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Plan Information

  • Plan Year01/01/2017 — 12/31/2017
  • Date of Plan05/01/1995
  • Net Assets as of 12/31/2017 $15,824,902
  • Plan Number1
  • Plan Type Single Employer
  • Is the plan collectively bargained? No
  • Did the plan file for an extension of time or the DFVC Program?Yes
  • Report Description This is an amended report.
  • Plan Funding ArrangementInsurance Trust
  • Plan Benefit ArrangementInsurance Trust

Participant Information as of 12/31/2017

  • Active (Eligible) Participants279
  • Retired or separated participants receiving benefits0
  • Other retired or separated participants entitled to future benefits37
  • Subtotal316
  • Deceased participants whose beneficiaries are receiving or are entitled to receive benefits0
  • Total316
  • Total number of participants as of 01/01/2017300
  • Number of participants with account balances299
  • Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested11


  • Total Benefit Payments$0
  • Corrective Distributions$0
  • Administrative Service Providers$0
  • Other Expenses$0
  • Total Expenses$0
  • Total Transfers$0

Sponsor Information

  • Address155 Jackson Road
  • CityDevens
  • StateMA
  • Zip01434-5614
  • Telephone(978) 563-6115
  • EIN04-2590187
  • Industry Code326100
  • Named AdministratorCynthia Hanam

Audit Information

  • Audit StatusAudited
  • AuditorO'Connor, Maloney & Company
  • Auditor EIN04-2595327
  • Audit Opinion Disclaimer
  • Audit TypeLimited Scope Audit

Benefits Provided Under the Plan

Code Benefit Description
2E Profit-sharing A defined contribution plan that allows employer discretionary contributions. These plans often contain a 401(k) feature.
2F ERISA section 404(c) Plan This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
2G 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.
2J 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.
2K 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 contributions 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.
2T Participant-directed Account Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
3D 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.

Questions and Answers

Question Answer Amount
During the plan year did the employer fail to transmit to the plan any participant contributions within the time period described in 29 CFT 2510.3-102? No
Were any loans by the plan or fixed income obligations due the plan in default as of the close of plan year or classified during the year as uncollectible? Disregard participant loans secured by participant's account balance. No
Were any leases to which the plan was a party in default or classified during the year as uncollectible? No
Were there any nonexempt transactions with any party-in-interest? No
Was this plan covered by a fidelity bond? Yes $500,000
Did the plan have a loss, whether or not reimbursed by the plan's fidelity bond, that was caused by fraud or dishonesty? No
Did the plan hold any assets whose current value was neither readily determinable on an established market nor set by an independent third party appraiser? No
Did the plan receive any noncash contributions whose value was neither readily determinable on an established market nor set by an independent third party appraiser? No
Did the plan have assets held for investment? Yes
Were any plan transactions or series of transactions in excess of 5% of the current value of plan assets? No
Were all the plan assets either distributed to participants or beneficiaries, transferred to another plan, or brought under the control of the PBGC? No
Has the plan failed to provide any benefit when due under the plan? No
If this is an individual account plan, was there a blackout period? Yes
If there was a blackout period, have you either provided the required notice or one of the exceptions to providing the notice applied under 29 CFR 2520.101-3? Yes


Income and Expense Statement

Income $3,392,026
Contributions $1,490,381
Cash Contributions $1,490,381
Cash from Employers $357,703
Cash from Participants $1,035,583
Others (including rollovers) $97,095
Noncash Contributions $0
Total Earnings on Investments $1,901,645
Total Interest $32,340
Interest-Bearing Cash $0
U.S. Government Securities $0
Corporate Debt Instruments $0
Loans (other than to participants) $0
Participant Loans $19,826
Interest from Other Investments $12,514
Total Dividends $607,299
Preferred Stock $0
Common Stock $0
Rents $0
Net gain (loss) on sale of assets $0
Aggregate Proceeds $0
Aggregate Carrying Amount $0
Total Unrealized Appreciation (depreciation) of assets $0
Real Estate $0
Other $0
Net investment gain (loss) from common/collective trusts $413
Net investment gain (loss) from pooled separate accounts $0
Net investment gain (loss) from master trust investment accounts $0
Net investment gain (loss) from 103-12 investment entities $0
Net investment gain (loss) from registered investment companies $1,261,593
Other Income $0
Expenses $437,367
Total Benefit Payments $351,374
Directly to participants or beneficiaries, including direct rollovers $351,374
To insurance carriers for the provision of benefits $0
Other Benefit Payment Fees $0
Corrective Distributions $38,359
Certain deemed distributions of participant loans $0
Interest expense $0
Total Administrative Expenses $47,634
Professional Fees $0
Contract Administrator Fees $0
Investment Advisory and management fees $0
Other Administrative Fees $47,634
Net Income $2,954,659
Transfers of Assets to this Plan $0
Transfers of Assets from this Plan $0

