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FORM 5500 DATA

A&D Health Care 401k Pension Plan

Overview

Plan Information

  • Plan Year01/01/2016 — 12/31/2016
  • Date of Plan01/01/2011
  • Net Assets as of 12/31/2016 $2,598,304
  • 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
  • Plan Funding ArrangementInsurance Trust
  • Plan Benefit ArrangementInsurance Trust

Participant Information as of 12/31/2016

  • Active (Eligible) Participants194
  • Retired or separated participants receiving benefits18
  • Other retired or separated participants entitled to future benefits0
  • Subtotal212
  • Deceased participants whose beneficiaries are receiving or are entitled to receive benefits0
  • Total212
  • Total number of participants as of 01/01/2016210
  • Number of participants with account balances106
  • Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested0

Expenses

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

Sponsor Information

  • Address3150 Enterprise Dr
  • CitySaginaw
  • StateMI
  • Zip48603
  • Telephone(800) 884-3335
  • EIN38-2821662
  • Industry Code621610

Audit Information

  • Audit StatusAudited
  • AuditorGardner Provenzano Thomas Luplow
  • Auditor EIN38-2613351
  • Audit Opinion Disclaimer
  • Audit TypeLimited Scope Audit

Benefits Provided Under the Plan

Code Benefit Description
2A Age/Service Weighted or New Comparability or Similar Plan Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New Comparability or Similar Plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the threshold or additional rate allowed under the permitted disparity rules of section 401(l)
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.
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.
3H Controlled Group Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

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 $125,000
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? No
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? No

Financials

Income and Expense Statement

Income $599,528
Contributions $422,910
Cash Contributions $422,910
Cash from Employers $160,260
Cash from Participants $262,192
Others (including rollovers) $458
Noncash Contributions $0
Total Earnings on Investments $176,618
Total Interest $0
Interest-Bearing Cash $0
U.S. Government Securities $0
Corporate Debt Instruments $0
Loans (other than to participants) $0
Participant Loans $0
Interest from Other Investments $0
Total Dividends $0
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 $0
Net investment gain (loss) from pooled separate accounts $176,618
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 $0
Other Income $0
Expenses $193,640
Total Benefit Payments $193,030
Directly to participants or beneficiaries, including direct rollovers $193,030
To insurance carriers for the provision of benefits $0
Other Benefit Payment Fees $0
Corrective Distributions $0
Certain deemed distributions of participant loans $0
Interest expense $0
Total Administrative Expenses $610
Professional Fees $0
Contract Administrator Fees $610
Investment Advisory and management fees $0
Other Administrative Fees $0
Net Income $405,888
Transfers of Assets to this Plan $0
Transfers of Assets from this Plan $0

Asset and Liability Statement

12/31/2016 12/31/2015 Change YOY
Total Assets $2,598,304 $2,192,416 18.51%
Total noninterest-bearing cash $0 $0 0.0%
Receivables $160,782 $147,366 9.10%
Employer Contributions $160,260 $146,844 9.14%
Participant Contributions $522 $522 0.00%
Other Contributions $0 $0 0.0%
General Investments $2,151 $1,396 54.08%
Interest-bearing cash $2,151 $1,396 54.08%
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 $0 $0 0.0%
Value of interest in common/collective trusts $0 $0 0.0%
Value of interest in pooled separate accounts $2,435,371 $2,043,654 19.17%
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 $0 $0 0.0%
Value of funds held in insurance co. general account $0 $0 0.0%
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 $0 $0 0.0%
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) $0 $0 0.0%
Net Assets $2,598,304 $2,192,416 18.51%

Service Providers

Persons Receiving Only Eligible Indirect Compensation

  • John Hancock Life Insurance Company

Other Service Providers Receiving Direct or Indirect Compensation

There are no service providers listed for this plan.

Indirect Compensation

There are no service providers with indirect compensation listed for this plan.

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.

