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Plan Information

  • Plan Year01/01/2008 — 12/31/2008
  • Date of Plan
  • Net Assets as of 12/31/2008 $8,436,780
  • Plan Number2
  • 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 12/31/2008

  • Active (Eligible) Participants233
  • Retired or separated participants receiving benefits0
  • Other retired or separated participants entitled to future benefits203
  • Subtotal436
  • Deceased participants whose beneficiaries are receiving or are entitled to receive benefits0
  • Total436
  • Total number of participants as of 01/01/2008475
  • Number of participants with account balances418
  • Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested22
  • Number of participants required to be reported on Schedule SSA28


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

Sponsor Information

  • Address155 Brookside Avenue
  • CityWest Warwick
  • StateRI
  • Zip02893-3865
  • Telephone(401) 828-0300
  • EIN05-0188360
  • Industry Code442210
  • Named Administrator,Nicl-'C44E^ -A ')P-R
  • Named Plan Sponsor(Nf^ C, R^^ L/-- Rei"

Plan Administrator Information

  • Administrator NameSAME
  • Administrator EIN

Audit Information

  • Audit StatusAudited
  • AuditorAndsager Bartlett, & Pieroni, LLP
  • Auditor EIN05-0479760
  • Audit Opinion Disclaimer

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.

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


Income and Expense Statement

Income $-2,701,282
Contributions $738,291
Cash Contributions $738,291
Cash from Employers $189,264
Cash from Participants $525,908
Others (including rollovers) $23,119
Noncash Contributions $0
Total Earnings on Investments $-3,439,573
Total Interest $13,291
Interest-Bearing Cash $0
U.S. Government Securities $0
Corporate Debt Instruments $0
Loans (other than to participants) $0
Participant Loans $13,291
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 $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 $-3,452,864
Other Income $0
Expenses $707,940
Total Benefit Payments $707,440
Directly to participants or beneficiaries, including direct rollovers $707,440
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 $500
Professional Fees $0
Contract Administrator Fees $500
Investment Advisory and management fees $0
Other Administrative Fees $0
Net Income $-3,409,222
Transfers of Assets to this Plan $0
Transfers of Assets from this Plan $0

Asset and Liability Statement

12/31/2008 12/31/2007 Change YOY
Total Assets $8,436,780 $11,846,002 -28.78%
Total noninterest-bearing cash $0 $0 0.0%
Receivables $194,526 $429,843 -54.74%
Employer Contributions $189,807 $429,843 -55.84%
Participant Contributions $4,719 $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 $252,077 $258,194 -2.37%
Value of interest in common/collective trusts $0 $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 $5,986,469 $9,784,875 -38.82%
Value of funds held in insurance co. general account $0 $1,373,090 -100.00%
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 $8,436,780 $11,846,002 -28.78%

Service Providers

Service Providers

There are no service providers listed for this plan.



Name of Investment Investment Manager Type of Investment Dollar Value
Map Contract: Separate Account D Ing Life Insurance and Annuity Comp DFE: Pooled Separate Account $5,986,469
Total $5,986,469

Insurance Information

Insurance Information

Insurance Carrier Summary Persons Covered
Ing Life Insurance and Annuity Company 449
EIN 71-0294708
Industry Code 86509
Contract Number PH9466
Contract Year 11/01/2008 — 12/31/2008
Value in General Account at Year End $2,003,708
Value in Separate Accounts at Year End $5,986,469
Insurance Fees and Commissions $34,348
Persons Receiving Commissions and Fees
Agent/Broker Organization Code Commissions Paid Fees Paid Purpose of Fees Paid
Paul Merlino 15 Mat.T-Ard Cove Way Barrington, RI 02806 Agent or Broker other than Insurance $21,190 $0
Bentley Employee Benefits Group 117 Metro Center Blvd., Suite 2007 Warwick, RI 02886 Third Party Administrator $0 $13,158 RECORDKEEPING
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 Guaranteed Investment,
Balance at the end of the previous year $1,373,090
Additions $2,423,338
Contributions Deposited during the year $960,295
Dividends and credits $0
Interest credited during the year $51,177
Transferred from separate account $1,270,313
Other $141,553
Total of Balance and Additions $0
Deductions $1,792,720
Disbursed from fund to pay benefits or purchase annuities during the year $710,562
Administration charge made by carrier $500
Transferred to Separate Account $0
Other $98,539
Balance at the end of the current year $2,003,708