401k Plan data: HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN plan

HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN 401k Plan overview

Plan Name	HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN
Plan identification number	001

HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS 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.
Prototype plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion or notification letter; and under which a seperate funding medium (for example, a seperate trust or custodial account) is established for the use of each adopting employer.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

HORIZON FIVE STAR ENTERPRISES, INC has sponsored the creation of one or more 401k plans.

Company Name: HORIZON FIVE STAR ENTERPRISES, INC

Employer identification number (EIN): 363377259

NAIC Classification: 326100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 JAMES GUINN
001 2015-01-01 DAVID SULLIVAN
001 2014-01-01 DAVID SULLIVAN
001 2013-01-01 DAVID SULLIVAN
001 2012-01-01 DAVID SULLIVAN
001 2011-01-01 DAVID E SULLIVAN
001 2009-01-01 DAVID E SULLIVAN
001 2009-01-01 DAVID E SULLIVAN

Plan id#	Filing Submission Date	Name of Administrator
001	2016-01-01	JAMES GUINN
001	2015-01-01	DAVID SULLIVAN
001	2014-01-01	DAVID SULLIVAN
001	2013-01-01	DAVID SULLIVAN
001	2012-01-01	DAVID SULLIVAN
001	2011-01-01	DAVID E SULLIVAN
001	2009-01-01	DAVID E SULLIVAN
001	2009-01-01	DAVID E SULLIVAN

Plan Statistics for HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN

401k plan membership statisitcs for HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN

Measure Date Value
2016: HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 131
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 108
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 13
Total of all active and inactive participants 2016-01-01 121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 121
Number of participants with account balances 2016-01-01 109
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 4
2015: HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 109
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 106
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 23
Total of all active and inactive participants 2015-01-01 129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 129
Number of participants with account balances 2015-01-01 105
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 3
2014: HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 96
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 85
Number of retired or separated participants receiving benefits 2014-01-01 21
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 106
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 106
Number of participants with account balances 2014-01-01 106
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 4
2013: HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 89
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 91
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 5
Total of all active and inactive participants 2013-01-01 96
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 96
Number of participants with account balances 2013-01-01 96
2012: HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 92
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 76
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 13
Total of all active and inactive participants 2012-01-01 89
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 89
Number of participants with account balances 2012-01-01 89
2011: HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 95
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 71
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 21
Total of all active and inactive participants 2011-01-01 92
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 92
Number of participants with account balances 2011-01-01 92
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 1
2009: HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 110
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 74
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 28
Total of all active and inactive participants 2009-01-01 102
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 102
Number of participants with account balances 2009-01-01 102

Measure	Date	Value
2016: HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	131
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	108
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	13
Total of all active and inactive participants	2016-01-01	121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	121
Number of participants with account balances	2016-01-01	109
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	4
2015: HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	109
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	106
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	23
Total of all active and inactive participants	2015-01-01	129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	129
Number of participants with account balances	2015-01-01	105
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	3
2014: HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	96
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	85
Number of retired or separated participants receiving benefits	2014-01-01	21
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	106
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	106
Number of participants with account balances	2014-01-01	106
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	4
2013: HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	89
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	91
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	5
Total of all active and inactive participants	2013-01-01	96
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	96
Number of participants with account balances	2013-01-01	96
2012: HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	92
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	76
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	13
Total of all active and inactive participants	2012-01-01	89
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	89
Number of participants with account balances	2012-01-01	89
2011: HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	95
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	71
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	21
Total of all active and inactive participants	2011-01-01	92
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	92
Number of participants with account balances	2011-01-01	92
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	1
2009: HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	110
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	74
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	28
Total of all active and inactive participants	2009-01-01	102
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	102
Number of participants with account balances	2009-01-01	102

Financial Data on HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN

Measure	Date	Value
2016 : HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$434,409
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$782,681
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$759,190
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$220,882
Value of total assets at end of year	2016-12-31	$3,850,409
Value of total assets at beginning of year	2016-12-31	$4,198,681
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$23,491
Total interest from all sources	2016-12-31	$6,921
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$495
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$495
Administrative expenses professional fees incurred	2016-12-31	$14,572
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$360,000
If this is an individual account plan, was there a blackout period	2016-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$193,919
Participant contributions at end of year	2016-12-31	$124,327
Participant contributions at beginning of year	2016-12-31	$174,448
Participant contributions at end of year	2016-12-31	$5,002
Participant contributions at beginning of year	2016-12-31	$4,580
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-12-31	$1,724
Total non interest bearing cash at end of year	2016-12-31	$117,878
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$-348,272
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$3,850,409
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$4,198,681
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Investment advisory and management fees	2016-12-31	$3,614
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$3,412,962
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$3,839,985
Interest on participant loans	2016-12-31	$6,921
Value of interest in common/collective trusts at end of year	2016-12-31	$188,516
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$178,937
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$130,485
Net investment gain/loss from pooled separate accounts	2016-12-31	$73,486
Net investment gain or loss from common/collective trusts	2016-12-31	$2,140
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$26,963
Employer contributions (assets) at beginning of year	2016-12-31	$731
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$759,190
Contract administrator fees	2016-12-31	$5,305
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2016-12-31	Yes
Did the plan have assets held for investment	2016-12-31	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	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	SIKICH, LLP
Accountancy firm EIN	2016-12-31	363168081
2015 : HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS 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	$217,023
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$243,385
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$222,818
Expenses. Certain deemed distributions of participant loans	2015-12-31	$2,023
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$210,447
Value of total assets at end of year	2015-12-31	$4,198,681
Value of total assets at beginning of year	2015-12-31	$4,225,043
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$18,544
Total interest from all sources	2015-12-31	$10,111
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	$360,000
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	$181,215
Participant contributions at end of year	2015-12-31	$174,448
Participant contributions at beginning of year	2015-12-31	$184,650
Participant contributions at end of year	2015-12-31	$4,580
Participant contributions at beginning of year	2015-12-31	$2,215
Other income not declared elsewhere	2015-12-31	$5,388
Administrative expenses (other) incurred	2015-12-31	$15
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	$-26,362
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$4,198,681
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$4,225,043
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 pooled separate accounts at end of year	2015-12-31	$3,839,985
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$3,868,886
Interest on participant loans	2015-12-31	$7,519
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$2,592
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$178,937
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$168,774
Net investment gain/loss from pooled separate accounts	2015-12-31	$-8,923
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	$29,232
Employer contributions (assets) at end of year	2015-12-31	$731
Employer contributions (assets) at beginning of year	2015-12-31	$518
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$222,818
Contract administrator fees	2015-12-31	$18,529
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	DUFFNER & COMPANY, P.C.
Accountancy firm EIN	2015-12-31	363522274
2014 : HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS 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	$562,845
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$116,840
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$96,950
Expenses. Certain deemed distributions of participant loans	2014-12-31	$6,236
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$199,664
Value of total assets at end of year	2014-12-31	$4,225,043
Value of total assets at beginning of year	2014-12-31	$3,779,038
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$13,654
Total interest from all sources	2014-12-31	$10,769
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	$360,000
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	$172,459
Participant contributions at end of year	2014-12-31	$184,650
Participant contributions at beginning of year	2014-12-31	$132,933
Participant contributions at end of year	2014-12-31	$2,215
Participant contributions at beginning of year	2014-12-31	$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	2014-12-31	No
Value of net income/loss	2014-12-31	$446,005
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$4,225,043
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$3,779,038
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 pooled separate accounts at end of year	2014-12-31	$3,868,886
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$3,480,261
Interest on participant loans	2014-12-31	$8,264
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$2,505
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$168,774
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$165,153
Net investment gain/loss from pooled separate accounts	2014-12-31	$352,412
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	$27,205
Employer contributions (assets) at end of year	2014-12-31	$518
Employer contributions (assets) at beginning of year	2014-12-31	$691
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$96,950
Contract administrator fees	2014-12-31	$13,654
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	CORCORAN, ENDER AND ASSOCIATES LLC
Accountancy firm EIN	2014-12-31	364323082
2013 : HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS 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	$787,974
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$180,161
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$154,479
Expenses. Certain deemed distributions of participant loans	2013-12-31	$13,417
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$191,908
Value of total assets at end of year	2013-12-31	$3,779,038
Value of total assets at beginning of year	2013-12-31	$3,171,225
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$12,265
Total interest from all sources	2013-12-31	$7,498
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	$377,903
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	$165,016
Participant contributions at end of year	2013-12-31	$132,933
Participant contributions at beginning of year	2013-12-31	$158,634
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	$607,813
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$3,779,038
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$3,171,225
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 pooled separate accounts at end of year	2013-12-31	$3,480,261
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$2,793,394
Interest on participant loans	2013-12-31	$5,212
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$2,286
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$165,153
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$219,197
Net investment gain/loss from pooled separate accounts	2013-12-31	$588,568
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	$26,892
Employer contributions (assets) at end of year	2013-12-31	$691
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	$154,479
Contract administrator fees	2013-12-31	$12,265
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	CORCORAN, ENDER AND ASSOCIATES LLC
Accountancy firm EIN	2013-12-31	364323082
2012 : HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS 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	$496,183
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$163,617
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$139,546
Expenses. Certain deemed distributions of participant loans	2012-12-31	$11,314
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$139,404
Value of total assets at end of year	2012-12-31	$3,171,225
Value of total assets at beginning of year	2012-12-31	$2,838,659
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$12,757
Total interest from all sources	2012-12-31	$8,310
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	$315,890
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	$139,270
Participant contributions at end of year	2012-12-31	$158,634
Participant contributions at beginning of year	2012-12-31	$94,698
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$134
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	$332,566
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$3,171,225
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$2,838,659
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 pooled separate accounts at end of year	2012-12-31	$2,793,394
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$2,501,721
Income. Interest from loans (other than to participants)	2012-12-31	$4,906
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$3,404
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$219,197
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$242,240
Net investment gain/loss from pooled separate accounts	2012-12-31	$348,469
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	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$139,546
Contract administrator fees	2012-12-31	$12,757
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	CORCORAN, ENDER AND ASSOCIATES LLC
Accountancy firm EIN	2012-12-31	364323082
2011 : HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN 2011 401k financial data
Total income from all sources (including contributions)	2011-12-31	$67,936
Total of all expenses incurred	2011-12-31	$371,436
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$348,610
Expenses. Certain deemed distributions of participant loans	2011-12-31	$8,193
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$139,860
Value of total assets at end of year	2011-12-31	$2,838,659
Value of total assets at beginning of year	2011-12-31	$3,142,159
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$14,633
Total interest from all sources	2011-12-31	$9,394
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	$350,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$139,860
Participant contributions at end of year	2011-12-31	$94,698
Participant contributions at beginning of year	2011-12-31	$126,652
Administrative expenses (other) incurred	2011-12-31	$14,633
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	$-303,500
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$2,838,659
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$3,142,159
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 pooled separate accounts at end of year	2011-12-31	$2,501,721
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$2,619,207
Interest on participant loans	2011-12-31	$4,966
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$4,428
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$242,240
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$396,300
Net investment gain/loss from pooled separate accounts	2011-12-31	$-81,318
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$348,610
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	CORCORAN, ENDER AND ASSOCIATES LLC
Accountancy firm EIN	2011-12-31	364323082
2010 : HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN 2010 401k financial data
Total income from all sources (including contributions)	2010-12-31	$537,328
Total of all expenses incurred	2010-12-31	$42,109
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$22,722
Expenses. Certain deemed distributions of participant loans	2010-12-31	$5,690
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$139,810
Value of total assets at end of year	2010-12-31	$3,142,159
Value of total assets at beginning of year	2010-12-31	$2,646,940
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$13,697
Total interest from all sources	2010-12-31	$12,683
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	$350,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$139,810
Participant contributions at end of year	2010-12-31	$126,652
Participant contributions at beginning of year	2010-12-31	$141,969
Participant contributions at beginning of year	2010-12-31	$6,671
Administrative expenses (other) incurred	2010-12-31	$13,697
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	$495,219
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$3,142,159
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$2,646,940
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 pooled separate accounts at end of year	2010-12-31	$2,619,207
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$2,453,788
Interest on participant loans	2010-12-31	$7,588
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$5,095
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$396,300
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$44,512
Net investment gain/loss from pooled separate accounts	2010-12-31	$384,835
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$22,722
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	CORCORAN, ENDER AND ASSOCIATES LLC
Accountancy firm EIN	2010-12-31	364323082

Form 5500 Responses for HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN

2016: HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS 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: HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS 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: HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Mulitple 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: HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Mulitple 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: HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Mulitple employer plan
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: HORIZON FIVE STAR COMPANIES RETIREMENT SAVINGS PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Mulitple employer plan
2009-01-01	Submission has been amended	Yes
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

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

E31 8491

Policy instance

Insurance contract or identification number	E31 8491
Number of Individuals Covered	105
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $10,189
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?	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
Commission paid to Insurance Broker	USD $10,189
Insurance broker organization code?	3
Insurance broker name	FSC AGENCY INC

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

E318491

Policy instance

Insurance contract or identification number	E318491
Number of Individuals Covered	106
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $9,409
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?	Yes
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 $9,409
Insurance broker organization code?	3
Insurance broker name	FSC AGENCY INC

UNION CENTRAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 80837 )

Policy contract number

791181

Policy instance

Insurance contract or identification number	791181
Number of Individuals Covered	0
Insurance policy start date	2013-01-01
Insurance policy end date	2013-03-04
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	Yes
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

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

E31 8491

Policy instance

Insurance contract or identification number	E31 8491
Number of Individuals Covered	96
Insurance policy start date	2013-03-05
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $6,168
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?	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 $6,168
Insurance broker organization code?	3
Insurance broker name	FSC AGENCY INC

UNION CENTRAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 80837 )

Policy contract number

791181

Policy instance

Insurance contract or identification number	791181
Number of Individuals Covered	89
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	Yes
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

UNION CENTRAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 80837 )

Policy contract number

ESP 9118

Policy instance

Insurance contract or identification number	ESP 9118
Number of Individuals Covered	95
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Are there contracts with allocated funds for group deferred annuity?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNION CENTRAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 80837 )

Policy contract number

ESP 9118

Policy instance

Insurance contract or identification number	ESP 9118
Number of Individuals Covered	95
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Are there contracts with allocated funds for group deferred annuity?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

HORIZON FIVE STAR COMPANY INSURANCE PLAN [EIN = 363771086]

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Company Name:	HORIZON FIVE STAR ENTERPRISES, INC
Employer identification number (EIN):	363377259
NAIC Classification:	326100