401k Plan data: PREMIUM HEALTHY SPRING WATER, INC. PROFIT SHARING PLAN plan

PREMIUM HEALTHY SPRING WATER, INC. PROFIT SHARING PLAN 401k Plan overview

Plan Name	PREMIUM HEALTHY SPRING WATER, INC. PROFIT SHARING PLAN
Plan identification number	001

PREMIUM HEALTHY SPRING WATER, INC. PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
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.
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.

401k Sponsoring company profile

PREMIUM HEALTHY SPRING WATER I has sponsored the creation of one or more 401k plans.

Company Name: PREMIUM HEALTHY SPRING WATER I

Employer identification number (EIN): 271235360

NAIC Classification: 312110
NAIC Description: Soft Drink and Ice Manufacturing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PREMIUM HEALTHY SPRING WATER, INC. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2013-01-01 LOUIS A. SAVANT
001 2012-01-01 LOUIS A. SAVANT
001 2011-01-01 LOUIS A. SAVANT
001 2010-09-01 LOUIS SAVANT

Plan id#	Filing Submission Date	Name of Administrator
001	2013-01-01	LOUIS A. SAVANT
001	2012-01-01	LOUIS A. SAVANT
001	2011-01-01	LOUIS A. SAVANT
001	2010-09-01	LOUIS SAVANT

Plan Statistics for PREMIUM HEALTHY SPRING WATER, INC. PROFIT SHARING PLAN

401k plan membership statisitcs for PREMIUM HEALTHY SPRING WATER, INC. PROFIT SHARING PLAN

Measure Date Value
2013: PREMIUM HEALTHY SPRING WATER, INC. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 1
Total of all active and inactive participants 2013-01-01 1
Total participants 2013-01-01 1
Number of participants with account balances 2013-01-01 1
2012: PREMIUM HEALTHY SPRING WATER, INC. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 2
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 1
Total of all active and inactive participants 2012-01-01 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 3
Number of participants with account balances 2012-01-01 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: PREMIUM HEALTHY SPRING WATER, INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 2
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 2
Number of participants with account balances 2011-01-01 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: PREMIUM HEALTHY SPRING WATER, INC. PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-09-01 2
Total number of active participants reported on line 7a of the Form 5500 2010-09-01 2
Number of retired or separated participants receiving benefits 2010-09-01 0
Number of other retired or separated participants entitled to future benefits 2010-09-01 0
Total of all active and inactive participants 2010-09-01 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-09-01 0
Total participants 2010-09-01 2
Number of participants with account balances 2010-09-01 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-09-01 0

Measure	Date	Value
2013: PREMIUM HEALTHY SPRING WATER, INC. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	1
Total of all active and inactive participants	2013-01-01	1
Total participants	2013-01-01	1
Number of participants with account balances	2013-01-01	1
2012: PREMIUM HEALTHY SPRING WATER, INC. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	2
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	1
Total of all active and inactive participants	2012-01-01	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	3
Number of participants with account balances	2012-01-01	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: PREMIUM HEALTHY SPRING WATER, INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	2
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	2
Number of participants with account balances	2011-01-01	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: PREMIUM HEALTHY SPRING WATER, INC. PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-09-01	2
Total number of active participants reported on line 7a of the Form 5500	2010-09-01	2
Number of retired or separated participants receiving benefits	2010-09-01	0
Number of other retired or separated participants entitled to future benefits	2010-09-01	0
Total of all active and inactive participants	2010-09-01	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-09-01	0
Total participants	2010-09-01	2
Number of participants with account balances	2010-09-01	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-09-01	0

Financial Data on PREMIUM HEALTHY SPRING WATER, INC. PROFIT SHARING PLAN

Measure	Date	Value
2013 : PREMIUM HEALTHY SPRING WATER, INC. PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$-583,474
Total plan assets at end of year	2013-12-31	$62,798
Total plan assets at beginning of year	2013-12-31	$646,272
Value of fidelity bond covering the plan	2013-12-31	$70,000
Other income received	2013-12-31	$-583,474
Net income (gross income less expenses)	2013-12-31	$-583,474
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$62,798
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$646,272
Assets. Value of employer securities	2013-12-31	$0
2012 : PREMIUM HEALTHY SPRING WATER, INC. PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$-2,018,609
Expenses. Total of all expenses incurred	2012-12-31	$0
Benefits paid (including direct rollovers)	2012-12-31	$0
Total plan assets at end of year	2012-12-31	$646,272
Total plan assets at beginning of year	2012-12-31	$2,664,881
Value of fidelity bond covering the plan	2012-12-31	$70,000
Total contributions received or receivable from participants	2012-12-31	$0
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$-2,018,609
Net income (gross income less expenses)	2012-12-31	$-2,018,609
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$646,272
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$2,664,881
Assets. Value of employer securities	2012-12-31	$583,484
Total contributions received or receivable from employer(s)	2012-12-31	$0
Value of certain deemed distributions of participant loans	2012-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$0
2011 : PREMIUM HEALTHY SPRING WATER, INC. PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$2,042,808
Expenses. Total of all expenses incurred	2011-12-31	$0
Benefits paid (including direct rollovers)	2011-12-31	$0
Total plan assets at end of year	2011-12-31	$2,664,881
Total plan assets at beginning of year	2011-12-31	$622,073
Value of fidelity bond covering the plan	2011-12-31	$250,000
Total contributions received or receivable from participants	2011-12-31	$0
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$2,042,808
Net income (gross income less expenses)	2011-12-31	$2,042,808
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$2,664,881
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$622,073
Assets. Value of employer securities	2011-12-31	$2,602,224
Total contributions received or receivable from employer(s)	2011-12-31	$0
Value of certain deemed distributions of participant loans	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$0
2010 : PREMIUM HEALTHY SPRING WATER, INC. PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$622,073
Expenses. Total of all expenses incurred	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$622,073
Total plan assets at beginning of year	2010-12-31	$0
Value of fidelity bond covering the plan	2010-12-31	$30,000
Total contributions received or receivable from participants	2010-12-31	$0
Contributions received from other sources (not participants or employers)	2010-12-31	$662,273
Other income received	2010-12-31	$-40,200
Net income (gross income less expenses)	2010-12-31	$622,073
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$622,073
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$0
Assets. Value of employer securities	2010-12-31	$559,558
Total contributions received or receivable from employer(s)	2010-12-31	$0

Form 5500 Responses for PREMIUM HEALTHY SPRING WATER, INC. PROFIT SHARING PLAN

2013: PREMIUM HEALTHY SPRING WATER, INC. PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: PREMIUM HEALTHY SPRING WATER, INC. PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: PREMIUM HEALTHY SPRING WATER, INC. PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: PREMIUM HEALTHY SPRING WATER, INC. PROFIT SHARING PLAN 2010 form 5500 responses
2010-09-01	Type of plan entity	Single employer plan
2010-09-01	First time form 5500 has been submitted	Yes
2010-09-01	Submission has been amended	No
2010-09-01	This submission is the final filing	No
2010-09-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2010-09-01	Plan is a collectively bargained plan	No
2010-09-01	Plan funding arrangement – Trust	Yes
2010-09-01	Plan benefit arrangement - Trust	Yes

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Company Name:	PREMIUM HEALTHY SPRING WATER I
Employer identification number (EIN):	271235360
NAIC Classification:	312110
NAIC Description:	Soft Drink and Ice Manufacturing