401k Plan data: RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN plan

RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN 401k Plan overview

Plan Name	RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN
Plan identification number	002

RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
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.
Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of 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.
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

RANDOLPH COMMUNITY SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name: RANDOLPH COMMUNITY SERVICES, INC.

Employer identification number (EIN): 561244921

NAIC Classification: 813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2022-07-01 KRYSTAL PARKS 2024-04-01
002 2021-07-01 KRYSTAL PARKS 2023-01-11
002 2020-07-01 KRYSTAL PARKS 2021-12-14
002 2019-07-01 KRYSTAL PARKS 2021-01-06
002 2018-07-01 KRYSTAL PARKS 2019-09-26
002 2017-07-01 KRYSTAL PARKS 2019-03-04
002 2016-07-01 KRYSTAL PARKS 2018-01-31
002 2015-07-01 KRYSTAL PARKS
002 2014-07-01 JANICE SCARBOROUGH JANICE SCARBOROUGH 2016-04-15
002 2013-07-01 JANICE SCARBOROUGH
002 2012-07-01 JANICE SCARBOROUGH
002 2011-07-01 JANICE SCARBOROUGH
002 2009-07-01 JANICE SCARBOROUGH

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2022-07-01	KRYSTAL PARKS	2024-04-01
002	2021-07-01	KRYSTAL PARKS	2023-01-11
002	2020-07-01	KRYSTAL PARKS	2021-12-14
002	2019-07-01	KRYSTAL PARKS	2021-01-06
002	2018-07-01	KRYSTAL PARKS	2019-09-26
002	2017-07-01	KRYSTAL PARKS	2019-03-04
002	2016-07-01	KRYSTAL PARKS	2018-01-31
002	2015-07-01	KRYSTAL PARKS
002	2014-07-01	JANICE SCARBOROUGH		JANICE SCARBOROUGH	2016-04-15
002	2013-07-01	JANICE SCARBOROUGH
002	2012-07-01	JANICE SCARBOROUGH
002	2011-07-01	JANICE SCARBOROUGH
002	2009-07-01	JANICE SCARBOROUGH

Plan Statistics for RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN

401k plan membership statisitcs for RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN

Measure Date Value
2015: RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-07-01 101
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 89
Number of retired or separated participants receiving benefits 2015-07-01 1
Number of other retired or separated participants entitled to future benefits 2015-07-01 3
Total of all active and inactive participants 2015-07-01 93
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-07-01 0
Total participants 2015-07-01 93
Number of participants with account balances 2015-07-01 92
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-07-01 0
2014: RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-07-01 126
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 85
Number of retired or separated participants receiving benefits 2014-07-01 23
Number of other retired or separated participants entitled to future benefits 2014-07-01 3
Total of all active and inactive participants 2014-07-01 111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-07-01 0
Total participants 2014-07-01 111
Number of participants with account balances 2014-07-01 109
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-07-01 1
2013: RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-07-01 121
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 108
Number of retired or separated participants receiving benefits 2013-07-01 0
Number of other retired or separated participants entitled to future benefits 2013-07-01 8
Total of all active and inactive participants 2013-07-01 116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-07-01 0
Total participants 2013-07-01 116
Number of participants with account balances 2013-07-01 116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-07-01 2
2012: RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 143
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 109
Number of retired or separated participants receiving benefits 2012-07-01 6
Number of other retired or separated participants entitled to future benefits 2012-07-01 0
Total of all active and inactive participants 2012-07-01 115
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-07-01 0
Total participants 2012-07-01 115
Number of participants with account balances 2012-07-01 114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-07-01 0
2011: RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-07-01 172
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 111
Number of retired or separated participants receiving benefits 2011-07-01 0
Number of other retired or separated participants entitled to future benefits 2011-07-01 27
Total of all active and inactive participants 2011-07-01 138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-07-01 0
Total participants 2011-07-01 138
Number of participants with account balances 2011-07-01 137
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-07-01 2
2009: RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-07-01 139
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 125
Number of retired or separated participants receiving benefits 2009-07-01 0
Number of other retired or separated participants entitled to future benefits 2009-07-01 6
Total of all active and inactive participants 2009-07-01 131
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-07-01 1
Total participants 2009-07-01 132
Number of participants with account balances 2009-07-01 129
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-07-01 0

Measure	Date	Value
2015: RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-07-01	101
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	89
Number of retired or separated participants receiving benefits	2015-07-01	1
Number of other retired or separated participants entitled to future benefits	2015-07-01	3
Total of all active and inactive participants	2015-07-01	93
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-07-01	0
Total participants	2015-07-01	93
Number of participants with account balances	2015-07-01	92
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-07-01	0
2014: RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-07-01	126
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	85
Number of retired or separated participants receiving benefits	2014-07-01	23
Number of other retired or separated participants entitled to future benefits	2014-07-01	3
Total of all active and inactive participants	2014-07-01	111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-07-01	0
Total participants	2014-07-01	111
Number of participants with account balances	2014-07-01	109
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-07-01	1
2013: RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-07-01	121
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	108
Number of retired or separated participants receiving benefits	2013-07-01	0
Number of other retired or separated participants entitled to future benefits	2013-07-01	8
Total of all active and inactive participants	2013-07-01	116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-07-01	0
Total participants	2013-07-01	116
Number of participants with account balances	2013-07-01	116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-07-01	2
2012: RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	143
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	109
Number of retired or separated participants receiving benefits	2012-07-01	6
Number of other retired or separated participants entitled to future benefits	2012-07-01	0
Total of all active and inactive participants	2012-07-01	115
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-07-01	0
Total participants	2012-07-01	115
Number of participants with account balances	2012-07-01	114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-07-01	0
2011: RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-07-01	172
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	111
Number of retired or separated participants receiving benefits	2011-07-01	0
Number of other retired or separated participants entitled to future benefits	2011-07-01	27
Total of all active and inactive participants	2011-07-01	138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-07-01	0
Total participants	2011-07-01	138
Number of participants with account balances	2011-07-01	137
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-07-01	2
2009: RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-07-01	139
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	125
Number of retired or separated participants receiving benefits	2009-07-01	0
Number of other retired or separated participants entitled to future benefits	2009-07-01	6
Total of all active and inactive participants	2009-07-01	131
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-07-01	1
Total participants	2009-07-01	132
Number of participants with account balances	2009-07-01	129
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-07-01	0

Financial Data on RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN

Measure	Date	Value
2016 : RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-06-30	$29,145
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-06-30	$30,554
Total income from all sources (including contributions)	2016-06-30	$218,113
Total loss/gain on sale of assets	2016-06-30	$0
Total of all expenses incurred	2016-06-30	$241,601
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-06-30	$220,936
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-06-30	$166,249
Value of total assets at end of year	2016-06-30	$1,452,484
Value of total assets at beginning of year	2016-06-30	$1,477,381
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-06-30	$20,665
Total interest from all sources	2016-06-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2016-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-06-30	No
Was this plan covered by a fidelity bond	2016-06-30	Yes
Value of fidelity bond cover	2016-06-30	$550,000
If this is an individual account plan, was there a blackout period	2016-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2016-06-30	No
Contributions received from participants	2016-06-30	$46,480
Participant contributions at end of year	2016-06-30	$0
Participant contributions at beginning of year	2016-06-30	$0
Assets. Other investments not covered elsewhere at end of year	2016-06-30	$178,922
Assets. Other investments not covered elsewhere at beginning of year	2016-06-30	$163,569
Income. Received or receivable in cash from other sources (including rollovers)	2016-06-30	$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	2016-06-30	No
Income. Non cash contributions	2016-06-30	$0
Value of net income/loss	2016-06-30	$-23,488
Value of net assets at end of year (total assets less liabilities)	2016-06-30	$1,423,339
Value of net assets at beginning of year (total assets less liabilities)	2016-06-30	$1,446,827
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-06-30	No
Were any leases to which the plan was party in default or uncollectible	2016-06-30	No
Investment advisory and management fees	2016-06-30	$20,665
Value of interest in pooled separate accounts at end of year	2016-06-30	$1,265,228
Value of interest in pooled separate accounts at beginning of year	2016-06-30	$1,300,177
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2016-06-30	$2,059
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-06-30	$4,507
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-06-30	$4,507
Expenses. Payments to insurance carriers foe the provision of benefits	2016-06-30	$56,837
Net investment gain/loss from pooled separate accounts	2016-06-30	$51,864
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-06-30	No
Was there a failure to transmit to the plan any participant contributions	2016-06-30	No
Has the plan failed to provide any benefit when due under the plan	2016-06-30	No
Contributions received in cash from employer	2016-06-30	$119,769
Employer contributions (assets) at end of year	2016-06-30	$6,275
Employer contributions (assets) at beginning of year	2016-06-30	$9,128
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-06-30	$164,099
Liabilities. Value of benefit claims payable at end of year	2016-06-30	$29,145
Liabilities. Value of benefit claims payable at beginning of year	2016-06-30	$30,554
Did the plan have assets held for investment	2016-06-30	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	2016-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2016-06-30	Disclaimer
Accountancy firm name	2016-06-30	RIVES & ASSOCIATES, LLP
Accountancy firm EIN	2016-06-30	200427530
2015 : RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-06-30	$30,554
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-06-30	$34,541
Total income from all sources (including contributions)	2015-06-30	$123,448
Total loss/gain on sale of assets	2015-06-30	$0
Total of all expenses incurred	2015-06-30	$510,015
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-06-30	$481,978
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-06-30	$154,332
Value of total assets at end of year	2015-06-30	$1,477,381
Value of total assets at beginning of year	2015-06-30	$1,867,935
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-06-30	$28,037
Total interest from all sources	2015-06-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2015-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-06-30	No
Was this plan covered by a fidelity bond	2015-06-30	Yes
Value of fidelity bond cover	2015-06-30	$550,000
If this is an individual account plan, was there a blackout period	2015-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2015-06-30	No
Contributions received from participants	2015-06-30	$39,977
Participant contributions at end of year	2015-06-30	$0
Participant contributions at beginning of year	2015-06-30	$0
Assets. Other investments not covered elsewhere at end of year	2015-06-30	$163,569
Assets. Other investments not covered elsewhere at beginning of year	2015-06-30	$181,049
Income. Received or receivable in cash from other sources (including rollovers)	2015-06-30	$0
Other income not declared elsewhere	2015-06-30	$-2,861
Administrative expenses (other) incurred	2015-06-30	$27,066
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-06-30	No
Income. Non cash contributions	2015-06-30	$0
Value of net income/loss	2015-06-30	$-386,567
Value of net assets at end of year (total assets less liabilities)	2015-06-30	$1,446,827
Value of net assets at beginning of year (total assets less liabilities)	2015-06-30	$1,833,394
