401k Plan data: RESTAURANT COVERAGE ASSOCIATES, INC 401(K) RETIREMENT PLAN plan

RESTAURANT COVERAGE ASSOCIATES, INC 401(K) RETIREMENT PLAN 401k Plan overview

Plan Name	RESTAURANT COVERAGE ASSOCIATES, INC 401(K) RETIREMENT PLAN
Plan identification number	001

RESTAURANT COVERAGE ASSOCIATES, INC 401(K) 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

RESTAURANT COVERAGE ASSOCIATES, INC has sponsored the creation of one or more 401k plans.

Company Name: RESTAURANT COVERAGE ASSOCIATES, INC

Employer identification number (EIN): 222395915

NAIC Classification: 524210
NAIC Description: Insurance Agencies and Brokerages

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RESTAURANT COVERAGE ASSOCIATES, INC 401(K) RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2019-01-01 MICHAEL LEONARD 2019-07-12
001 2018-01-01 MICHAEL LEONARD 2019-07-11
001 2017-01-01 MICHAEL LEONARD 2018-06-29
001 2016-01-01 MICHAEL LEONARD 2017-10-13 MICHAEL LEONARD 2017-10-13
001 2015-01-01 JAMES HENRY
001 2015-01-01 JAMES HENRY
001 2014-01-01 JAMES HENRY
001 2013-01-01 JAMES HENRY
001 2012-01-01 JAMES HENRY JAMES HENRY 2013-10-15
001 2011-01-01 JAMES HENRY JAMES HENRY 2013-10-18

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2019-01-01	MICHAEL LEONARD	2019-07-12
001	2018-01-01	MICHAEL LEONARD	2019-07-11
001	2017-01-01	MICHAEL LEONARD	2018-06-29
001	2016-01-01	MICHAEL LEONARD	2017-10-13	MICHAEL LEONARD	2017-10-13
001	2015-01-01	JAMES HENRY
001	2015-01-01	JAMES HENRY
001	2014-01-01	JAMES HENRY
001	2013-01-01	JAMES HENRY
001	2012-01-01	JAMES HENRY		JAMES HENRY	2013-10-15
001	2011-01-01	JAMES HENRY		JAMES HENRY	2013-10-18

Plan Statistics for RESTAURANT COVERAGE ASSOCIATES, INC 401(K) RETIREMENT PLAN

401k plan membership statisitcs for RESTAURANT COVERAGE ASSOCIATES, INC 401(K) RETIREMENT PLAN

Measure Date Value
2015: RESTAURANT COVERAGE ASSOCIATES, INC 401(K) RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 110
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 9
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 63
Total of all active and inactive participants 2015-01-01 72
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 72
Number of participants with account balances 2015-01-01 68
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 5
2014: RESTAURANT COVERAGE ASSOCIATES, INC 401(K) RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 117
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 73
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 37
Total of all active and inactive participants 2014-01-01 110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 110
Number of participants with account balances 2014-01-01 94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 8
2013: RESTAURANT COVERAGE ASSOCIATES, INC 401(K) RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 131
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 92
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 25
Total of all active and inactive participants 2013-01-01 117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 117
Number of participants with account balances 2013-01-01 99
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 3
2012: RESTAURANT COVERAGE ASSOCIATES, INC 401(K) RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 123
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 106
Number of retired or separated participants receiving benefits 2012-01-01 1
Number of other retired or separated participants entitled to future benefits 2012-01-01 24
Total of all active and inactive participants 2012-01-01 131
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 131
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 25
2011: RESTAURANT COVERAGE ASSOCIATES, INC 401(K) RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 137
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 105
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 23
Total of all active and inactive participants 2011-01-01 128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 128
Number of participants with account balances 2011-01-01 101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0

Measure	Date	Value
2015: RESTAURANT COVERAGE ASSOCIATES, INC 401(K) RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	110
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	9
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	63
Total of all active and inactive participants	2015-01-01	72
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	72
Number of participants with account balances	2015-01-01	68
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	5
2014: RESTAURANT COVERAGE ASSOCIATES, INC 401(K) RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	117
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	73
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	37
Total of all active and inactive participants	2014-01-01	110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	110
Number of participants with account balances	2014-01-01	94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	8
2013: RESTAURANT COVERAGE ASSOCIATES, INC 401(K) RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	131
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	92
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	25
Total of all active and inactive participants	2013-01-01	117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	117
Number of participants with account balances	2013-01-01	99
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	3
2012: RESTAURANT COVERAGE ASSOCIATES, INC 401(K) RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	123
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	106
Number of retired or separated participants receiving benefits	2012-01-01	1
Number of other retired or separated participants entitled to future benefits	2012-01-01	24
Total of all active and inactive participants	2012-01-01	131
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	131
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	25
2011: RESTAURANT COVERAGE ASSOCIATES, INC 401(K) RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	137
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	105
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	23
Total of all active and inactive participants	2011-01-01	128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	128
Number of participants with account balances	2011-01-01	101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0

Financial Data on RESTAURANT COVERAGE ASSOCIATES, INC 401(K) RETIREMENT PLAN

Measure	Date	Value
2015 : RESTAURANT COVERAGE ASSOCIATES, INC 401(K) 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	$49,852
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$3,765,978
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$3,729,335
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$287,130
Value of total assets at end of year	2015-12-31	$4,736,738
Value of total assets at beginning of year	2015-12-31	$8,452,864
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$36,643
Total interest from all sources	2015-12-31	$17,184
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	$1,000,000
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
Funding deficiency by the employer to the plan for this plan year	2015-12-31	$0
Minimum employer required contribution for this plan year	2015-12-31	$0
Amount contributed by the employer to the plan for this plan year	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	$244,472
Participant contributions at end of year	2015-12-31	$153,609
Participant contributions at beginning of year	2015-12-31	$154,255
Total non interest bearing cash at end of year	2015-12-31	$693
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
Value of net income/loss	2015-12-31	$-3,716,126
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$4,736,738
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$8,452,864
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
Investment advisory and management fees	2015-12-31	$34,068
Value of interest in pooled separate accounts at end of year	2015-12-31	$3,962,044
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$7,096,854
Interest on participant loans	2015-12-31	$6,225
Interest earned on other investments	2015-12-31	$10,959
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$620,392
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$1,201,755
Net investment gain/loss from pooled separate accounts	2015-12-31	$-254,462
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	$42,658
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$3,729,335
Contract administrator fees	2015-12-31	$2,575
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	SMART DEVINE
Accountancy firm EIN	2015-12-31	232932984
2014 : RESTAURANT COVERAGE ASSOCIATES, INC 401(K) 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	$763,908
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$940,025
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$899,748
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$601,348
Value of total assets at end of year	2014-12-31	$8,452,864
Value of total assets at beginning of year	2014-12-31	$8,628,981
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$40,277
Total interest from all sources	2014-12-31	$15,752
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	$1,000,000
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	$442,487
Participant contributions at end of year	2014-12-31	$154,255
Participant contributions at beginning of year	2014-12-31	$164,898
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	$-176,117
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$8,452,864
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$8,628,981
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
Investment advisory and management fees	2014-12-31	$39,652
Value of interest in pooled separate accounts at end of year	2014-12-31	$7,096,854
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$7,321,168
Interest on participant loans	2014-12-31	$6,051
Interest earned on other investments	2014-12-31	$9,701
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$1,201,755
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$1,142,915
Net investment gain or loss from common/collective trusts	2014-12-31	$146,808
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	$158,861
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$899,748
Contract administrator fees	2014-12-31	$625
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	SMART DEVINE
Accountancy firm EIN	2014-12-31	232932984
2013 : RESTAURANT COVERAGE ASSOCIATES, INC 401(K) 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	$2,380,555
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$694,676
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$685,811
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$975,726
Value of total assets at end of year	2013-12-31	$8,628,981
Value of total assets at beginning of year	2013-12-31	$6,943,102
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$8,865
Total interest from all sources	2013-12-31	$30,524
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	$1,000,000
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	$474,167
Participant contributions at end of year	2013-12-31	$164,898
Participant contributions at beginning of year	2013-12-31	$183,256
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$328,851
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	$1,685,879
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$8,628,981
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$6,943,102
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
Investment advisory and management fees	2013-12-31	$8,015
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	$5,997,141
Value of interest in pooled separate accounts at end of year	2013-12-31	$7,321,168
Interest on participant loans	2013-12-31	$8,921
Interest earned on other investments	2013-12-31	$21,603
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$1,142,915
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$762,705
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$681,352
Net investment gain/loss from pooled separate accounts	2013-12-31	$692,953
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	$172,708
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$685,811
Contract administrator fees	2013-12-31	$850
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	No
Opinion of an independent qualified public accountant for this plan	2013-12-31	Unqualified
Accountancy firm name	2013-12-31	BAKER TILLY VIRCHOW KRAUSE
Accountancy firm EIN	2013-12-31	390859910
2012 : RESTAURANT COVERAGE ASSOCIATES, INC 401(K) RETIREMENT PLAN 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2012-12-31	$0
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total transfer of assets to this plan	2012-12-31	$0
Total transfer of assets from this plan	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	$1,378,020
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$75,693
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$74,869
Expenses. Certain deemed distributions of participant loans	2012-12-31	$0
Value of total corrective distributions	2012-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$749,531
Value of total assets at end of year	2012-12-31	$6,943,102
Value of total assets at beginning of year	2012-12-31	$5,640,775
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$824
Total interest from all sources	2012-12-31	$11,452
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	$1,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Funding deficiency by the employer to the plan for this plan year	2012-12-31	$0
Minimum employer required contribution for this plan year	2012-12-31	$0
Amount contributed by the employer to the plan for this plan year	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	$463,153
Participant contributions at end of year	2012-12-31	$183,256
Participant contributions at beginning of year	2012-12-31	$171,642
Participant contributions at end of year	2012-12-31	$0
Participant contributions at beginning of year	2012-12-31	$27,928
Assets. Other investments not covered elsewhere at end of year	2012-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2012-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$113,243
Other income not declared elsewhere	2012-12-31	$0
Administrative expenses (other) incurred	2012-12-31	$824
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	$1,302,327
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$6,943,102
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$5,640,775
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	$5,997,141
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$4,780,092
Value of interest in pooled separate accounts at end of year	2012-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$0
Interest on participant loans	2012-12-31	$9,734
Interest earned on other investments	2012-12-31	$1,718
Value of interest in common/collective trusts at end of year	2012-12-31	$0
Value of interest in common/collective trusts at beginning of year	2012-12-31	$648,839
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$762,705
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$0
Net investment gain/loss from pooled separate accounts	2012-12-31	$617,037
Net investment gain or loss from common/collective trusts	2012-12-31	$0
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
Assets. Invements in employer securities at end of year	2012-12-31	$0
Assets. Invements in employer securities at beginning of year	2012-12-31	$0
Contributions received in cash from employer	2012-12-31	$173,135
Employer contributions (assets) at end of year	2012-12-31	$0
Employer contributions (assets) at beginning of year	2012-12-31	$12,274
Income. Dividends from common stock	2012-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$74,869
Asset. Corporate debt instrument debt (other) at end of year	2012-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2012-12-31	$0
Assets. Corporate common stocks other than exployer securities at end of year	2012-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2012-12-31	$0
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	PARENTEBEARD
Accountancy firm EIN	2012-12-31	232932984
2011 : RESTAURANT COVERAGE ASSOCIATES, INC 401(K) RETIREMENT PLAN 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2011-12-31	$0
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total transfer of assets to this plan	2011-12-31	$0
Total transfer of assets from this plan	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	$329,974
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$710,627
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$709,594
Expenses. Certain deemed distributions of participant loans	2011-12-31	$0
Value of total corrective distributions	2011-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$602,871
Value of total assets at end of year	2011-12-31	$5,600,573
Value of total assets at beginning of year	2011-12-31	$5,981,226
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$1,033
Total interest from all sources	2011-12-31	$7,069
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	$1,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Funding deficiency by the employer to the plan for this plan year	2011-12-31	$0
Minimum employer required contribution for this plan year	2011-12-31	$0
Amount contributed by the employer to the plan for this plan year	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	$419,880
Participant contributions at end of year	2011-12-31	$171,642
Participant contributions at beginning of year	2011-12-31	$174,133
Participant contributions at end of year	2011-12-31	$27,928
Participant contributions at beginning of year	2011-12-31	$48,641
Assets. Other investments not covered elsewhere at end of year	2011-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2011-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$0
Other income not declared elsewhere	2011-12-31	$0
Administrative expenses (other) incurred	2011-12-31	$1,033
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	$-380,653
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$5,600,573
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$5,981,226
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	$4,780,092
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$5,086,089
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	$7,069
Interest earned on other investments	2011-12-31	$0
Value of interest in common/collective trusts at end of year	2011-12-31	$648,839
Value of interest in common/collective trusts at beginning of year	2011-12-31	$721,004
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$0
Net investment gain/loss from pooled separate accounts	2011-12-31	$-279,966
Net investment gain or loss from common/collective trusts	2011-12-31	$0
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	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Assets. Invements in employer securities at end of year	2011-12-31	$0
Assets. Invements in employer securities at beginning of year	2011-12-31	$0
Contributions received in cash from employer	2011-12-31	$182,991
Employer contributions (assets) at end of year	2011-12-31	$12,274
Employer contributions (assets) at beginning of year	2011-12-31	$38,275
Income. Dividends from common stock	2011-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$709,594
Asset. Corporate debt instrument debt (other) at end of year	2011-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2011-12-31	$0
Assets. Corporate common stocks other than exployer securities at end of year	2011-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2011-12-31	$0
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	No
Opinion of an independent qualified public accountant for this plan	2011-12-31	Unqualified
Accountancy firm name	2011-12-31	GARY T. STEELE
Accountancy firm EIN	2011-12-31	223253789
2010 : RESTAURANT COVERAGE ASSOCIATES, INC 401(K) RETIREMENT PLAN 2010 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2010-12-31	$0
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total transfer of assets to this plan	2010-12-31	$0
Total transfer of assets from this plan	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	$1,196,892
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$29,761
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$28,963
Expenses. Certain deemed distributions of participant loans	2010-12-31	$0
Value of total corrective distributions	2010-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$543,246
Value of total assets at end of year	2010-12-31	$5,981,226
Value of total assets at beginning of year	2010-12-31	$4,814,095
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$798
Total interest from all sources	2010-12-31	$6,730
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	$1,000,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Funding deficiency by the employer to the plan for this plan year	2010-12-31	$0
Minimum employer required contribution for this plan year	2010-12-31	$0
Amount contributed by the employer to the plan for this plan year	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	$396,381
Participant contributions at end of year	2010-12-31	$174,133
Participant contributions at beginning of year	2010-12-31	$119,372
Assets. Other investments not covered elsewhere at end of year	2010-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2010-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$0
Other income not declared elsewhere	2010-12-31	$0
Administrative expenses (other) incurred	2010-12-31	$798
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	$1,167,131
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$5,981,226
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$4,814,095
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	$5,086,089
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$4,333,584
Value of interest in pooled separate accounts at end of year	2010-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$0
Interest on participant loans	2010-12-31	$6,730
Interest earned on other investments	2010-12-31	$0
Value of interest in common/collective trusts at end of year	2010-12-31	$721,004
Value of interest in common/collective trusts at beginning of year	2010-12-31	$361,139
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$0
Net investment gain/loss from pooled separate accounts	2010-12-31	$646,916
Net investment gain or loss from common/collective trusts	2010-12-31	$0
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	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Assets. Invements in employer securities at end of year	2010-12-31	$0
Assets. Invements in employer securities at beginning of year	2010-12-31	$0
Contributions received in cash from employer	2010-12-31	$146,865
Income. Dividends from common stock	2010-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$28,963
Asset. Corporate debt instrument debt (other) at end of year	2010-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2010-12-31	$0
Assets. Corporate common stocks other than exployer securities at end of year	2010-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2010-12-31	$0
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	GARY T. STEELE, ATTORNEY AT LAW
Accountancy firm EIN	2010-12-31	223253789

