401k Plan data: CENTRAL CONTINUING CARE 401(K) PROFIT SHARING PLAN plan

CENTRAL CONTINUING CARE 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	CENTRAL CONTINUING CARE 401(K) PROFIT SHARING PLAN
Plan identification number	001

CENTRAL CONTINUING CARE 401(K) PROFIT SHARING 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

CENTRAL CONTINUING CARE has sponsored the creation of one or more 401k plans.

Company Name: CENTRAL CONTINUING CARE

Employer identification number (EIN): 561889099

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CENTRAL CONTINUING CARE 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2014-10-01 MARK PAYNE
001 2013-10-01 MARK PAYNE
001 2012-10-01 MARK PAYNE
001 2011-10-01 KAREN TAYLO 2014-07-01
001 2010-10-01 KAREN TAYLO 2012-07-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2014-10-01	MARK PAYNE
001	2013-10-01	MARK PAYNE
001	2012-10-01	MARK PAYNE
001	2011-10-01	KAREN TAYLO	2014-07-01
001	2010-10-01	KAREN TAYLO	2012-07-13

Plan Statistics for CENTRAL CONTINUING CARE 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for CENTRAL CONTINUING CARE 401(K) PROFIT SHARING PLAN

Measure Date Value
2014: CENTRAL CONTINUING CARE 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-10-01 128
Total number of active participants reported on line 7a of the Form 5500 2014-10-01 0
Number of retired or separated participants receiving benefits 2014-10-01 0
Number of other retired or separated participants entitled to future benefits 2014-10-01 0
Total of all active and inactive participants 2014-10-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-10-01 0
Total participants 2014-10-01 0
Number of participants with account balances 2014-10-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-10-01 0
2013: CENTRAL CONTINUING CARE 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-10-01 136
Total number of active participants reported on line 7a of the Form 5500 2013-10-01 101
Number of retired or separated participants receiving benefits 2013-10-01 4
Number of other retired or separated participants entitled to future benefits 2013-10-01 16
Total of all active and inactive participants 2013-10-01 121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-10-01 0
Total participants 2013-10-01 121
Number of participants with account balances 2013-10-01 61
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-10-01 2
2012: CENTRAL CONTINUING CARE 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-10-01 140
Total number of active participants reported on line 7a of the Form 5500 2012-10-01 116
Number of retired or separated participants receiving benefits 2012-10-01 2
Number of other retired or separated participants entitled to future benefits 2012-10-01 16
Total of all active and inactive participants 2012-10-01 134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-10-01 0
Total participants 2012-10-01 134
Number of participants with account balances 2012-10-01 63
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-10-01 0

Measure	Date	Value
2014: CENTRAL CONTINUING CARE 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-10-01	128
Total number of active participants reported on line 7a of the Form 5500	2014-10-01	0
Number of retired or separated participants receiving benefits	2014-10-01	0
Number of other retired or separated participants entitled to future benefits	2014-10-01	0
Total of all active and inactive participants	2014-10-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-10-01	0
Total participants	2014-10-01	0
Number of participants with account balances	2014-10-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-10-01	0
2013: CENTRAL CONTINUING CARE 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-10-01	136
Total number of active participants reported on line 7a of the Form 5500	2013-10-01	101
Number of retired or separated participants receiving benefits	2013-10-01	4
Number of other retired or separated participants entitled to future benefits	2013-10-01	16
Total of all active and inactive participants	2013-10-01	121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-10-01	0
Total participants	2013-10-01	121
Number of participants with account balances	2013-10-01	61
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-10-01	2
2012: CENTRAL CONTINUING CARE 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-10-01	140
Total number of active participants reported on line 7a of the Form 5500	2012-10-01	116
Number of retired or separated participants receiving benefits	2012-10-01	2
Number of other retired or separated participants entitled to future benefits	2012-10-01	16
Total of all active and inactive participants	2012-10-01	134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-10-01	0
Total participants	2012-10-01	134
Number of participants with account balances	2012-10-01	63
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-10-01	0

