401k Plan data: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN plan

SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 401k Plan overview

Plan Name	SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN
Plan identification number	002

SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

SAFE HARBOR BEHAVIORAL HEALTH has sponsored the creation of one or more 401k plans.

Company Name: SAFE HARBOR BEHAVIORAL HEALTH

Employer identification number (EIN): 251317492

NAIC Classification: 621112
NAIC Description: Offices of Physicians, Mental Health Specialists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2015-01-01 REBECCA HOVER
002 2014-01-01 REBECCA HOVER
002 2013-01-01 REBECCA J HOVER
002 2012-01-01 JONATHAN D. EVANS
002 2011-01-01 JONATHAN D. EVANS
002 2009-01-01 MELANNE J. PAGE

Plan id#	Filing Submission Date	Name of Administrator
002	2015-01-01	REBECCA HOVER
002	2014-01-01	REBECCA HOVER
002	2013-01-01	REBECCA J HOVER
002	2012-01-01	JONATHAN D. EVANS
002	2011-01-01	JONATHAN D. EVANS
002	2009-01-01	MELANNE J. PAGE

Plan Statistics for SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN

401k plan membership statisitcs for SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN

Measure Date Value
2015: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 233
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 186
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 31
Total of all active and inactive participants 2015-01-01 217
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 217
Number of participants with account balances 2015-01-01 119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 14
2014: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 231
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 201
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 30
Total of all active and inactive participants 2014-01-01 231
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 231
Number of participants with account balances 2014-01-01 127
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 5
2013: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 225
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 201
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 28
Total of all active and inactive participants 2013-01-01 229
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 229
Number of participants with account balances 2013-01-01 121
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 9
2012: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 246
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 195
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 27
Total of all active and inactive participants 2012-01-01 222
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 222
Number of participants with account balances 2012-01-01 107
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 4
2011: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 211
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 215
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 28
Total of all active and inactive participants 2011-01-01 243
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 243
Number of participants with account balances 2011-01-01 102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 6
2009: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 191
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 177
Number of other retired or separated participants entitled to future benefits 2009-01-01 21
Total of all active and inactive participants 2009-01-01 198
Total participants 2009-01-01 198
Number of participants with account balances 2009-01-01 77

Measure	Date	Value
2015: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	233
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	186
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	31
Total of all active and inactive participants	2015-01-01	217
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	217
Number of participants with account balances	2015-01-01	119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	14
2014: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	231
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	201
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	30
Total of all active and inactive participants	2014-01-01	231
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	231
Number of participants with account balances	2014-01-01	127
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	5
2013: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	225
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	201
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	28
Total of all active and inactive participants	2013-01-01	229
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	229
Number of participants with account balances	2013-01-01	121
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	9
2012: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	246
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	195
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	27
Total of all active and inactive participants	2012-01-01	222
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	222
Number of participants with account balances	2012-01-01	107
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	4
2011: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	211
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	215
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	28
Total of all active and inactive participants	2011-01-01	243
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	243
Number of participants with account balances	2011-01-01	102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	6
2009: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	191
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	177
Number of other retired or separated participants entitled to future benefits	2009-01-01	21
Total of all active and inactive participants	2009-01-01	198
Total participants	2009-01-01	198
Number of participants with account balances	2009-01-01	77