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-06-30	No
Were any leases to which the plan was party in default or uncollectible	2015-06-30	No
Investment advisory and management fees	2015-06-30	$971
Value of interest in pooled separate accounts at end of year	2015-06-30	$0
Value of interest in pooled separate accounts at beginning of year	2015-06-30	$39,443
Value of interest in common/collective trusts at end of year	2015-06-30	$1,300,177
Value of interest in common/collective trusts at beginning of year	2015-06-30	$1,646,438
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-06-30	$4,507
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-06-30	$1,005
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-06-30	$1,005
Expenses. Payments to insurance carriers foe the provision of benefits	2015-06-30	$27,693
Net investment gain/loss from pooled separate accounts	2015-06-30	$-28,023
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-06-30	No
Was there a failure to transmit to the plan any participant contributions	2015-06-30	No
Has the plan failed to provide any benefit when due under the plan	2015-06-30	No
Contributions received in cash from employer	2015-06-30	$114,355
Employer contributions (assets) at end of year	2015-06-30	$9,128
Employer contributions (assets) at beginning of year	2015-06-30	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-06-30	$454,285
Liabilities. Value of benefit claims payable at end of year	2015-06-30	$30,554
Liabilities. Value of benefit claims payable at beginning of year	2015-06-30	$34,541
Did the plan have assets held for investment	2015-06-30	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	2015-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2015-06-30	Disclaimer
Accountancy firm name	2015-06-30	RIVES & ASSOCIATES, LLP
Accountancy firm EIN	2015-06-30	200427530
2014 : RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2014-06-30	$27,508
Total unrealized appreciation/depreciation of assets	2014-06-30	$27,508
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-06-30	$34,541
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-06-30	$37,059
Total income from all sources (including contributions)	2014-06-30	$336,793
Total loss/gain on sale of assets	2014-06-30	$0
Total of all expenses incurred	2014-06-30	$264,789
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-06-30	$235,170
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-06-30	$195,027
Value of total assets at end of year	2014-06-30	$1,867,935
Value of total assets at beginning of year	2014-06-30	$1,798,449
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-06-30	$29,619
Total interest from all sources	2014-06-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2014-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-06-30	No
Was this plan covered by a fidelity bond	2014-06-30	Yes
Value of fidelity bond cover	2014-06-30	$550,000
If this is an individual account plan, was there a blackout period	2014-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2014-06-30	No
Contributions received from participants	2014-06-30	$49,304
Participant contributions at end of year	2014-06-30	$0
Participant contributions at beginning of year	2014-06-30	$1,381
Assets. Other investments not covered elsewhere at end of year	2014-06-30	$181,049
Assets. Other investments not covered elsewhere at beginning of year	2014-06-30	$168,695
Administrative expenses (other) incurred	2014-06-30	$20,936
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-06-30	No
Value of net income/loss	2014-06-30	$72,004
Value of net assets at end of year (total assets less liabilities)	2014-06-30	$1,833,394
Value of net assets at beginning of year (total assets less liabilities)	2014-06-30	$1,761,390
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-06-30	No
Were any leases to which the plan was party in default or uncollectible	2014-06-30	No
Investment advisory and management fees	2014-06-30	$8,683
Value of interest in pooled separate accounts at end of year	2014-06-30	$39,443
Value of interest in pooled separate accounts at beginning of year	2014-06-30	$32,939
Value of interest in common/collective trusts at end of year	2014-06-30	$1,646,438
Value of interest in common/collective trusts at beginning of year	2014-06-30	$1,583,861
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-06-30	$1,005
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-06-30	$1,123
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-06-30	$1,123
Expenses. Payments to insurance carriers foe the provision of benefits	2014-06-30	$34,541
Net investment gain/loss from pooled separate accounts	2014-06-30	$5,698
Net investment gain or loss from common/collective trusts	2014-06-30	$108,560
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-06-30	No
Was there a failure to transmit to the plan any participant contributions	2014-06-30	No
Has the plan failed to provide any benefit when due under the plan	2014-06-30	No
Contributions received in cash from employer	2014-06-30	$145,723
Employer contributions (assets) at end of year	2014-06-30	$0
Employer contributions (assets) at beginning of year	2014-06-30	$10,450
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-06-30	$200,629
Liabilities. Value of benefit claims payable at end of year	2014-06-30	$34,541
Liabilities. Value of benefit claims payable at beginning of year	2014-06-30	$37,059
Did the plan have assets held for investment	2014-06-30	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	2014-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2014-06-30	Disclaimer
Accountancy firm name	2014-06-30	BLACKMAN & SLOOP
