Annual Return of A One-Participant (Owners/Partners and                                              OMB No. 1545-1610
Form 5500-EZ
                                   Their Spouses) Retirement Plan or A Foreign Plan
                                 This form is required to be filed under section 6058(a) of the Internal Revenue Code.              2021
                                 Certain foreign retirement plans are also required to file this form (see instructions).
Department of the Treasury       ▶ Complete all entries in accordance with the instructions to the Form 5500-EZ.                    This Form is Open 
Internal Revenue Service         ▶ Go to www.irs.gov/Form5500EZ for instructions and the latest information.                        to Public Inspection.
Part I   Annual Return Identification Information
For the calendar plan year 2021 or fiscal plan year beginning (MM/DD/YYYY)                                               and ending
A    This return is:       (1) the first return filed for the plan       (3)   the final return filed for the plan
                           (2) an amended return                         (4)   a short plan year return (less than 12 months)
B    Check box if filing under     Form 5558       automatic extension
                                   special extension (enter description)
C    If this return is for a foreign plan, check this box (see instructions) . . .  . .    .                . . .        . . . .  . .   . . .  ▶
D    If this return is for the IRS Late Filer Penalty Relief Program, check this box (see instructions) .                  . . .  . .   . . .  ▶
E    If this is a retroactively adopted plan permitted by SECURE Act section 201, check here .                  .        . . . .  . .   . . .  ▶
Part II  Basic Plan Information — enter all requested information.
1a   Name of plan                                                                                           1b  Three-digit 
                                                                                                                plan number (PN) ▶
                                                                                                            1c  Date plan first became effective 
                                                                                                                (MM/DD/YYYY)

2a   Employer’s name                                                                                        2b  Employer Identification Number (EIN) 
                                                                                                                (Do not enter your Social Security Number)
     Trade name of business (if different from name of employer)
                                                                                                            2c  Employer’s telephone number
     In care of name
                                                                                                            2d  Business code (see instructions)
     Mailing address (room, apt., suite no. and street, or P.O. box)

     City or town, state or province, country, and ZIP or foreign postal code (if foreign, see instructions)

3a   Plan administrator’s name (if same as employer, enter “Same”)                                          3b  Administrator’s EIN

     In care of name                                                                                        3c  Administrator’s telephone number

     Mailing address (room, apt., suite no. and street, or P.O. box)

     City or town, state or province, country, and ZIP or foreign postal code (if foreign, see instructions)

4    If the employer’s name, the employer’s EIN, and/or the plan name has changed since the 
     last return filed for this plan, enter the employer’s name and EIN, the plan name, and the 
     plan number for the last return in the appropriate space provided
 a   Employer’s name                                                                                              4b   EIN

4c   Plan name                                                                                                    4d   PN

5a(1) Total number of participants at the beginning of the plan year     .   . . .  . .    .                . .   5a(1)
 a(2) Total number of active participants at the beginning of the plan year    . .  . .    .                . .   5a(2)
 b(1)Total number of participants at the end of the plan year        . . .   . . .  . .    .                . .   5b(1)
 b(2)Total number of active participants at the end of the plan year     .   . . .  . .    .                . .   5b(2)
 c   Number  of  participants  who  terminated  employment  during  the  plan  year  with  accrued 
     benefits that were less than 100% vested .    . . .           . . . .   . . .  . .    .                . .          5c
Part III Financial Information
                                                                                           (1) Beginning of year                    (2) End of year

6a   Total plan assets     .   . . . .   . . .   . . . .           . . . .   . . .  6a

 b   Total plan liabilities .  . . . .   . . .   . . . .           . . . .   . . .  6b

 c   Net plan assets (subtract line 6b from 6a)  . . . .           . . . .   . . .  6c
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 5500-EZ.                  Catalog Number 63263R  Form 5500-EZ (2021)

Form 5500-EZ (2021)                                                                                                                       Page  2
Part III Financial Information (continued)
7    Contributions received or receivable from:                                                                                     Amount

a    Employers.       . . . . . .   .  . .           . . . . . . . .  . . . .    .  . .                            . .  . . 7a

b    Participants .     . . . . .   .  . .           . . . . . . . .  . . . .    .  . .                            . .  . . 7b

c    Others (including rollovers) . .  . .           . . . . . . . .  . . . .    .  . .                            . .  . . 7c
Part IV  Plan Characteristics
8    Enter the applicable two-character feature codes from the List of Plan Characteristics Codes in the instructions.

Part V   Compliance and Funding Questions
                                                                                                                          Yes No    Amount
9    During the plan year, did the plan have any participant loans? 
     If “Yes,” enter amount as of year end .         . . . . . . . .  . . . .    .  . .                                9
10   Is this a defined benefit plan that is subject to minimum funding requirements?
     If “Yes,” complete Schedule SB (Form 5500) and line 10a below (see instructions)                                10
a    Enter the unpaid minimum required contributions for all years from Schedule SB (Form 5500), 
     line 40 .      . . . . . . .   .  . .           . . . . . . . .  . . . .    .  . .                            . .  . . 10a
11   Is  this  a  defined  contribution  plan  subject  to  the  minimum  funding  requirements 
     of section 412 of the Code? .  .  . .           . . . . . . . .  . . . .    .  . .                              11
     If “Yes,” complete lines 11a or 11b, 11c, 11d, and 11e below, as applicable.
a    If  a  waiver  of  the  minimum  funding  standard  for  a  prior  year  is  being  amortized  in  this  plan 
     year,  enter  the  month,  day,  and  year  (MM/DD/YYYY)  of  the  letter  ruling  granting  the  waiver 
     (see instructions)   . . . .   .  . .           . . . . . . . .  . . . .    .  . .                            . .  . . 11a
b    Enter the minimum required contribution for this plan year .  .  . . . .    .  . .                            . .  . . 11b
c    Enter the amount contributed by the employer to the plan for this plan year .  . .                            . .  . . 11c
d    Subtract the amount in line 11c from the amount in line 11b. Enter the result (enter a minus sign 
     to the left of a negative amount) . .           . . . . . . . .  . . . .    .  . .                            . .  . . 11d
                                                                                                                          Yes No N/A
e    Will  the  minimum  funding  amount  reported  on  line  11d  be  met  by  the  funding 
     deadline? .      . . . . . .   .  . .           . . . . . . . .  . . . .    .  . .                              11e
Caution: A penalty for the late or incomplete filing of this return will be assessed unless reasonable cause is established.
     Under penalties of perjury, I declare that I have examined this return including, if applicable, any related Schedule MB (Form 5500) or Schedule SB (Form 5500)
     signed by an enrolled actuary, and, to the best of my knowledge and belief, it is true, correct, and complete.
     ▲
Sign 
Here
         Signature of employer or plan administrator             Date               Type or print name of individual signing as employer or 
                                                                                    plan administrator
                                                                                                                                 Form 5500-EZ (2021)