401k Plan data: ROMANTINE, INC. EMPLOYEES RETIREMENT SAVINGS PLAN plan

ROMANTINE, INC. EMPLOYEES RETIREMENT SAVINGS PLAN 401k Plan overview

Plan Name	ROMANTINE, INC. EMPLOYEES RETIREMENT SAVINGS PLAN
Plan identification number	001

ROMANTINE, INC. EMPLOYEES RETIREMENT SAVINGS 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.
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.
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 contribtions 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.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
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

ROMANTINE, INC. has sponsored the creation of one or more 401k plans.

Company Name: ROMANTINE, INC.

Employer identification number (EIN): 251536705

NAIC Classification: 445110
NAIC Description: Supermarkets and Other Grocery (except Convenience) Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ROMANTINE, INC. EMPLOYEES RETIREMENT SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2012-01-01 FRED ROMANTINE 2013-01-07
001 2011-01-01 FRED ROMANTINE
001 2009-01-01 FRED ROMANTINE
001 2009-01-01 FRED ROMANTINE

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2012-01-01	FRED ROMANTINE	2013-01-07
001	2011-01-01	FRED ROMANTINE
001	2009-01-01	FRED ROMANTINE
001	2009-01-01	FRED ROMANTINE

Plan Statistics for ROMANTINE, INC. EMPLOYEES RETIREMENT SAVINGS PLAN

401k plan membership statisitcs for ROMANTINE, INC. EMPLOYEES RETIREMENT SAVINGS PLAN

Measure Date Value
2011: ROMANTINE, INC. EMPLOYEES RETIREMENT SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 109
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 0
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 27
Total of all active and inactive participants 2011-01-01 27
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 27
Number of participants with account balances 2011-01-01 27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: ROMANTINE, INC. EMPLOYEES RETIREMENT SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 109
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 96
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 5
Total of all active and inactive participants 2009-01-01 101
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 101
Number of participants with account balances 2009-01-01 54
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2011: ROMANTINE, INC. EMPLOYEES RETIREMENT SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	109
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	0
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	27
Total of all active and inactive participants	2011-01-01	27
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	27
Number of participants with account balances	2011-01-01	27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: ROMANTINE, INC. EMPLOYEES RETIREMENT SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	109
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	96
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	5
Total of all active and inactive participants	2009-01-01	101
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	101
Number of participants with account balances	2009-01-01	54
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on ROMANTINE, INC. EMPLOYEES RETIREMENT SAVINGS PLAN

Measure	Date	Value
2011 : ROMANTINE, INC. EMPLOYEES RETIREMENT SAVINGS PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$30,596
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$678,819
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$664,583
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$87,142
Value of total assets at end of year	2011-12-31	$851,038
Value of total assets at beginning of year	2011-12-31	$1,499,261
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$14,236
Total interest from all sources	2011-12-31	$3,579
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2011-12-31	$0
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$200,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$59,144
Participant contributions at end of year	2011-12-31	$2,917
Participant contributions at beginning of year	2011-12-31	$2,714
Participant contributions at end of year	2011-12-31	$0
Participant contributions at beginning of year	2011-12-31	$4,918
Total non interest bearing cash at end of year	2011-12-31	$0
Total non interest bearing cash at beginning of year	2011-12-31	$344
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$-648,223
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$851,038
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$1,499,261
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$794,631
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$1,239,832
Value of interest in pooled separate accounts at end of year	2011-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$0
Interest on participant loans	2011-12-31	$204
Interest earned on other investments	2011-12-31	$3,375
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$53,490
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$248,309
Net investment gain/loss from pooled separate accounts	2011-12-31	$-60,125
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$27,998
Employer contributions (assets) at end of year	2011-12-31	$0
Employer contributions (assets) at beginning of year	2011-12-31	$3,144
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$664,583
Contract administrator fees	2011-12-31	$14,236
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	LOUIS PLUNG & COMPANY
Accountancy firm EIN	2011-12-31	251637458
2010 : ROMANTINE, INC. EMPLOYEES RETIREMENT SAVINGS PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$300,991
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$45,930
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$31,151
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$125,032
Value of total assets at end of year	2010-12-31	$1,499,261
Value of total assets at beginning of year	2010-12-31	$1,244,200
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$14,779
Total interest from all sources	2010-12-31	$482
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$200,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$81,881
Participant contributions at end of year	2010-12-31	$2,714
Participant contributions at beginning of year	2010-12-31	$14,067
Participant contributions at end of year	2010-12-31	$4,918
Participant contributions at beginning of year	2010-12-31	$4,856
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$80
Other income not declared elsewhere	2010-12-31	$139
Total non interest bearing cash at end of year	2010-12-31	$344
Total non interest bearing cash at beginning of year	2010-12-31	$394
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$255,061
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$1,499,261
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$1,244,200
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$1,239,832
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$993,023
Interest on participant loans	2010-12-31	$482
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$248,309
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$228,785
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$175,338
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$43,071
Employer contributions (assets) at end of year	2010-12-31	$3,144
Employer contributions (assets) at beginning of year	2010-12-31	$3,075
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$31,151
Contract administrator fees	2010-12-31	$14,779
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	LOUIS PLUNG & COMPANY
Accountancy firm EIN	2010-12-31	251637458

Form 5500 Responses for ROMANTINE, INC. EMPLOYEES RETIREMENT SAVINGS PLAN

2011: ROMANTINE, INC. EMPLOYEES RETIREMENT SAVINGS PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: ROMANTINE, INC. EMPLOYEES RETIREMENT SAVINGS PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

88359

Policy instance

Insurance contract or identification number	88359
Number of Individuals Covered	27
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,908
Total amount of fees paid to insurance company	USD $141
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

88359

Policy instance

Insurance contract or identification number	88359
Number of Individuals Covered	58
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,496
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,496
Insurance broker organization code?	3
Insurance broker name	CES INSURANCE AGENCY, INC.

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Company Name:	ROMANTINE, INC.
Employer identification number (EIN):	251536705
NAIC Classification:	445110
NAIC Description:	Supermarkets and Other Grocery (except Convenience) Stores