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FORM 5500 DATA

Clover Holdings 401k Plan

Overview

Plan Information

  • Plan Year01/01/2014 — 12/31/2014
  • Date of Plan01/01/1999
  • Net Assets as of 12/31/2014 $30,739,894
  • 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 12/31/2014

  • Active (Eligible) Participants1,337
  • Retired or separated participants receiving benefits0
  • Other retired or separated participants entitled to future benefits109
  • Subtotal1,446
  • Deceased participants whose beneficiaries are receiving or are entitled to receive benefits1
  • Total1,447
  • Total number of participants as of 01/01/20141,673
  • Number of participants with account balances1,052
  • Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested155

Expenses

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

Sponsor Information

  • Address4200 Columbus St
  • CityOttawa
  • StateIL
  • Zip61350-9538
  • Telephone(815) 431-8100
  • EIN36-4375236
  • Industry Code334110
  • Named AdministratorCheryl Terry
  • Named Plan SponsorCheryl Terry

Audit Information

  • Audit StatusAudited
  • AuditorFgmk, LLC
  • Auditor EIN36-2929601
  • 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.

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 $10,000,000
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 $6,353,166
Contributions $4,563,099
Cash Contributions $4,563,099
Cash from Employers $1,122,868
Cash from Participants $3,155,384
Others (including rollovers) $284,847
Noncash Contributions $0
Total Earnings on Investments $1,790,067
Total Interest $44,803
Interest-Bearing Cash $0
U.S. Government Securities $0
Corporate Debt Instruments $0
Loans (other than to participants) $0
Participant Loans $44,803
Interest from Other Investments $0
Total Dividends $59,166
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 $1,476,779
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 $209,319
Other Income $0
Expenses $4,057,902
Total Benefit Payments $3,940,550
Directly to participants or beneficiaries, including direct rollovers $3,940,550
To insurance carriers for the provision of benefits $0
Other Benefit Payment Fees $0
Corrective Distributions $86,559
Certain deemed distributions of participant loans $0
Interest expense $0
Total Administrative Expenses $30,793
Professional Fees $0
Contract Administrator Fees $30,793
Investment Advisory and management fees $0
Other Administrative Fees $0
Net Income $2,295,264
Transfers of Assets to this Plan $0
Transfers of Assets from this Plan $0

Asset and Liability Statement

12/31/2014 12/31/2013 Change YOY
Total Assets $30,739,894 $28,444,630 8.07%
Total noninterest-bearing cash $0 $0 0.0%
Receivables $0 $0 0.0%
Employer Contributions $0 $0 0.0%
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 $920,741 $849,988 8.32%
Value of interest in common/collective trusts $0 $0 0.0%
Value of interest in pooled separate accounts $24,980,993 $23,604,858 5.83%
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 $4,838,160 $3,989,784 21.26%
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 $30,739,894 $28,444,630 8.07%

Service Providers

Persons Receiving Only Eligible Indirect Compensation

  • Principal Life Insurance Company

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
Principal Life Insurance Company Contract Administrator, Participant loan processing, Direct payment from the plan, Recordkeeping fees Contract Administrator $30,792 $0 $30,792
Total $30,792 $0 $30,792

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
Prin Sam Balanced Sep Acct-R4 Principal Life Insurance Company DFE: Pooled Separate Account $5,112,932
Prin Sam Cons Growth Sa-R4 Principal Life Insurance Company DFE: Pooled Separate Account $3,752,028
Prin Sam Strat Growth Sa-R4 Principal Life Insurance Company DFE: Pooled Separate Account $2,440,207
Prin Sam Cons Balanced Sa-R4 Principal Life Insurance Company DFE: Pooled Separate Account $2,129,209
Prin Lgcap S&P 500 Index Sa-R4 Principal Life Insurance Company DFE: Pooled Separate Account $1,729,045
Prin Money Market Sep Acct-R4 Principal Life Insurance Company DFE: Pooled Separate Account $1,565,779
Prin Midcap Value I Sa-R4 Principal Life Insurance Company DFE: Pooled Separate Account $1,400,547
Prin Sam Flexible Income Sa-R4 Principal Life Insurance Company DFE: Pooled Separate Account $1,376,077
Prin Largecap Growth I Sa-R4 Principal Life Insurance Company DFE: Pooled Separate Account $991,004
Prin Intl I Separate Acct-R4 Principal Life Insurance Company DFE: Pooled Separate Account $962,512
Prin Smallcap Growth I Sa-R4 Principal Life Insurance Company DFE: Pooled Separate Account $942,871
Prin Largecap Blend II Sa-R4 Principal Life Insurance Company DFE: Pooled Separate Account $800,988
Prin Midcap Growth III Sa-R4 Principal Life Insurance Company DFE: Pooled Separate Account $761,208
Prin Smallcap Value II Sa-R4 Principal Life Insurance Company DFE: Pooled Separate Account $747,582
Prin Inflation Protect Sa-R4 Principal Life Insurance Company DFE: Pooled Separate Account $269,005
Total $24,980,994

Insurance Information

Insurance Information

Insurance Carrier Summary Persons Covered
Principal Life Insurance Company 1,447
EIN 42-0127290
Industry Code 61271
Contract Number 453615
Contract Year 01/01/2014 — 12/31/2014
Value in General Account at Year End $0
Value in Separate Accounts at Year End $24,980,993
Insurance Fees and Commissions $60,440
Persons Receiving Commissions and Fees
Agent/Broker Organization Code Commissions Paid Fees Paid Purpose of Fees Paid
Correll Co Investment Services Corp 9655 S 78th Ave Hickory Hills, IL 60457 -2211 Insurance Agent or Broker $30,220 $0
The Leaders Group Inc 26 W Dry Creek Cir Littleton, CO 80120 -8067 Insurance Agent or Broker $30,220 $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
Type of Contract Unspecified
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