401k Plan data: SILVER BLUFF, LLC 401(K) PLAN plan

SILVER BLUFF, LLC 401(K) PLAN 401k Plan overview

Plan Name	SILVER BLUFF, LLC 401(K) PLAN
Plan identification number	001

SILVER BLUFF, LLC 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

SILVER BLUFF, LLC has sponsored the creation of one or more 401k plans.

Company Name: SILVER BLUFF, LLC

Employer identification number (EIN): 561378443

NAIC Classification: 623000
NAIC Description: Nursing and Residential Care Facilities

Additional information about SILVER BLUFF, LLC

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 2011-02-16

Company Identification Number: L11000020269

Legal Registered Office Address: 10901 burnt mill road

Jacksonville

32256

More information about SILVER BLUFF, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SILVER BLUFF, LLC 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2015-01-01 BOB LEATHERWOOD BOB LEATHERWOOD 2016-10-12
001 2014-01-01 BOB LEATHERWOOD
001 2013-01-01 BOB LEATHERWOOD
001 2012-01-01 BOB LEATHERWOOD BOB LEATHERWOOD 2013-09-25
001 2011-01-01 BOB LEATHERWOOD
001 2009-01-01 BOB LEATHERWOOD
001 2009-01-01 BOB LEATHERWOOD

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2015-01-01	BOB LEATHERWOOD	BOB LEATHERWOOD	2016-10-12
001	2014-01-01	BOB LEATHERWOOD
001	2013-01-01	BOB LEATHERWOOD
001	2012-01-01	BOB LEATHERWOOD	BOB LEATHERWOOD	2013-09-25
001	2011-01-01	BOB LEATHERWOOD
001	2009-01-01	BOB LEATHERWOOD
001	2009-01-01	BOB LEATHERWOOD

Plan Statistics for SILVER BLUFF, LLC 401(K) PLAN

401k plan membership statisitcs for SILVER BLUFF, LLC 401(K) PLAN

Measure Date Value
2015: SILVER BLUFF, LLC 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 131
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 0
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 0
Total of all active and inactive participants 2015-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 0
Number of participants with account balances 2015-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: SILVER BLUFF, LLC 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 144
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 123
Number of retired or separated participants receiving benefits 2014-01-01 1
Number of other retired or separated participants entitled to future benefits 2014-01-01 7
Total of all active and inactive participants 2014-01-01 131
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 131
Number of participants with account balances 2014-01-01 54
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 2
2013: SILVER BLUFF, LLC 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 131
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 133
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 2013-01-01 138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 138
Number of participants with account balances 2013-01-01 52
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 4
2012: SILVER BLUFF, LLC 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 135
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 115
Number of retired or separated participants receiving benefits 2012-01-01 1
Number of other retired or separated participants entitled to future benefits 2012-01-01 4
Total of all active and inactive participants 2012-01-01 120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 120
Number of participants with account balances 2012-01-01 116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 14
2011: SILVER BLUFF, LLC 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 168
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 160
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 160
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 160
Number of participants with account balances 2011-01-01 66
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: SILVER BLUFF, LLC 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 149
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 148
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 5
Total of all active and inactive participants 2009-01-01 153
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 1
Total participants 2009-01-01 154
Number of participants with account balances 2009-01-01 73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 7

Measure	Date	Value
2015: SILVER BLUFF, LLC 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	131
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	0
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	0
Total of all active and inactive participants	2015-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	0
Number of participants with account balances	2015-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: SILVER BLUFF, LLC 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	144
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	123
Number of retired or separated participants receiving benefits	2014-01-01	1
Number of other retired or separated participants entitled to future benefits	2014-01-01	7
Total of all active and inactive participants	2014-01-01	131
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	131
Number of participants with account balances	2014-01-01	54
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	2
2013: SILVER BLUFF, LLC 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	131
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	133
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	138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	138
Number of participants with account balances	2013-01-01	52
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	4
2012: SILVER BLUFF, LLC 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	135
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	115
Number of retired or separated participants receiving benefits	2012-01-01	1
Number of other retired or separated participants entitled to future benefits	2012-01-01	4
Total of all active and inactive participants	2012-01-01	120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	120
Number of participants with account balances	2012-01-01	116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	14
2011: SILVER BLUFF, LLC 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	168
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	160
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	160
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	160
Number of participants with account balances	2011-01-01	66
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: SILVER BLUFF, LLC 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	149
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	148
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	5
Total of all active and inactive participants	2009-01-01	153
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	1
Total participants	2009-01-01	154
Number of participants with account balances	2009-01-01	73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	7

Financial Data on SILVER BLUFF, LLC 401(K) PLAN

Measure	Date	Value
2015 : SILVER BLUFF, LLC 401(K) PLAN 2015 401k financial data
Total transfer of assets from this plan	2015-12-31	$1,112,008
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	$22,132
Total of all expenses incurred	2015-12-31	$104,999
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$100,706
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$48,472
Value of total assets at end of year	2015-12-31	$0
Value of total assets at beginning of year	2015-12-31	$1,194,875
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$4,293
Total interest from all sources	2015-12-31	$1,659
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2015-12-31	$0
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$100,000
If this is an individual account plan, was there a blackout period	2015-12-31	Yes
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	$42,689
Participant contributions at end of year	2015-12-31	$0
Participant contributions at beginning of year	2015-12-31	$64,644
Participant contributions at end of year	2015-12-31	$0
Participant contributions at beginning of year	2015-12-31	$2,325
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-82,867
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$1,194,875
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	$0
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$1,125,634
Interest on participant loans	2015-12-31	$1,659
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$1,821
Net investment gain/loss from pooled separate accounts	2015-12-31	$-27,999
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	$5,783
Employer contributions (assets) at end of year	2015-12-31	$0
Employer contributions (assets) at beginning of year	2015-12-31	$451
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$100,706
Contract administrator fees	2015-12-31	$4,293
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	2015-12-31	Yes
Did the plan have assets held for investment	2015-12-31	No
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	Yes
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	GOLDSMITH MOLIS & GRAY, PLLC
Accountancy firm EIN	2015-12-31	453054896
2014 : SILVER BLUFF, LLC 401(K) 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	$144,938
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$212,017
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$183,104
Expenses. Certain deemed distributions of participant loans	2014-12-31	$22,479
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$78,004
Value of total assets at end of year	2014-12-31	$1,194,875
Value of total assets at beginning of year	2014-12-31	$1,261,954
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$6,434
Total interest from all sources	2014-12-31	$2,481
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
Administrative expenses professional fees incurred	2014-12-31	$6,434
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$100,000
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	$67,450
Participant contributions at end of year	2014-12-31	$64,644
Participant contributions at beginning of year	2014-12-31	$74,595
Participant contributions at end of year	2014-12-31	$2,325
Participant contributions at beginning of year	2014-12-31	$2,681
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	$-67,079
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$1,194,875
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$1,261,954
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	$1,125,634
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$1,180,528
Interest on participant loans	2014-12-31	$2,481
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$1,821
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$3,652
Net investment gain/loss from pooled separate accounts	2014-12-31	$64,453
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	No
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	$10,554
Employer contributions (assets) at end of year	2014-12-31	$451
Employer contributions (assets) at beginning of year	2014-12-31	$498
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$183,104
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	GOLDSMITH MOLIS & GRAY, PLLC
Accountancy firm EIN	2014-12-31	453054896
2013 : SILVER BLUFF, LLC 401(K) 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	$275,772
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$39,062
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$33,120
Value of total corrective distributions	2013-12-31	$608
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$86,138
Value of total assets at end of year	2013-12-31	$1,261,954
Value of total assets at beginning of year	2013-12-31	$1,025,244
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$5,334
Total interest from all sources	2013-12-31	$3,011
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
Administrative expenses professional fees incurred	2013-12-31	$5,334
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$100,000
If this is an individual account plan, was there a blackout period	2013-12-31	Yes
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	$72,434
Participant contributions at end of year	2013-12-31	$74,595
Participant contributions at beginning of year	2013-12-31	$89,284
Participant contributions at end of year	2013-12-31	$2,681
Participant contributions at beginning of year	2013-12-31	$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	2013-12-31	No
Value of net income/loss	2013-12-31	$236,710
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$1,261,954
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$1,025,244
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$935,960
Value of interest in pooled separate accounts at end of year	2013-12-31	$1,180,528
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$0
Interest on participant loans	2013-12-31	$3,011
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$3,652
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$0
Net investment gain/loss from pooled separate accounts	2013-12-31	$186,623
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	No
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	$13,704
Employer contributions (assets) at end of year	2013-12-31	$498
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	$33,120
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	2013-12-31	Yes
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	GOLDSMITH MOLIS & GRAY, PLLC
Accountancy firm EIN	2013-12-31	453054896
2012 : SILVER BLUFF, LLC 401(K) PLAN 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2012-12-31	$0
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total transfer of assets to this plan	2012-12-31	$0
Total transfer of assets from this plan	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$224,728
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$85,878
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$82,733
Expenses. Certain deemed distributions of participant loans	2012-12-31	$0
Value of total corrective distributions	2012-12-31	$798
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$118,728
Value of total assets at end of year	2012-12-31	$1,025,244
Value of total assets at beginning of year	2012-12-31	$886,394
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$2,347
Total interest from all sources	2012-12-31	$3,149
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	$100,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Funding deficiency by the employer to the plan for this plan year	2012-12-31	$0
Minimum employer required contribution for this plan year	2012-12-31	$0
Amount contributed by the employer to the plan for this plan year	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$100,878
Participant contributions at end of year	2012-12-31	$89,284
Participant contributions at beginning of year	2012-12-31	$68,124
Assets. Other investments not covered elsewhere at end of year	2012-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2012-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$0
Other income not declared elsewhere	2012-12-31	$0
Administrative expenses (other) incurred	2012-12-31	$2,347
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	$138,850
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$1,025,244
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$886,394
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$935,960
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$814,587
Value of interest in pooled separate accounts at end of year	2012-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$0
Interest on participant loans	2012-12-31	$3,149
Interest earned on other investments	2012-12-31	$0
Value of interest in common/collective trusts at end of year	2012-12-31	$0
Value of interest in common/collective trusts at beginning of year	2012-12-31	$3,683
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$0
Net investment gain/loss from pooled separate accounts	2012-12-31	$102,851
Net investment gain or loss from common/collective trusts	2012-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Assets. Invements in employer securities at end of year	2012-12-31	$0
Assets. Invements in employer securities at beginning of year	2012-12-31	$0
Contributions received in cash from employer	2012-12-31	$17,850
Income. Dividends from common stock	2012-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$82,733
Asset. Corporate debt instrument debt (other) at end of year	2012-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2012-12-31	$0
Assets. Corporate common stocks other than exployer securities at end of year	2012-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2012-12-31	$0
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	GOLDSMITH MOLIS & GRAY, PLLC
Accountancy firm EIN	2012-12-31	463054896
2011 : SILVER BLUFF, LLC 401(K) PLAN 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2011-12-31	$0
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total transfer of assets to this plan	2011-12-31	$0
Total transfer of assets from this plan	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$98,335
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$53,349
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$50,154
Expenses. Certain deemed distributions of participant loans	2011-12-31	$0
Value of total corrective distributions	2011-12-31	$733
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$115,499
Value of total assets at end of year	2011-12-31	$886,394
Value of total assets at beginning of year	2011-12-31	$841,408
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$2,462
Total interest from all sources	2011-12-31	$2,500
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$100,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Funding deficiency by the employer to the plan for this plan year	2011-12-31	$0
Minimum employer required contribution for this plan year	2011-12-31	$0
Amount contributed by the employer to the plan for this plan year	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$97,182
Participant contributions at end of year	2011-12-31	$68,124
Participant contributions at beginning of year	2011-12-31	$54,254
Assets. Other investments not covered elsewhere at end of year	2011-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2011-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$0
Other income not declared elsewhere	2011-12-31	$0
Administrative expenses (other) incurred	2011-12-31	$2,462
Total non interest bearing cash at beginning of year	2011-12-31	$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	2011-12-31	No
Value of net income/loss	2011-12-31	$44,986
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$886,394
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$841,408
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$814,587
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$784,552
Value of interest in pooled separate accounts at end of year	2011-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$0
Interest on participant loans	2011-12-31	$2,500
Interest earned on other investments	2011-12-31	$0
Value of interest in common/collective trusts at end of year	2011-12-31	$3,683
Value of interest in common/collective trusts at beginning of year	2011-12-31	$2,602
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$0
Net investment gain/loss from pooled separate accounts	2011-12-31	$-19,664
Net investment gain or loss from common/collective trusts	2011-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Assets. Invements in employer securities at end of year	2011-12-31	$0
Assets. Invements in employer securities at beginning of year	2011-12-31	$0
Contributions received in cash from employer	2011-12-31	$18,317
Income. Dividends from common stock	2011-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$50,154
Asset. Corporate debt instrument debt (other) at end of year	2011-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2011-12-31	$0
Assets. Corporate common stocks other than exployer securities at end of year	2011-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2011-12-31	$0
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	GABLER MOLIS & COMPANY, PA
Accountancy firm EIN	2011-12-31	561721764
2010 : SILVER BLUFF, LLC 401(K) PLAN 2010 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2010-12-31	$0
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total transfer of assets to this plan	2010-12-31	$0
Total transfer of assets from this plan	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$190,034
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$67,229
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$63,960
Expenses. Certain deemed distributions of participant loans	2010-12-31	$0
Value of total corrective distributions	2010-12-31	$768
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$116,051
Value of total assets at end of year	2010-12-31	$841,407
Value of total assets at beginning of year	2010-12-31	$718,602
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$2,501
Total interest from all sources	2010-12-31	$2,491
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$100,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Funding deficiency by the employer to the plan for this plan year	2010-12-31	$0
Minimum employer required contribution for this plan year	2010-12-31	$0
Amount contributed by the employer to the plan for this plan year	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$97,752
Participant contributions at end of year	2010-12-31	$54,254
Participant contributions at beginning of year	2010-12-31	$49,441
Assets. Other investments not covered elsewhere at end of year	2010-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2010-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$0
Other income not declared elsewhere	2010-12-31	$0
Administrative expenses (other) incurred	2010-12-31	$2,501
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	$122,805
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$841,407
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$718,602
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$784,551
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$667,205
Value of interest in pooled separate accounts at end of year	2010-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$0
Interest on participant loans	2010-12-31	$2,491
Interest earned on other investments	2010-12-31	$0
Value of interest in common/collective trusts at end of year	2010-12-31	$2,602
Value of interest in common/collective trusts at beginning of year	2010-12-31	$1,956
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$0
Net investment gain/loss from pooled separate accounts	2010-12-31	$71,492
Net investment gain or loss from common/collective trusts	2010-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Assets. Invements in employer securities at end of year	2010-12-31	$0
Assets. Invements in employer securities at beginning of year	2010-12-31	$0
Contributions received in cash from employer	2010-12-31	$18,299
Income. Dividends from common stock	2010-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$63,960
Asset. Corporate debt instrument debt (other) at end of year	2010-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2010-12-31	$0
Assets. Corporate common stocks other than exployer securities at end of year	2010-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2010-12-31	$0
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	GABLERMOLIS & COMPANY, PA
Accountancy firm EIN	2010-12-31	561721764
2009 : SILVER BLUFF, LLC 401(K) PLAN 2009 401k financial data
Funding deficiency by the employer to the plan for this plan year	2009-12-31	$0
Minimum employer required contribution for this plan year	2009-12-31	$0
Amount contributed by the employer to the plan for this plan year	2009-12-31	$0

Form 5500 Responses for SILVER BLUFF, LLC 401(K) PLAN

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

Insurance Providers Used on plan

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )

Policy contract number

601204-000

Policy instance

Insurance contract or identification number	601204-000
Number of Individuals Covered	0
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,527
Total amount of fees paid to insurance company	USD $1,662
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,527
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSION
Insurance broker organization code?	3
Insurance broker name	RETIREMENT STRATEGIES, INC.

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )

Policy contract number

601204-000

Policy instance

Insurance contract or identification number	601204-000
Number of Individuals Covered	54
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,277
Total amount of fees paid to insurance company	USD $1,854
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 $3,277
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSION
Insurance broker organization code?	3
Insurance broker name	RETIREMENT STRATEGIES,INC

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

Policy contract number

GA-801773

Policy instance

Insurance contract or identification number	GA-801773
Number of Individuals Covered	0
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $696
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 $696
Insurance broker organization code?	3
Insurance broker name	MERRILL LYNCH LIFE AGENCY

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )

Policy contract number

601204-000

Policy instance

Insurance contract or identification number	601204-000
Number of Individuals Covered	138
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $7,764
Total amount of fees paid to insurance company	USD $3,713
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 $7,764
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSION
Insurance broker organization code?	3
Insurance broker name	RETIREMENT STRATEGIES INC

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

Policy contract number

GA-801773

Policy instance

Insurance contract or identification number	GA-801773
Number of Individuals Covered	116
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,627
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,627
Insurance broker organization code?	3
Insurance broker name	MERRILL LYNCH LIFE AGENCY

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

Policy contract number

GA-801773

Policy instance

Insurance contract or identification number	GA-801773
Number of Individuals Covered	66
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,410
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

GA-801773

Policy instance

Insurance contract or identification number	GA-801773
Number of Individuals Covered	71
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,982
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	SILVER BLUFF, LLC
Employer identification number (EIN):	561378443
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	2011-02-16
Company Identification Number:	L11000020269
Legal Registered Office Address:	10901 burnt mill road Jacksonville 32256