Accountancy firm EIN	2014-06-30	561304727
2013 : RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2013-06-30	$36,104
Total unrealized appreciation/depreciation of assets	2013-06-30	$36,104
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-06-30	$37,059
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-06-30	$38,179
Total income from all sources (including contributions)	2013-06-30	$348,117
Total loss/gain on sale of assets	2013-06-30	$0
Total of all expenses incurred	2013-06-30	$252,008
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-06-30	$227,966
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-06-30	$193,758
Value of total assets at end of year	2013-06-30	$1,798,449
Value of total assets at beginning of year	2013-06-30	$1,703,460
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-06-30	$24,042
Total interest from all sources	2013-06-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2013-06-30	$21,220
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-06-30	$21,220
Was this plan covered by a fidelity bond	2013-06-30	Yes
Value of fidelity bond cover	2013-06-30	$500,000
If this is an individual account plan, was there a blackout period	2013-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2013-06-30	No
Contributions received from participants	2013-06-30	$48,432
Participant contributions at end of year	2013-06-30	$1,381
Participant contributions at beginning of year	2013-06-30	$0
Assets. Other investments not covered elsewhere at end of year	2013-06-30	$168,695
Assets. Other investments not covered elsewhere at beginning of year	2013-06-30	$0
Administrative expenses (other) incurred	2013-06-30	$24,042
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-06-30	No
Value of net income/loss	2013-06-30	$96,109
Value of net assets at end of year (total assets less liabilities)	2013-06-30	$1,761,390
Value of net assets at beginning of year (total assets less liabilities)	2013-06-30	$1,665,281
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-06-30	No
Were any leases to which the plan was party in default or uncollectible	2013-06-30	No
Value of interest in pooled separate accounts at end of year	2013-06-30	$32,939
Value of interest in pooled separate accounts at beginning of year	2013-06-30	$1,654,301
Value of interest in common/collective trusts at end of year	2013-06-30	$1,583,861
Value of interest in common/collective trusts at beginning of year	2013-06-30	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-06-30	$1,123
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-06-30	$47,557
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-06-30	$47,557
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-06-30	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-06-30	$1,602
Expenses. Payments to insurance carriers foe the provision of benefits	2013-06-30	$37,059
Net investment gain/loss from pooled separate accounts	2013-06-30	$43,831
Net investment gain or loss from common/collective trusts	2013-06-30	$53,204
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-06-30	Yes
Was there a failure to transmit to the plan any participant contributions	2013-06-30	No
Has the plan failed to provide any benefit when due under the plan	2013-06-30	No
Contributions received in cash from employer	2013-06-30	$145,326
Employer contributions (assets) at end of year	2013-06-30	$10,450
Employer contributions (assets) at beginning of year	2013-06-30	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-06-30	$190,907
Liabilities. Value of benefit claims payable at end of year	2013-06-30	$37,059
Liabilities. Value of benefit claims payable at beginning of year	2013-06-30	$38,179
Did the plan have assets held for investment	2013-06-30	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	2013-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2013-06-30	Disclaimer
Accountancy firm name	2013-06-30	BLACKMAN & SLOOP
Accountancy firm EIN	2013-06-30	561304727
2012 : RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-06-30	$38,179
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-06-30	$43,689
Total income from all sources (including contributions)	2012-06-30	$254,318
Total loss/gain on sale of assets	2012-06-30	$18,588
Total of all expenses incurred	2012-06-30	$173,681
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-06-30	$147,887
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-06-30	$215,888
Value of total assets at end of year	2012-06-30	$1,703,460
Value of total assets at beginning of year	2012-06-30	$1,628,333
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-06-30	$25,794
Total interest from all sources	2012-06-30	$75
Total dividends received (eg from common stock, registered investment company shares)	2012-06-30	$19,767
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-06-30	$19,767
Was this plan covered by a fidelity bond	2012-06-30	Yes
Value of fidelity bond cover	2012-06-30	$550,000
If this is an individual account plan, was there a blackout period	2012-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2012-06-30	No
Contributions received from participants	2012-06-30	$49,560
Income. Received or receivable in cash from other sources (including rollovers)	2012-06-30	$5,056
Administrative expenses (other) incurred	2012-06-30	$1,541
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-06-30	No
Value of net income/loss	2012-06-30	$80,637
Value of net assets at end of year (total assets less liabilities)	2012-06-30	$1,665,281
Value of net assets at beginning of year (total assets less liabilities)	2012-06-30	$1,584,644
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-06-30	No
