401k Plan data: THOMAS JEFFERSON CLASSICAL ACADEMY 403(B) PLAN plan

THOMAS JEFFERSON CLASSICAL ACADEMY 403(B) PLAN 401k Plan overview

Plan Name	THOMAS JEFFERSON CLASSICAL ACADEMY 403(B) PLAN
Plan identification number	001

THOMAS JEFFERSON CLASSICAL ACADEMY 403(B) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
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.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
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

THOMAS JEFFERSON CLASSICAL ACADEMY has sponsored the creation of one or more 401k plans.

Company Name: THOMAS JEFFERSON CLASSICAL ACADEMY

Employer identification number (EIN): 562123336

NAIC Classification: 611000

Additional information about THOMAS JEFFERSON CLASSICAL ACADEMY

Jurisdiction of Incorporation: North Carolina Secretary of State

Incorporation Date:

Company Identification Number: 0468978

More information about THOMAS JEFFERSON CLASSICAL ACADEMY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THOMAS JEFFERSON CLASSICAL ACADEMY 403(B) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2012-07-01 EDITH SHUMATE EDITH SHUMATE 2014-02-03
001 2011-12-01 EDITH SHUMATE EDITH SHUMATE 2013-04-09
001 2011-07-01 JOE MAIMONE EDITH SHUMATE 2016-11-17
001 2010-07-01 EDITH SHUMATE 2011-09-14
001 2009-07-01 EDITH SHUMATE 2013-04-15 EDITH SHUMATE 2013-04-15

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2012-07-01	EDITH SHUMATE		EDITH SHUMATE	2014-02-03
001	2011-12-01	EDITH SHUMATE		EDITH SHUMATE	2013-04-09
001	2011-07-01	JOE MAIMONE		EDITH SHUMATE	2016-11-17
001	2010-07-01	EDITH SHUMATE	2011-09-14
001	2009-07-01	EDITH SHUMATE	2013-04-15	EDITH SHUMATE	2013-04-15

Plan Statistics for THOMAS JEFFERSON CLASSICAL ACADEMY 403(B) PLAN

401k plan membership statisitcs for THOMAS JEFFERSON CLASSICAL ACADEMY 403(B) PLAN

Measure Date Value
2012: THOMAS JEFFERSON CLASSICAL ACADEMY 403(B) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 123
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 127
Number of retired or separated participants receiving benefits 2012-07-01 0
Number of other retired or separated participants entitled to future benefits 2012-07-01 5
Total of all active and inactive participants 2012-07-01 132
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-07-01 1
Total participants 2012-07-01 133
Number of participants with account balances 2012-07-01 126
2011: THOMAS JEFFERSON CLASSICAL ACADEMY 403(B) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-12-01 123
Total number of active participants reported on line 7a of the Form 5500 2011-12-01 117
Number of retired or separated participants receiving benefits 2011-12-01 0
Number of other retired or separated participants entitled to future benefits 2011-12-01 0
Total of all active and inactive participants 2011-12-01 117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-12-01 0
Total participants 2011-12-01 117
Number of participants with account balances 2011-12-01 117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-12-01 117
Total participants, beginning-of-year 2011-07-01 126
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 0
Number of retired or separated participants receiving benefits 2011-07-01 0
Number of other retired or separated participants entitled to future benefits 2011-07-01 0
Total of all active and inactive participants 2011-07-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-07-01 0
Total participants 2011-07-01 0
Number of participants with account balances 2011-07-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-07-01 0

Measure	Date	Value
2012: THOMAS JEFFERSON CLASSICAL ACADEMY 403(B) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	123
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	127
Number of retired or separated participants receiving benefits	2012-07-01	0
Number of other retired or separated participants entitled to future benefits	2012-07-01	5
Total of all active and inactive participants	2012-07-01	132
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-07-01	1
Total participants	2012-07-01	133
Number of participants with account balances	2012-07-01	126
2011: THOMAS JEFFERSON CLASSICAL ACADEMY 403(B) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-12-01	123
Total number of active participants reported on line 7a of the Form 5500	2011-12-01	117
Number of retired or separated participants receiving benefits	2011-12-01	0
Number of other retired or separated participants entitled to future benefits	2011-12-01	0
Total of all active and inactive participants	2011-12-01	117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-12-01	0
Total participants	2011-12-01	117
Number of participants with account balances	2011-12-01	117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-12-01	117
Total participants, beginning-of-year	2011-07-01	126
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	0
Number of retired or separated participants receiving benefits	2011-07-01	0
Number of other retired or separated participants entitled to future benefits	2011-07-01	0
Total of all active and inactive participants	2011-07-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-07-01	0
Total participants	2011-07-01	0
Number of participants with account balances	2011-07-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-07-01	0

Financial Data on THOMAS JEFFERSON CLASSICAL ACADEMY 403(B) PLAN

Measure	Date	Value
2013 : THOMAS JEFFERSON CLASSICAL ACADEMY 403(B) PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-06-30	$0
Total income from all sources (including contributions)	2013-06-30	$757,919
Total loss/gain on sale of assets	2013-06-30	$0
Total of all expenses incurred	2013-06-30	$106,030
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-06-30	$106,030
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-06-30	$541,851
Value of total assets at end of year	2013-06-30	$2,567,442
Value of total assets at beginning of year	2013-06-30	$1,915,553
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-06-30	$0
Total interest from all sources	2013-06-30	$216,068
Total dividends received (eg from common stock, registered investment company shares)	2013-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-06-30	No
Was this plan covered by a fidelity bond	2013-06-30	No
If this is an individual account plan, was there a blackout period	2013-06-30	No
Funding deficiency by the employer to the plan for this plan year	2013-06-30	$0
Minimum employer required contribution for this plan year	2013-06-30	$0
Amount contributed by the employer to the plan for this plan year	2013-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2013-06-30	No
Contributions received from participants	2013-06-30	$262,316
Participant contributions at beginning of year	2013-06-30	$0
Income. Received or receivable in cash from other sources (including rollovers)	2013-06-30	$54,374
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-06-30	No
Value of net income/loss	2013-06-30	$651,889
Value of net assets at end of year (total assets less liabilities)	2013-06-30	$2,567,442
Value of net assets at beginning of year (total assets less liabilities)	2013-06-30	$1,915,553
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-06-30	No
Were any leases to which the plan was party in default or uncollectible	2013-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-06-30	$0
Value of interest in pooled separate accounts at end of year	2013-06-30	$2,567,442
Value of interest in pooled separate accounts at beginning of year	2013-06-30	$1,915,553
Interest earned on other investments	2013-06-30	$216,068
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-06-30	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-06-30	No
Was there a failure to transmit to the plan any participant contributions	2013-06-30	No
Has the plan failed to provide any benefit when due under the plan	2013-06-30	No
Contributions received in cash from employer	2013-06-30	$225,161
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-06-30	$106,030
Did the plan have assets held for investment	2013-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2013-06-30	Disclaimer
Accountancy firm name	2013-06-30	DARRELL L. KELLER CPA PA
Accountancy firm EIN	2013-06-30	510471443
2012 : THOMAS JEFFERSON CLASSICAL ACADEMY 403(B) PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-06-30	$0
Total transfer of assets to this plan	2012-06-30	$0
Total transfer of assets from this plan	2012-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-06-30	$0
Expenses. Interest paid	2012-06-30	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2012-06-30	$0
Total income from all sources (including contributions)	2012-06-30	$2,002,710
Total loss/gain on sale of assets	2012-06-30	$0
Total of all expenses incurred	2012-06-30	$87,157
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-06-30	$87,157
Value of total corrective distributions	2012-06-30	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-06-30	$1,974,771
Value of total assets at end of year	2012-06-30	$1,915,553
Value of total assets at beginning of year	2012-06-30	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-06-30	$0
Total interest from all sources	2012-06-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2012-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-06-30	No
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2012-06-30	$0
Total dividends received from registered investment company shares (eg mutual funds)	2012-06-30	$0
Administrative expenses professional fees incurred	2012-06-30	$0
Was this plan covered by a fidelity bond	2012-06-30	No
Value of fidelity bond cover	2012-06-30	$250,000
If this is an individual account plan, was there a blackout period	2012-06-30	No
Funding deficiency by the employer to the plan for this plan year	2012-06-30	$0
Minimum employer required contribution for this plan year	2012-06-30	$0
Amount contributed by the employer to the plan for this plan year	2012-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2012-06-30	No
Contributions received from participants	2012-06-30	$135,340
Participant contributions at end of year	2012-06-30	$0
Participant contributions at beginning of year	2012-06-30	$0
Income. Received or receivable in cash from other sources (including rollovers)	2012-06-30	$1,710,577
Administrative expenses (other) incurred	2012-06-30	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-06-30	No
Income. Non cash contributions	2012-06-30	$0
Value of net income/loss	2012-06-30	$1,915,553
Value of net assets at end of year (total assets less liabilities)	2012-06-30	$1,915,553
Value of net assets at beginning of year (total assets less liabilities)	2012-06-30	$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-06-30	No
Were any leases to which the plan was party in default or uncollectible	2012-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-06-30	$132,004
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-06-30	$2,175,552
Value of interest in pooled separate accounts at end of year	2012-06-30	$1,915,553
Value of interest in pooled separate accounts at beginning of year	2012-06-30	$0
Interest on participant loans	2012-06-30	$0
Interest earned on other investments	2012-06-30	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-06-30	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-06-30	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2012-06-30	$0
Net investment gain/loss from pooled separate accounts	2012-06-30	$27,939
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-06-30	No
Was there a failure to transmit to the plan any participant contributions	2012-06-30	No
Has the plan failed to provide any benefit when due under the plan	2012-06-30	No
Contributions received in cash from employer	2012-06-30	$128,854
Income. Dividends from preferred stock	2012-06-30	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-06-30	$87,157
Contract administrator fees	2012-06-30	$0
Did the plan have assets held for investment	2012-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2012-06-30	Disclaimer
Accountancy firm name	2012-06-30	DARRELL L. KELER, CPA, PA
Accountancy firm EIN	2012-06-30	510471443
2011 : THOMAS JEFFERSON CLASSICAL ACADEMY 403(B) PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-11-30	$0
Total transfer of assets from this plan	2011-11-30	$132,004
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-11-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-11-30	$0
Total income from all sources (including contributions)	2011-11-30	$112,013
Total loss/gain on sale of assets	2011-11-30	$0
Total of all expenses incurred	2011-11-30	$2,265,324
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-11-30	$2,263,199
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-11-30	$190,336
Value of total assets at end of year	2011-11-30	$0
Value of total assets at beginning of year	2011-11-30	$2,285,315
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-11-30	$2,125
Total interest from all sources	2011-11-30	$1,345
Total dividends received (eg from common stock, registered investment company shares)	2011-11-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-11-30	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2011-11-30	$0
Was this plan covered by a fidelity bond	2011-11-30	Yes
Value of fidelity bond cover	2011-11-30	$250,000
If this is an individual account plan, was there a blackout period	2011-11-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-11-30	$0
Were there any nonexempt tranactions with any party-in-interest	2011-11-30	No
Contributions received from participants	2011-11-30	$98,565
Income. Received or receivable in cash from other sources (including rollovers)	2011-11-30	$5,750
Administrative expenses (other) incurred	2011-11-30	$2,125
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-11-30	No
Value of net income/loss	2011-11-30	$-2,153,311
Value of net assets at end of year (total assets less liabilities)	2011-11-30	$0
Value of net assets at beginning of year (total assets less liabilities)	2011-11-30	$2,285,315
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-11-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-11-30	No
Were any leases to which the plan was party in default or uncollectible	2011-11-30	No
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-11-30	$2,175,552
Interest earned on other investments	2011-11-30	$1,345
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-11-30	$109,763
Net investment gain/loss from pooled separate accounts	2011-11-30	$-79,668
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-11-30	No
Was there a failure to transmit to the plan any participant contributions	2011-11-30	No
Has the plan failed to provide any benefit when due under the plan	2011-11-30	No
Contributions received in cash from employer	2011-11-30	$86,021
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-11-30	$2,263,199
Did the plan have assets held for investment	2011-11-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-11-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-11-30	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-11-30	Yes
Opinion of an independent qualified public accountant for this plan	2011-11-30	Disclaimer
Accountancy firm name	2011-11-30	DARRELL L. KELLER, CPA, PA
Accountancy firm EIN	2011-11-30	510471443

Form 5500 Responses for THOMAS JEFFERSON CLASSICAL ACADEMY 403(B) PLAN

2012: THOMAS JEFFERSON CLASSICAL ACADEMY 403(B) PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Submission has been amended	No
2012-07-01	This submission is the final filing	No
2012-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-07-01	Plan is a collectively bargained plan	No
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan funding arrangement – Trust	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2011: THOMAS JEFFERSON CLASSICAL ACADEMY 403(B) PLAN 2011 form 5500 responses
2011-12-01	Type of plan entity	Single employer plan
2011-12-01	First time form 5500 has been submitted	Yes
2011-12-01	Submission has been amended	No
2011-12-01	This submission is the final filing	No
2011-12-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2011-12-01	Plan is a collectively bargained plan	No
2011-12-01	Plan funding arrangement – Insurance	Yes
2011-12-01	Plan funding arrangement – Trust	Yes
2011-12-01	Plan benefit arrangement – Insurance	Yes
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Submission has been amended	Yes
2011-07-01	This submission is the final filing	Yes
2011-07-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2011-07-01	Plan is a collectively bargained plan	No
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan funding arrangement – Trust	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

GA 753037

Policy instance

Insurance contract or identification number	GA 753037
Number of Individuals Covered	126
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $8,735
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 $8,735
Insurance broker organization code?	3
Insurance broker name	RAYMOND JAMES FINANCIAL SERVICES

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

Policy contract number

GA 753037

Policy instance

Insurance contract or identification number	GA 753037
Number of Individuals Covered	117
Insurance policy start date	2011-12-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $19,747
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 750978

Policy instance

Insurance contract or identification number	GA 750978
Number of Individuals Covered	0
Insurance policy start date	2011-07-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $5,290
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 $5,290
Insurance broker organization code?	3
Insurance broker name	RAYMOND JAMES FINANCIAL SERVICES

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Company Name:	THOMAS JEFFERSON CLASSICAL ACADEMY
Employer identification number (EIN):	562123336
NAIC Classification:	611000

Jurisdiction of Incorporation:	North Carolina Secretary of State
Incorporation Date:
Company Identification Number:	0468978