Investments

Investments

Name of Investment Investment Manager Type of Investment Dollar Value
Jh Ls Bal Active Strategy John Hancock USA DFE: Pooled Separate Account $439,924
Jh Ls Grow Active Strategy John Hancock USA DFE: Pooled Separate Account $429,943
Jh Ls Con Active Strategy John Hancock USA DFE: Pooled Separate Account $227,503
Jh Ls Mod Active Strategy John Hancock USA DFE: Pooled Separate Account $223,891
Equity Income Fund John Hancock USA DFE: Pooled Separate Account $184,052
Fidelity Contrafund John Hancock USA DFE: Pooled Separate Account $153,844
Income Fund of America John Hancock USA DFE: Pooled Separate Account $127,355
Utilities Fund John Hancock USA DFE: Pooled Separate Account $109,008
Real Est. Securities Fund John Hancock USA DFE: Pooled Separate Account $90,477
Science & Technology Fund John Hancock USA DFE: Pooled Separate Account $64,485
Jh Thru 2030 Active Strategy John Hancock USA DFE: Pooled Separate Account $60,405
High Yield Fund John Hancock USA DFE: Pooled Separate Account $44,539
Jh Ls Agg Active Strategy John Hancock USA DFE: Pooled Separate Account $37,988
Jh Thru 2035 Active Strategy John Hancock USA DFE: Pooled Separate Account $37,108
Mid Cap Index Fund John Hancock USA DFE: Pooled Separate Account $30,490
Jh Thru 2025 Active Strategy John Hancock USA DFE: Pooled Separate Account $27,633
Jh Thru 2050 Active Strategy John Hancock USA DFE: Pooled Separate Account $25,075
Dfa U.S. Small Cap Fund John Hancock USA DFE: Pooled Separate Account $23,599
Fidelity Adv Leveraged Co Stk John Hancock USA DFE: Pooled Separate Account $17,020
Jh Thru 2040 Active Stategy John Hancock USA DFE: Pooled Separate Account $11,077
Dfa Emerging Markets Value John Hancock USA DFE: Pooled Separate Account $10,616
Value Fund John Hancock USA DFE: Pooled Separate Account $9,049
Fidelity Advisor Total Bond John Hancock USA DFE: Pooled Separate Account $7,571
New Perspective Fund John Hancock USA DFE: Pooled Separate Account $5,320
Templeton World John Hancock USA DFE: Pooled Separate Account $5,279
Fundamental Investors John Hancock USA DFE: Pooled Separate Account $4,445
Oppenheimer Global John Hancock USA DFE: Pooled Separate Account $4,420
Blackrock Global Allocation John Hancock USA DFE: Pooled Separate Account $4,045
Jh Thru 2045 Active Strategy John Hancock USA DFE: Pooled Separate Account $3,493
Vanguard Explorer Fund John Hancock USA DFE: Pooled Separate Account $3,286
Jh Thru 2020 Active Strategy John Hancock USA DFE: Pooled Separate Account $3,167
Mid Cap Stock Fund John Hancock USA DFE: Pooled Separate Account $3,097
Jh Thru 2055 Active Strategy John Hancock USA DFE: Pooled Separate Account $2,573
Europacific Growth Fund John Hancock USA DFE: Pooled Separate Account $2,285
John Hancock Stable Value John Hancock USA DFE: Pooled Separate Account $2,151
Oppenheimer Intl Bond John Hancock USA DFE: Pooled Separate Account $1,314
Vanguard Growth Index Fund John Hancock USA DFE: Pooled Separate Account $595
Total $2,438,122

Insurance Information

Insurance Information

Insurance Carrier Summary Persons Covered
John Hancock USA 110
EIN 01-0233346
Industry Code 65838
Contract Number 99072
Contract Year 01/01/2016 — 12/31/2016
Value in General Account at Year End $401
Value in Separate Accounts at Year End $2,437,122
Insurance Fees and Commissions $10,023
Persons Receiving Commissions and Fees
Agent/Broker Organization Code Commissions Paid Fees Paid Purpose of Fees Paid
Questar Agency, Inc. Insurance Agent or Broker $8,911 $0
Pension Plan Services, Inc. 8263 S Saginaw St Ste 1 Grand Blanc, MI 48439 Third Party Administrator $0 $1,112 TPA COMPENSATION
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
Type of Contract GROUP ANNUITY
Balance at the end of the previous year $0
Additions $0
Contributions Deposited during the year $0
Dividends and credits $0
Interest credited during the year $0
Transferred from separate account $0
Other $0
Total of Balance and Additions $0
Deductions $0
Disbursed from fund to pay benefits or purchase annuities during the year $0
Administration charge made by carrier $0
Transferred to Separate Account $0
Other $0
Balance at the end of the current year $0