Financial Data on CENTRAL CONTINUING CARE 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2015 : CENTRAL CONTINUING CARE 401(K) PROFIT SHARING PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-08-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-08-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-08-31	$330
Total income from all sources (including contributions)	2015-08-31	$20,398
Total loss/gain on sale of assets	2015-08-31	$0
Total of all expenses incurred	2015-08-31	$527,360
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-08-31	$515,674
Value of total corrective distributions	2015-08-31	$121
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-08-31	$21,323
Value of total assets at end of year	2015-08-31	$0
Value of total assets at beginning of year	2015-08-31	$507,292
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-08-31	$11,565
Total interest from all sources	2015-08-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2015-08-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-08-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2015-08-31	$0
Was this plan covered by a fidelity bond	2015-08-31	Yes
Value of fidelity bond cover	2015-08-31	$50,000
If this is an individual account plan, was there a blackout period	2015-08-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-08-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-08-31	No
Contributions received from participants	2015-08-31	$18,352
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-08-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-08-31	$0
Administrative expenses (other) incurred	2015-08-31	$10,285
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-08-31	No
Value of net income/loss	2015-08-31	$-506,962
Value of net assets at end of year (total assets less liabilities)	2015-08-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2015-08-31	$506,962
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-08-31	No
Were any leases to which the plan was party in default or uncollectible	2015-08-31	No
Investment advisory and management fees	2015-08-31	$1,280
Value of interest in pooled separate accounts at end of year	2015-08-31	$0
Value of interest in pooled separate accounts at beginning of year	2015-08-31	$447,475
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-08-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-08-31	$59,206
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-08-31	$59,206
Net investment gain/loss from pooled separate accounts	2015-08-31	$-925
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-08-31	No
Was there a failure to transmit to the plan any participant contributions	2015-08-31	No
Has the plan failed to provide any benefit when due under the plan	2015-08-31	No
Contributions received in cash from employer	2015-08-31	$2,971
Employer contributions (assets) at end of year	2015-08-31	$0
Employer contributions (assets) at beginning of year	2015-08-31	$611
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-08-31	$515,674
Liabilities. Value of benefit claims payable at end of year	2015-08-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2015-08-31	$330
Did the plan have assets held for investment	2015-08-31	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	2015-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-08-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-08-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-08-31	Disclaimer
Accountancy firm name	2015-08-31	LBA HAYNES STRAND PLLC
Accountancy firm EIN	2015-08-31	204759472
2014 : CENTRAL CONTINUING CARE 401(K) PROFIT SHARING PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-09-30	$330
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-09-30	$838
Total income from all sources (including contributions)	2014-09-30	$82,929
Total loss/gain on sale of assets	2014-09-30	$0
Total of all expenses incurred	2014-09-30	$15,080
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-09-30	$14,757
Value of total corrective distributions	2014-09-30	$148
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-09-30	$55,074
Value of total assets at end of year	2014-09-30	$507,292
Value of total assets at beginning of year	2014-09-30	$439,951
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-09-30	$175
Total interest from all sources	2014-09-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2014-09-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-09-30	No
Was this plan covered by a fidelity bond	2014-09-30	Yes
Value of fidelity bond cover	2014-09-30	$50,000
If this is an individual account plan, was there a blackout period	2014-09-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-09-30	$0
Were there any nonexempt tranactions with any party-in-interest	2014-09-30	No
Contributions received from participants	2014-09-30	$49,026
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-09-30	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-09-30	$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	2014-09-30	No
Value of net income/loss	2014-09-30	$67,849
Value of net assets at end of year (total assets less liabilities)	2014-09-30	$506,962
Value of net assets at beginning of year (total assets less liabilities)	2014-09-30	$439,113
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-09-30	No
Were any leases to which the plan was party in default or uncollectible	2014-09-30	No
Investment advisory and management fees	2014-09-30	$175
Value of interest in pooled separate accounts at end of year	2014-09-30	$447,475
Value of interest in pooled separate accounts at beginning of year	2014-09-30	$385,974
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-09-30	$59,206
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-09-30	$53,353
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-09-30	$53,353
Net investment gain/loss from pooled separate accounts	2014-09-30	$27,855
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-09-30	No
Was there a failure to transmit to the plan any participant contributions	2014-09-30	No
Has the plan failed to provide any benefit when due under the plan	2014-09-30	No
Contributions received in cash from employer	2014-09-30	$6,048
Employer contributions (assets) at end of year	2014-09-30	$611
Employer contributions (assets) at beginning of year	2014-09-30	$624
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-09-30	$14,757
Liabilities. Value of benefit claims payable at end of year	2014-09-30	$330
Liabilities. Value of benefit claims payable at beginning of year	2014-09-30	$838
Did the plan have assets held for investment	2014-09-30	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	2014-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-09-30	Yes
Opinion of an independent qualified public accountant for this plan	2014-09-30	Disclaimer
Accountancy firm name	2014-09-30	LBA HAYNES STRAND PLLC
Accountancy firm EIN	2014-09-30	204759472
2013 : CENTRAL CONTINUING CARE 401(K) PROFIT SHARING PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-09-30	$13,766
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-09-30	$479
Total income from all sources (including contributions)	2013-09-30	$87,975
Total loss/gain on sale of assets	2013-09-30	$0
Total of all expenses incurred	2013-09-30	$24,359
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-09-30	$24,058
Value of total corrective distributions	2013-09-30	$182
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-09-30	$55,026
Value of total assets at end of year	2013-09-30	$439,951
Value of total assets at beginning of year	2013-09-30	$363,048
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-09-30	$119
Total interest from all sources	2013-09-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2013-09-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-09-30	No
Was this plan covered by a fidelity bond	2013-09-30	Yes
Value of fidelity bond cover	2013-09-30	$50,000
If this is an individual account plan, was there a blackout period	2013-09-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-09-30	$0
Were there any nonexempt tranactions with any party-in-interest	2013-09-30	No
Contributions received from participants	2013-09-30	$47,591
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2013-09-30	$12,899
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-09-30	$13,104
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-09-30	$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	2013-09-30	No
Value of net income/loss	2013-09-30	$63,616
Value of net assets at end of year (total assets less liabilities)	2013-09-30	$426,185
Value of net assets at beginning of year (total assets less liabilities)	2013-09-30	$362,569
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-09-30	No
Were any leases to which the plan was party in default or uncollectible	2013-09-30	No
Investment advisory and management fees	2013-09-30	$119
Value of interest in pooled separate accounts at end of year	2013-09-30	$385,974
Value of interest in pooled separate accounts at beginning of year	2013-09-30	$327,201
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-09-30	$53,353
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-09-30	$35,455
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-09-30	$35,455
Net investment gain/loss from pooled separate accounts	2013-09-30	$32,949
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-09-30	No
Was there a failure to transmit to the plan any participant contributions	2013-09-30	No
Has the plan failed to provide any benefit when due under the plan	2013-09-30	No
Contributions received in cash from employer	2013-09-30	$7,435
Employer contributions (assets) at end of year	2013-09-30	$624
Employer contributions (assets) at beginning of year	2013-09-30	$392
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-09-30	$11,159
Liabilities. Value of benefit claims payable at end of year	2013-09-30	$662
Liabilities. Value of benefit claims payable at beginning of year	2013-09-30	$479
Did the plan have assets held for investment	2013-09-30	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	2013-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-09-30	No
Opinion of an independent qualified public accountant for this plan	2013-09-30	Unqualified
Accountancy firm name	2013-09-30	CENTRAL CONTINUING CARE
Accountancy firm EIN	2013-09-30	561889099