Asset and Liability Statement

12/31/2017 12/31/2016 Change YOY
Total Assets $15,863,261 $12,903,483 22.94%
Total noninterest-bearing cash $49,445 $0 0.0%
Receivables $8,173 $6,398 27.74%
Employer Contributions $8,173 $6,398 27.74%
Participant Contributions $0 $0 0.0%
Other Contributions $0 $0 0.0%
General Investments $0 $0 0.0%
Interest-bearing cash $0 $0 0.0%
U.S. Government Securities $0 $0 0.0%
Corporate Debt Instruments $0 $0 0.0%
Preferred $0 $0 0.0%
All Other $0 $0 0.0%
Corporate Stocks $0 $0 0.0%
Preferred $0 $0 0.0%
Common $0 $0 0.0%
Partnership/joint venture interests $0 $0 0.0%
Real estate (other than employer real property) $0 $0 0.0%
Loans (other than to participants) $0 $0 0.0%
Participants Loans $435,954 $332,485 31.12%
Value of interest in common/collective trusts $194,722 $0 0.0%
Value of interest in pooled separate accounts $0 $0 0.0%
Value of interest in master trust investment accounts $0 $0 0.0%
Value of interest in 103-12 investment entities $0 $0 0.0%
Value of interest in registered investment companies $15,130,712 $11,465,855 31.96%
Value of funds held in insurance co. general account $44,255 $1,098,745 -95.97%
Other Investments $0 $0 0.0%
Employer-related Investments $0 $0 0.0%
Employer Securities $0 $0 0.0%
Employer Real Property $0 $0 0.0%
Buildings and other property used in plan operation $0 $0 0.0%
Total Liabilities $38,359 $33,240 15.40%
Benefit Claims Payable (1) $0 $0 0.0%
Operating Payables (1) $0 $0 0.0%
Acquisition Indebtedness (1) $0 $0 0.0%
Other liabilities (1) $38,359 $33,240 15.40%
Net Assets $15,824,902 $12,870,243 22.96%

Service Providers

Persons Receiving Only Eligible Indirect Compensation

  • Fidelity Investments Institutional

Other Service Providers Receiving Direct or Indirect Compensation

Name Nature of Service Relationship to Plan Sponsor Direct Compensation Paid by Plan Indirect Compensation Paid by Plan Total Compensation
Empower Retirement Advisory Ser Investment management Investment $35,157 $0 $35,157
Swerdlin Northeast, LLC Contract Administrator Contract Admin $300 $6,667 $6,967
O'Connor, Maloney & Co. Accounting (including auditing) Auditor $5,129 $0 $5,129
Great-West Life & Annuity Insurance Recordkeeping fees Recordkeeper $1,150 $0 $1,150
Fidelity Investments Institutional Participant loan processing, Sub-transfer agency fees, Recordkeeping fees, Account maintenance fees Recordkeeper $631 $0 $631
Total $42,367 $6,667 $49,034

Indirect Compensation

Name Source of Indirect Compensation* Nature of Service Description of Indirect Compensation Indirect Compensation Paid by Plan
Fidelity Investments Institutional Crln E Sm Cap Gr A - U.S. Bancorp Sub-transfer agency fees 0.25% $0
Fidelity Investments Institutional Metwest Tot Rtn Bd M - Bny Mellon Sub-transfer agency fees 0.14% $0
Fidelity Investments Institutional Oakmark Intl Inv - Boston Financia Sub-transfer agency fees 0.25% $0
Fidelity Investments Institutional Pnr Sel Md Cp Gr A - Boston Financ Sub-transfer agency fees 0.35% $0
Fidelity Investments Institutional Trp Blue Chip Gr Adv - T. Rowe Pri Sub-transfer agency fees 0.40% $0
Fidelity Investments Institutional Victory S Estb Val A - Fis Investo Sub-transfer agency fees 0.25% $0
Fidelity Investments Institutional Vrts C Lgcp Val Eq A - Virtus Fund Sub-transfer agency fees 0.40% $0
Swerdlin Northeast, LLC Great-West Life & Annuity Insur Contract Administrator Tpa Allowance Payment $6,667
*As outlined by the Form 5500 Instructions for service providers with indirect compensation.

Service Providers Who Fail or Refuse to Provide Information

There are no service providers who failed or refused to provide information.

Termination Information on Accountants and Enrolled Actuaries

There is no termination information for this plan.



Name of Investment Investment Manager Type of Investment Dollar Value
Fa Stable Value Fidelity Management Trust Company DFE: Common/Collective Trust $194,722
Total $194,722

Insurance Information

Insurance Information

Insurance Carrier Summary Persons Covered
Great-West Life & Annuity Insurance Company 15
EIN 84-0467907
Industry Code 68322
Contract Number 939258-01
Contract Year 01/01/2017 — 12/31/2017
Value in General Account at Year End $44,255
Value in Separate Accounts at Year End $0
Insurance Fees and Commissions $23,046
Persons Receiving Commissions and Fees
Agent/Broker Organization Code Commissions Paid Fees Paid Purpose of Fees Paid
James Blue 4 Copley Pl 6th Floor Boston, MA 02116 Insurance Agent or Broker $23,046 $0
Allocated Funds
Type of Contract Unspecified
Basis of premium rates
Premiums paid to carrier $0
Premiums due but unpaid at the end of the year $0
If the carrier, service, or other organization incurred any specific costs in connection with the acquisition or retention of the contract or policy, enter amount $0
Specify the nature of the costs
Unallocated Funds
Balance at the end of the previous year $1,098,745
Additions $614,502
Contributions Deposited during the year $134,979
Dividends and credits $0
Interest credited during the year $12,514
Transferred from separate account $442,123
Other $24,886
Total of Balance and Additions $1,713,247
Deductions $1,668,992
Disbursed from fund to pay benefits or purchase annuities during the year $1,529,612
Administration charge made by carrier $5,738
Transferred to Separate Account $133,642
Other $0
Balance at the end of the current year $44,255