Form 5500 Responses for RESTAURANT COVERAGE ASSOCIATES, INC 401(K) RETIREMENT PLAN

2015: RESTAURANT COVERAGE ASSOCIATES, INC 401(K) 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: RESTAURANT COVERAGE ASSOCIATES, INC 401(K) 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: RESTAURANT COVERAGE ASSOCIATES, INC 401(K) RETIREMENT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	Yes
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: RESTAURANT COVERAGE ASSOCIATES, INC 401(K) 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
2011: RESTAURANT COVERAGE ASSOCIATES, INC 401(K) RETIREMENT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	Yes
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

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

17745

Policy instance

Insurance contract or identification number	17745
Number of Individuals Covered	68
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $21,262
Total amount of fees paid to insurance company	USD $5,167
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 $19,502
Insurance broker organization code?	3
Amount paid for insurance broker fees	5167
Additional information about fees paid to insurance broker	MRKT. FEES
Insurance broker name	MUTUAL OF OMAHA INVESTOR

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

17745

Policy instance

Insurance contract or identification number	17745
Number of Individuals Covered	94
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $27,305
Total amount of fees paid to insurance company	USD $8,382
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?	No
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 $20,557
Insurance broker organization code?	3
Amount paid for insurance broker fees	8382
Additional information about fees paid to insurance broker	MRKT FEES
Insurance broker name	DANIEL JUTKIEWICZ

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

17745

Policy instance

Insurance contract or identification number	17745
Number of Individuals Covered	99
Insurance policy start date	2013-04-09
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $148,460
Total amount of fees paid to insurance company	USD $59,817
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?	No
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
Amount paid for insurance broker fees	55602
Additional information about fees paid to insurance broker	MRKT FEES
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $54,800
Insurance broker name	401K COACH

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-710865

Policy instance

Insurance contract or identification number	GA-710865
Number of Individuals Covered	0
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
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?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
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

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-710865

Policy instance

Insurance contract or identification number	GA-710865
Number of Individuals Covered	107
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $23,813
Total amount of fees paid to insurance company	USD $74
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?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
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 $23,813
Insurance broker organization code?	3
Amount paid for insurance broker fees	74
Additional information about fees paid to insurance broker	SALES/MARKETING
Insurance broker name	LPL FINANCIAL LLC

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-710865

Policy instance

Insurance contract or identification number	GA-710865
Number of Individuals Covered	101
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $23,576
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?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
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

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-710865

Policy instance

Insurance contract or identification number	GA-710865
Number of Individuals Covered	107
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $19,001
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?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
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

Potentially related plans

RESTAURANT COVERAGE ASSOCIATION, INC. 401(K) RETIREMENT PLAN [EIN = 223392031]

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Company Name:	RESTAURANT COVERAGE ASSOCIATES, INC
Employer identification number (EIN):	222395915
NAIC Classification:	524210
NAIC Description:	Insurance Agencies and Brokerages