Form 5500 Responses for CENTRAL CONTINUING CARE 401(K) PROFIT SHARING PLAN

2014: CENTRAL CONTINUING CARE 401(K) PROFIT SHARING PLAN 2014 form 5500 responses
2014-10-01	Type of plan entity	Single employer plan
2014-10-01	Submission has been amended	No
2014-10-01	This submission is the final filing	Yes
2014-10-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2014-10-01	Plan is a collectively bargained plan	No
2014-10-01	Plan funding arrangement – Insurance	Yes
2014-10-01	Plan funding arrangement – Trust	Yes
2014-10-01	Plan benefit arrangement – Insurance	Yes
2014-10-01	Plan benefit arrangement - Trust	Yes
2013: CENTRAL CONTINUING CARE 401(K) PROFIT SHARING PLAN 2013 form 5500 responses
2013-10-01	Type of plan entity	Single employer plan
2013-10-01	Submission has been amended	No
2013-10-01	This submission is the final filing	No
2013-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-10-01	Plan is a collectively bargained plan	No
2013-10-01	Plan funding arrangement – Insurance	Yes
2013-10-01	Plan funding arrangement – Trust	Yes
2013-10-01	Plan benefit arrangement – Insurance	Yes
2013-10-01	Plan benefit arrangement - Trust	Yes
2012: CENTRAL CONTINUING CARE 401(K) PROFIT SHARING PLAN 2012 form 5500 responses
2012-10-01	Type of plan entity	Single employer plan
2012-10-01	Submission has been amended	Yes
2012-10-01	This submission is the final filing	No
2012-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-10-01	Plan is a collectively bargained plan	No
2012-10-01	Plan funding arrangement – Insurance	Yes
2012-10-01	Plan funding arrangement – Trust	Yes
2012-10-01	Plan benefit arrangement – Insurance	Yes
2012-10-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

GA-823491

Policy instance

Insurance contract or identification number	GA-823491
Number of Individuals Covered	0
Insurance policy start date	2014-10-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $1,548
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,548
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	SALES/MARKETING
Insurance broker organization code?	3
Insurance broker name	LPL FINANCIAL LLC

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

Policy contract number

GA-823491

Policy instance

Insurance contract or identification number	GA-823491
Number of Individuals Covered	60
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $1,396
Total amount of fees paid to insurance company	USD $10
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,396
Amount paid for insurance broker fees	10
Additional information about fees paid to insurance broker	SALES/MARKETING
Insurance broker organization code?	3
Insurance broker name	LPL FINANCIAL LLC

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

Policy contract number

GA-823491

Policy instance

Insurance contract or identification number	GA-823491
Number of Individuals Covered	62
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $1,344
Total amount of fees paid to insurance company	USD $70
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,152
Amount paid for insurance broker fees	70
Additional information about fees paid to insurance broker	SALES/MARKETING
Insurance broker organization code?	3
Insurance broker name	MVP PLAN ADMINISTRATORS INC.

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Company Name:	CENTRAL CONTINUING CARE
Employer identification number (EIN):	561889099
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities