401k Plan data: HAPPY HOLLOW CHILDREN'S CENTER 401K PLAN plan

HAPPY HOLLOW CHILDREN'S CENTER 401K PLAN 401k Plan overview

Plan Name	HAPPY HOLLOW CHILDREN'S CENTER 401K PLAN
Plan identification number	001

HAPPY HOLLOW CHILDREN'S CENTER 401K 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.

401k Sponsoring company profile

HAPPY HOLLOW CHILDRENS CENTER has sponsored the creation of one or more 401k plans.

Company Name: HAPPY HOLLOW CHILDRENS CENTER

Employer identification number (EIN): 352292756

NAIC Classification: 611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HAPPY HOLLOW CHILDREN'S CENTER 401K PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2020-01-01 LAURA L SILAN 2020-09-08
001 2019-01-01 LAURA L SILAN 2020-06-10
001 2018-01-01 MARIO SILAN 2019-07-03
001 2017-01-01 MARIO SILAN 2018-06-12
001 2016-01-01 MARIO SILAN 2017-06-05
001 2015-01-01 MARIO SILAN 2016-06-01
001 2014-01-01 MARIO SILAN
001 2013-01-01 MARIO SILAN
001 2012-01-01 MARIO SILAN MARIO SILAN 2013-06-24
001 2011-01-01 MARIO SILAN
001 2010-01-01 MARIO SILAN
001 2009-01-01 MARIO SILAN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2020-01-01	LAURA L SILAN	2020-09-08
001	2019-01-01	LAURA L SILAN	2020-06-10
001	2018-01-01	MARIO SILAN	2019-07-03
001	2017-01-01	MARIO SILAN	2018-06-12
001	2016-01-01	MARIO SILAN	2017-06-05
001	2015-01-01	MARIO SILAN	2016-06-01
001	2014-01-01	MARIO SILAN
001	2013-01-01	MARIO SILAN
001	2012-01-01	MARIO SILAN		MARIO SILAN	2013-06-24
001	2011-01-01	MARIO SILAN
001	2010-01-01	MARIO SILAN
001	2009-01-01	MARIO SILAN

Plan Statistics for HAPPY HOLLOW CHILDREN'S CENTER 401K PLAN

401k plan membership statisitcs for HAPPY HOLLOW CHILDREN'S CENTER 401K PLAN

Measure Date Value
2014: HAPPY HOLLOW CHILDREN'S CENTER 401K PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 2
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 0
Total of all active and inactive participants 2014-01-01 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 2
Number of participants with account balances 2014-01-01 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: HAPPY HOLLOW CHILDREN'S CENTER 401K PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 3
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 0
Total of all active and inactive participants 2013-01-01 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 3
Number of participants with account balances 2013-01-01 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: HAPPY HOLLOW CHILDREN'S CENTER 401K PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 3
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 0
Total of all active and inactive participants 2012-01-01 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 3
Number of participants with account balances 2012-01-01 3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: HAPPY HOLLOW CHILDREN'S CENTER 401K PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 4
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 4
Number of participants with account balances 2011-01-01 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: HAPPY HOLLOW CHILDREN'S CENTER 401K PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 7
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 7
Number of participants with account balances 2010-01-01 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: HAPPY HOLLOW CHILDREN'S CENTER 401K PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 6
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 6
Number of participants with account balances 2009-01-01 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2014: HAPPY HOLLOW CHILDREN'S CENTER 401K PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	2
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	0
Total of all active and inactive participants	2014-01-01	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	2
Number of participants with account balances	2014-01-01	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: HAPPY HOLLOW CHILDREN'S CENTER 401K PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	3
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	0
Total of all active and inactive participants	2013-01-01	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	3
Number of participants with account balances	2013-01-01	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: HAPPY HOLLOW CHILDREN'S CENTER 401K PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	3
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	0
Total of all active and inactive participants	2012-01-01	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	3
Number of participants with account balances	2012-01-01	3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: HAPPY HOLLOW CHILDREN'S CENTER 401K PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	4
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	4
Number of participants with account balances	2011-01-01	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: HAPPY HOLLOW CHILDREN'S CENTER 401K PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	7
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	7
Number of participants with account balances	2010-01-01	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: HAPPY HOLLOW CHILDREN'S CENTER 401K PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	6
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	6
Number of participants with account balances	2009-01-01	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on HAPPY HOLLOW CHILDREN'S CENTER 401K PLAN

Measure	Date	Value
2014 : HAPPY HOLLOW CHILDREN'S CENTER 401K PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total income from all sources	2014-12-31	$83,178
Expenses. Total of all expenses incurred	2014-12-31	$300
Benefits paid (including direct rollovers)	2014-12-31	$0
Total plan assets at end of year	2014-12-31	$395,539
Total plan assets at beginning of year	2014-12-31	$312,661
Total contributions received or receivable from participants	2014-12-31	$44,917
Expenses. Other expenses not covered elsewhere	2014-12-31	$300
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$34,779
Net income (gross income less expenses)	2014-12-31	$82,878
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$395,539
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$312,661
Assets. Value of participant loans	2014-12-31	$0
Total contributions received or receivable from employer(s)	2014-12-31	$3,482
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
2013 : HAPPY HOLLOW CHILDREN'S CENTER 401K PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total income from all sources	2013-12-31	$106,348
Expenses. Total of all expenses incurred	2013-12-31	$300
Benefits paid (including direct rollovers)	2013-12-31	$0
Total plan assets at end of year	2013-12-31	$312,661
Total plan assets at beginning of year	2013-12-31	$206,613
Total contributions received or receivable from participants	2013-12-31	$38,500
Expenses. Other expenses not covered elsewhere	2013-12-31	$300
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$66,268
Net income (gross income less expenses)	2013-12-31	$106,048
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$312,661
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$206,613
Assets. Value of participant loans	2013-12-31	$0
Total contributions received or receivable from employer(s)	2013-12-31	$1,580
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
2012 : HAPPY HOLLOW CHILDREN'S CENTER 401K PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total income from all sources	2012-12-31	$78,375
Expenses. Total of all expenses incurred	2012-12-31	$300
Benefits paid (including direct rollovers)	2012-12-31	$0
Total plan assets at end of year	2012-12-31	$206,613
Total plan assets at beginning of year	2012-12-31	$128,538
Total contributions received or receivable from participants	2012-12-31	$49,023
Expenses. Other expenses not covered elsewhere	2012-12-31	$300
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$25,170
Net income (gross income less expenses)	2012-12-31	$78,075
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$206,613
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$128,538
Assets. Value of participant loans	2012-12-31	$0
Total contributions received or receivable from employer(s)	2012-12-31	$4,182
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
2011 : HAPPY HOLLOW CHILDREN'S CENTER 401K PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total income from all sources	2011-12-31	$14,790
Expenses. Total of all expenses incurred	2011-12-31	$300
Benefits paid (including direct rollovers)	2011-12-31	$0
Total plan assets at end of year	2011-12-31	$128,538
Total plan assets at beginning of year	2011-12-31	$114,048
Total contributions received or receivable from participants	2011-12-31	$22,458
Expenses. Other expenses not covered elsewhere	2011-12-31	$300
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-9,606
Net income (gross income less expenses)	2011-12-31	$14,490
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$128,538
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$114,048
Assets. Value of participant loans	2011-12-31	$0
Total contributions received or receivable from employer(s)	2011-12-31	$1,938
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
2010 : HAPPY HOLLOW CHILDREN'S CENTER 401K PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total income from all sources	2010-12-31	$33,466
Expenses. Total of all expenses incurred	2010-12-31	$300
Benefits paid (including direct rollovers)	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$114,048
Total plan assets at beginning of year	2010-12-31	$80,882
Total contributions received or receivable from participants	2010-12-31	$20,387
Expenses. Other expenses not covered elsewhere	2010-12-31	$300
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$13,079
Net income (gross income less expenses)	2010-12-31	$33,166
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$114,048
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$80,882
Assets. Value of participant loans	2010-12-31	$0
Total contributions received or receivable from employer(s)	2010-12-31	$0
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0

Form 5500 Responses for HAPPY HOLLOW CHILDREN'S CENTER 401K PLAN

2014: HAPPY HOLLOW CHILDREN'S CENTER 401K 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
2013: HAPPY HOLLOW CHILDREN'S CENTER 401K 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
2012: HAPPY HOLLOW CHILDREN'S CENTER 401K 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: HAPPY HOLLOW CHILDREN'S CENTER 401K 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
2010: HAPPY HOLLOW CHILDREN'S CENTER 401K PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: HAPPY HOLLOW CHILDREN'S CENTER 401K 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

Insurance Providers Used on plan

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

Policy contract number

GA-811076

Policy instance

Insurance contract or identification number	GA-811076
Number of Individuals Covered	2
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,310
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
Commission paid to Insurance Broker	USD $1,310
Insurance broker organization code?	3
Insurance broker name	MERRILL LYNCH LIFE AGENCY INC

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

Policy contract number

GA-811076

Policy instance

Insurance contract or identification number	GA-811076
Number of Individuals Covered	2
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $552
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-811076

Policy instance

Insurance contract or identification number	GA-811076
Number of Individuals Covered	2
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $436
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
Commission paid to Insurance Broker	USD $436
Insurance broker organization code?	3
Insurance broker name	MERRILL LYNCH LIFE AGENCY

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Company Name:	HAPPY HOLLOW CHILDRENS CENTER
Employer identification number (EIN):	352292756
NAIC Classification:	611000