Were any leases to which the plan was party in default or uncollectible	2012-06-30	No
Investment advisory and management fees	2012-06-30	$15,199
Value of interest in pooled separate accounts at end of year	2012-06-30	$1,654,301
Value of interest in pooled separate accounts at beginning of year	2012-06-30	$1,557,342
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-06-30	$47,557
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-06-30	$67,604
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-06-30	$67,604
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-06-30	$75
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-06-30	$1,602
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-06-30	$2,712
Expenses. Payments to insurance carriers foe the provision of benefits	2012-06-30	$38,179
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-06-30	Yes
Was there a failure to transmit to the plan any participant contributions	2012-06-30	No
Has the plan failed to provide any benefit when due under the plan	2012-06-30	No
Contributions received in cash from employer	2012-06-30	$161,272
Employer contributions (assets) at end of year	2012-06-30	$0
Employer contributions (assets) at beginning of year	2012-06-30	$675
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-06-30	$109,708
Contract administrator fees	2012-06-30	$9,054
Liabilities. Value of benefit claims payable at end of year	2012-06-30	$38,179
Liabilities. Value of benefit claims payable at beginning of year	2012-06-30	$43,689
Did the plan have assets held for investment	2012-06-30	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	2012-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-06-30	No
Aggregate proceeds on sale of assets	2012-06-30	$18,588
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2012-06-30	Disclaimer
Accountancy firm name	2012-06-30	BLACKMAN & SLOOP
Accountancy firm EIN	2012-06-30	561304727
2011 : RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-06-30	$43,689
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-06-30	$29,136
Total income from all sources (including contributions)	2011-06-30	$434,491
Total loss/gain on sale of assets	2011-06-30	$187,912
Total of all expenses incurred	2011-06-30	$109,111
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-06-30	$87,326
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-06-30	$233,158
Value of total assets at end of year	2011-06-30	$1,628,333
Value of total assets at beginning of year	2011-06-30	$1,288,400
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-06-30	$21,785
Total interest from all sources	2011-06-30	$568
Total dividends received (eg from common stock, registered investment company shares)	2011-06-30	$12,853
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-06-30	$12,853
Was this plan covered by a fidelity bond	2011-06-30	Yes
Value of fidelity bond cover	2011-06-30	$550,000
If this is an individual account plan, was there a blackout period	2011-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2011-06-30	No
Contributions received from participants	2011-06-30	$45,594
Income. Received or receivable in cash from other sources (including rollovers)	2011-06-30	$38
Administrative expenses (other) incurred	2011-06-30	$1,453
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-06-30	No
Value of net income/loss	2011-06-30	$325,380
Value of net assets at end of year (total assets less liabilities)	2011-06-30	$1,584,644
Value of net assets at beginning of year (total assets less liabilities)	2011-06-30	$1,259,264
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-06-30	No
Were any leases to which the plan was party in default or uncollectible	2011-06-30	No
Investment advisory and management fees	2011-06-30	$12,198
Value of interest in pooled separate accounts at end of year	2011-06-30	$1,557,342
Value of interest in pooled separate accounts at beginning of year	2011-06-30	$1,236,410
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-06-30	$67,604
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-06-30	$50,428
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-06-30	$50,428
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-06-30	$568
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-06-30	$2,712
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-06-30	$1,562
Expenses. Payments to insurance carriers foe the provision of benefits	2011-06-30	$43,689
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-06-30	No
Was there a failure to transmit to the plan any participant contributions	2011-06-30	No
Has the plan failed to provide any benefit when due under the plan	2011-06-30	No
Contributions received in cash from employer	2011-06-30	$187,526
Employer contributions (assets) at end of year	2011-06-30	$675
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-06-30	$43,637
Contract administrator fees	2011-06-30	$8,134
Liabilities. Value of benefit claims payable at end of year	2011-06-30	$43,689
Liabilities. Value of benefit claims payable at beginning of year	2011-06-30	$29,136
Did the plan have assets held for investment	2011-06-30	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	2011-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-06-30	No
Aggregate proceeds on sale of assets	2011-06-30	$187,912
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2011-06-30	Disclaimer
Accountancy firm name	2011-06-30	RIVES & ASSOCIATES, LLP
Accountancy firm EIN	2011-06-30	200427530
2010 : RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN 2010 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-06-30	$0