Financial Data on SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN

Measure	Date	Value
2015 : SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$374,876
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$466,156
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$458,633
Value of total corrective distributions	2015-12-31	$5,773
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$415,968
Value of total assets at end of year	2015-12-31	$3,229,273
Value of total assets at beginning of year	2015-12-31	$3,320,553
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$1,750
Total interest from all sources	2015-12-31	$1,871
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$278,574
Participant contributions at end of year	2015-12-31	$43,670
Participant contributions at beginning of year	2015-12-31	$45,426
Participant contributions at end of year	2015-12-31	$0
Participant contributions at beginning of year	2015-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Income. Non cash contributions	2015-12-31	$35,173
Value of net income/loss	2015-12-31	$-91,280
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$3,229,273
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$3,320,553
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$0
Value of interest in pooled separate accounts at end of year	2015-12-31	$3,158,511
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$3,264,915
Interest on participant loans	2015-12-31	$1,778
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$21,394
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$10,212
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$10,212
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$93
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$5,698
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$0
Net investment gain/loss from pooled separate accounts	2015-12-31	$-42,963
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$102,221
Employer contributions (assets) at end of year	2015-12-31	$0
Employer contributions (assets) at beginning of year	2015-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$458,633
Contract administrator fees	2015-12-31	$1,750
Did the plan have assets held for investment	2015-12-31	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	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	K2S PC
Accountancy firm EIN	2015-12-31	251483438
2014 : SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$829,316
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$263,007
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$231,840
Expenses. Certain deemed distributions of participant loans	2014-12-31	$1,764
Value of total corrective distributions	2014-12-31	$25,813
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$697,458
Value of total assets at end of year	2014-12-31	$3,320,553
Value of total assets at beginning of year	2014-12-31	$2,754,244
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$3,590
Total interest from all sources	2014-12-31	$1,150
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$500,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$271,894
Participant contributions at end of year	2014-12-31	$45,426
Participant contributions at beginning of year	2014-12-31	$24,504
Participant contributions at end of year	2014-12-31	$0
Participant contributions at beginning of year	2014-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$311,982
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$566,309
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$3,320,553
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$2,754,244
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$0
Value of interest in pooled separate accounts at end of year	2014-12-31	$3,264,915
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$2,719,500
Interest on participant loans	2014-12-31	$1,145
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$10,212
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$8,788
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$8,788
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$5
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$1,452
Net investment gain/loss from pooled separate accounts	2014-12-31	$130,708
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$113,582
Employer contributions (assets) at end of year	2014-12-31	$0
Employer contributions (assets) at beginning of year	2014-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$231,840
Contract administrator fees	2014-12-31	$3,590
Did the plan have assets held for investment	2014-12-31	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	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	K2S PC
Accountancy firm EIN	2014-12-31	251483438
2013 : SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$803,757
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$160,198
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$156,478
Expenses. Certain deemed distributions of participant loans	2013-12-31	$2,282
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$414,429
Value of total assets at end of year	2013-12-31	$2,754,244
Value of total assets at beginning of year	2013-12-31	$2,110,685
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$1,438
Total interest from all sources	2013-12-31	$639
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$212,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$274,696
Participant contributions at end of year	2013-12-31	$24,504
Participant contributions at beginning of year	2013-12-31	$16,115
Participant contributions at end of year	2013-12-31	$0
Participant contributions at beginning of year	2013-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$50,425
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$643,559
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$2,754,244
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$2,110,685
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$0
Value of interest in pooled separate accounts at end of year	2013-12-31	$2,719,500
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$2,075,292
Income. Interest from loans (other than to participants)	2013-12-31	$634
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$8,788
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$6,963
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$6,963
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$5
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$1,452
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$12,315
Net investment gain/loss from pooled separate accounts	2013-12-31	$388,689
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$89,308
Employer contributions (assets) at end of year	2013-12-31	$0
Employer contributions (assets) at beginning of year	2013-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$156,478
Contract administrator fees	2013-12-31	$1,438
Did the plan have assets held for investment	2013-12-31	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	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	BKD, LLP
Accountancy firm EIN	2013-12-31	440160260
2012 : SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$601,399
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$222,860
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$221,516
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$359,940
Value of total assets at end of year	2012-12-31	$2,110,685
Value of total assets at beginning of year	2012-12-31	$1,732,146
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$1,344
Total interest from all sources	2012-12-31	$714
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$133,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$245,091
Participant contributions at end of year	2012-12-31	$16,115
Participant contributions at beginning of year	2012-12-31	$22,603
Participant contributions at end of year	2012-12-31	$0
Participant contributions at beginning of year	2012-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$13,915
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$378,539
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$2,110,685
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$1,732,146
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$0
Value of interest in pooled separate accounts at end of year	2012-12-31	$2,075,292
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$1,697,060
Interest on participant loans	2012-12-31	$710
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$6,963
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$2,630
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$2,630
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$4
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$12,315
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$9,853
Net investment gain/loss from pooled separate accounts	2012-12-31	$240,745
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$100,934
Employer contributions (assets) at end of year	2012-12-31	$0
Employer contributions (assets) at beginning of year	2012-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$221,516
Contract administrator fees	2012-12-31	$1,344
Did the plan have assets held for investment	2012-12-31	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	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	MALIN BERGQUIST & COMPANY LLP
Accountancy firm EIN	2012-12-31	251249913
2011 : SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT 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	$287,559
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$131,823
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$130,660
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$338,018
Value of total assets at end of year	2011-12-31	$1,732,146
Value of total assets at beginning of year	2011-12-31	$1,576,410
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$1,163
Total interest from all sources	2011-12-31	$1,146
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	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$133,000
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	$228,131
Participant contributions at end of year	2011-12-31	$22,603
Participant contributions at beginning of year	2011-12-31	$22,013
Participant contributions at end of year	2011-12-31	$0
Participant contributions at beginning of year	2011-12-31	$8,330
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$17,403
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	$155,736
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$1,732,146
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$1,576,410
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	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$0
Value of interest in pooled separate accounts at end of year	2011-12-31	$1,697,060
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$1,535,424
Income. Interest from loans (other than to participants)	2011-12-31	$1,139
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$2,630
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$1,751
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$1,751
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$7
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$9,853
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$6,049
Net investment gain/loss from pooled separate accounts	2011-12-31	$-51,605
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	$92,484
Employer contributions (assets) at end of year	2011-12-31	$0
Employer contributions (assets) at beginning of year	2011-12-31	$2,843
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$130,660
Contract administrator fees	2011-12-31	$1,163
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	MALIN BERGQUIST & COMPANY LLP
Accountancy firm EIN	2011-12-31	251249913
2010 : SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT 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	$463,627
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$184,445
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$183,503
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$292,731
Value of total assets at end of year	2010-12-31	$1,576,410
Value of total assets at beginning of year	2010-12-31	$1,297,228
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$942
Total interest from all sources	2010-12-31	$1,719
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	$133,000
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	$214,342
Participant contributions at end of year	2010-12-31	$22,013
Participant contributions at beginning of year	2010-12-31	$30,459
Participant contributions at end of year	2010-12-31	$8,330
Participant contributions at beginning of year	2010-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$1,434
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	$279,182
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$1,576,410
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$1,297,228
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	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$0
Value of interest in pooled separate accounts at end of year	2010-12-31	$1,535,424
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$1,264,432
Interest on participant loans	2010-12-31	$1,713
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$1,751
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$874
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$874
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$6
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$6,049
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$1,463
Net investment gain/loss from pooled separate accounts	2010-12-31	$169,177
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	$76,955
Employer contributions (assets) at end of year	2010-12-31	$2,843
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$183,503
Contract administrator fees	2010-12-31	$942
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	COLEMAN & CO. P.C.
Accountancy firm EIN	2010-12-31	232907194
2009 : SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN

2015: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT 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 funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: SAFE HARBOR BEHAVIORAL HEALTH 401K RETIREMENT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
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 funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	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

25732

Policy instance

Insurance contract or identification number	25732
Number of Individuals Covered	138
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $11,806
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	1
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 $10,125
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	NA
Insurance broker organization code?	3
Insurance broker name	THE VARGO COMPANY

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

Policy contract number

25732

Policy instance

Insurance contract or identification number	25732
Number of Individuals Covered	134
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $10,824
Total amount of fees paid to insurance company	USD $3,421
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	1
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 $9,328
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	NA
Insurance broker organization code?	3
Insurance broker name	THE VARGO COMPANY

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

Policy contract number

25732

Policy instance

Insurance contract or identification number	25732
Number of Individuals Covered	130
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $8,965
Total amount of fees paid to insurance company	USD $1,942
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	1
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 $7,779
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	NA
Insurance broker organization code?	3
Insurance broker name	THE VARGO COMPANY

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

Policy contract number

25732

Policy instance

Insurance contract or identification number	25732
Number of Individuals Covered	111
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $7,400
Total amount of fees paid to insurance company	USD $1,175
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	1
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 $6,449
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	NA
Insurance broker organization code?	3
Insurance broker name	THE VARGO COMPANY

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

Policy contract number

25732

Policy instance

Insurance contract or identification number	25732
Number of Individuals Covered	105
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $6,628
Total amount of fees paid to insurance company	USD $935
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	1
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

25732

Policy instance

Insurance contract or identification number	25732
Number of Individuals Covered	102
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $5,542
Total amount of fees paid to insurance company	USD $700
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	1
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 $4,845
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	NA
Insurance broker organization code?	3
Insurance broker name	THE VARGO COMPANY

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Company Name:	SAFE HARBOR BEHAVIORAL HEALTH
Employer identification number (EIN):	251317492
NAIC Classification:	621112
NAIC Description:	Offices of Physicians, Mental Health Specialists