Form 5500 Responses for RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN

2015: RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Submission has been amended	No
2015-07-01	This submission is the final filing	No
2015-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-07-01	Plan is a collectively bargained plan	No
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan funding arrangement – Trust	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement - Trust	Yes
2014: RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Submission has been amended	No
2014-07-01	This submission is the final filing	No
2014-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-07-01	Plan is a collectively bargained plan	No
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan funding arrangement – Trust	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement - Trust	Yes
2013: RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Submission has been amended	No
2013-07-01	This submission is the final filing	No
2013-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-07-01	Plan is a collectively bargained plan	No
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan funding arrangement – Trust	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement - Trust	Yes
2012: RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Submission has been amended	No
2012-07-01	This submission is the final filing	No
2012-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-07-01	Plan is a collectively bargained plan	No
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan funding arrangement – Trust	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement - Trust	Yes
2011: RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Submission has been amended	No
2011-07-01	This submission is the final filing	No
2011-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-07-01	Plan is a collectively bargained plan	No
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan funding arrangement – Trust	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement - Trust	Yes
2009: RANDOLPH COMMUNITY SERVICES, INC. RETIREMENT PLAN 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	Submission has been amended	No
2009-07-01	This submission is the final filing	No
2009-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-07-01	Plan is a collectively bargained plan	No
2009-07-01	Plan funding arrangement – Insurance	Yes
2009-07-01	Plan funding arrangement – Trust	Yes
2009-07-01	Plan benefit arrangement – Insurance	Yes
2009-07-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 78778 )

Policy contract number

300229

Policy instance

Insurance contract or identification number	300229
Number of Individuals Covered	84
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $13,413
Total amount of fees paid to insurance company	USD $1,024
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 $13,413
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	4
Insurance broker name	SWBC INVESTMENT ADVISORY SVC, LLC

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 78778 )

Policy contract number

30029

Policy instance

Insurance contract or identification number	30029
Number of Individuals Covered	105
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $16,802
Total amount of fees paid to insurance company	USD $16,802
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 $16,802
Amount paid for insurance broker fees	16802
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	PARK AVE SECURITIES FBO EDWIN HILL

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 78778 )

Policy contract number

30029

Policy instance

Insurance contract or identification number	30029
Number of Individuals Covered	105
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $16,802
Total amount of fees paid to insurance company	USD $16,802
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 $16,802
Amount paid for insurance broker fees	16802
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	PARK AVE SECURITIES FBO EDWIN HILL

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

Policy contract number

74041

Policy instance

Insurance contract or identification number	74041
Number of Individuals Covered	0
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $133
Total amount of fees paid to insurance company	USD $140
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
Amount paid for insurance broker fees	140
Additional information about fees paid to insurance broker	TPA FEES AND COMPENSATION
Insurance broker organization code?	5
Commission paid to Insurance Broker	USD $133
Insurance broker name	PARK AVENUE SECURITIES

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

PJ475 A6

Policy instance

Insurance contract or identification number	PJ475 A6
Number of Individuals Covered	114
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
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?	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 $0
Insurance broker organization code?	3
Insurance broker name	GUARDIAN LIFE INSURANCE

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

Policy contract number

74041

Policy instance

Insurance contract or identification number	74041
Number of Individuals Covered	40
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $1,886
Total amount of fees paid to insurance company	USD $1,705
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

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

PJ475 A6

Policy instance

Insurance contract or identification number	12294354
Number of Individuals Covered	1335
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
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	Yes
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
Total amount of commissions paid to insurance broker	USD $5,023
Total amount of fees paid to insurance company	USD $0

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

PJ475 A6

Policy instance

Insurance contract or identification number	PJ475 A6
Number of Individuals Covered	125
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $3,154
Total amount of fees paid to insurance company	USD $0

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

Policy contract number

74041

Policy instance

Insurance contract or identification number	74041
Number of Individuals Covered	40
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $1,635
Total amount of fees paid to insurance company	USD $1,598
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes

Potentially related plans

RANDOLPH COMMUNITY CLINIC 401K PROFIT SHARING PLAN [EIN = 391999706]

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Company Name:	RANDOLPH COMMUNITY SERVICES, INC.
Employer identification number (EIN):	561244921
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations