401k Plan data: COMMUNICARE HEALTH CENTER RETIREMENT PLAN plan

COMMUNICARE HEALTH CENTER RETIREMENT PLAN 401k Plan overview

Plan Name	COMMUNICARE HEALTH CENTER RETIREMENT PLAN
Plan identification number	002

COMMUNICARE HEALTH CENTER RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
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.
Participant-directed brokerage accounts provided as an investment option under the plan.
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

COMMUNICARE HEALTH CENTERS, INC. has sponsored the creation of one or more 401k plans.

Company Name: COMMUNICARE HEALTH CENTERS, INC.

Employer identification number (EIN): 942188574

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Additional information about COMMUNICARE HEALTH CENTERS, INC.

Jurisdiction of Incorporation: California Department of State

Incorporation Date:

Company Identification Number: C0676670

More information about COMMUNICARE HEALTH CENTERS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COMMUNICARE HEALTH CENTER RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2015-07-01 SHERRY CAUCHOIS 2015-11-03
002 2014-07-01 SHERRY CAUCHOIS 2015-11-03
002 2013-07-01 SHERRY CAUCHOIS 2014-11-17
002 2012-07-01 SHERRY CAUCHOIS
002 2011-07-01 SHERRY CAUCHOIS
002 2010-07-01 SHERRY CAUCHOIS
002 2009-07-01 ASSOCIATED PENSION CONSULTANTS

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
002	2015-07-01	SHERRY CAUCHOIS	2015-11-03
002	2014-07-01	SHERRY CAUCHOIS	2015-11-03
002	2013-07-01	SHERRY CAUCHOIS	2014-11-17
002	2012-07-01	SHERRY CAUCHOIS
002	2011-07-01	SHERRY CAUCHOIS
002	2010-07-01	SHERRY CAUCHOIS
002	2009-07-01	ASSOCIATED PENSION CONSULTANTS

Plan Statistics for COMMUNICARE HEALTH CENTER RETIREMENT PLAN

401k plan membership statisitcs for COMMUNICARE HEALTH CENTER RETIREMENT PLAN

Measure Date Value
2012: COMMUNICARE HEALTH CENTER RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 178
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 13
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 12
Total of all active and inactive participants 2012-07-01 25
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-07-01 0
Total participants 2012-07-01 25
Number of participants with account balances 2012-07-01 25
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-07-01 0
2011: COMMUNICARE HEALTH CENTER RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-07-01 204
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 145
Number of other retired or separated participants entitled to future benefits 2011-07-01 25
Total of all active and inactive participants 2011-07-01 170
Total participants 2011-07-01 170
Number of participants with account balances 2011-07-01 171
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-07-01 5
2010: COMMUNICARE HEALTH CENTER RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-07-01 118
Total number of active participants reported on line 7a of the Form 5500 2010-07-01 132
Number of other retired or separated participants entitled to future benefits 2010-07-01 56
Total of all active and inactive participants 2010-07-01 188
Total participants 2010-07-01 188
Number of participants with account balances 2010-07-01 192
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-07-01 19
2009: COMMUNICARE HEALTH CENTER RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-07-01 196
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 141
Number of retired or separated participants receiving benefits 2009-07-01 0
Number of other retired or separated participants entitled to future benefits 2009-07-01 56
Total of all active and inactive participants 2009-07-01 197
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-07-01 0
Total participants 2009-07-01 197
Number of participants with account balances 2009-07-01 195
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-07-01 9

Measure	Date	Value
2012: COMMUNICARE HEALTH CENTER RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	178
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	13
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	12
Total of all active and inactive participants	2012-07-01	25
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-07-01	0
Total participants	2012-07-01	25
Number of participants with account balances	2012-07-01	25
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-07-01	0
2011: COMMUNICARE HEALTH CENTER RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-07-01	204
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	145
Number of other retired or separated participants entitled to future benefits	2011-07-01	25
Total of all active and inactive participants	2011-07-01	170
Total participants	2011-07-01	170
Number of participants with account balances	2011-07-01	171
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-07-01	5
2010: COMMUNICARE HEALTH CENTER RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-07-01	118
Total number of active participants reported on line 7a of the Form 5500	2010-07-01	132
Number of other retired or separated participants entitled to future benefits	2010-07-01	56
Total of all active and inactive participants	2010-07-01	188
Total participants	2010-07-01	188
Number of participants with account balances	2010-07-01	192
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-07-01	19
2009: COMMUNICARE HEALTH CENTER RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-07-01	196
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	141
Number of retired or separated participants receiving benefits	2009-07-01	0
Number of other retired or separated participants entitled to future benefits	2009-07-01	56
Total of all active and inactive participants	2009-07-01	197
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-07-01	0
Total participants	2009-07-01	197
Number of participants with account balances	2009-07-01	195
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-07-01	9

Financial Data on COMMUNICARE HEALTH CENTER RETIREMENT PLAN

Measure	Date	Value
2013 : COMMUNICARE HEALTH CENTER RETIREMENT PLAN 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-06-30	$99,505
Total income from all sources (including contributions)	2013-06-30	$547,649
Total of all expenses incurred	2013-06-30	$2,996,247
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-06-30	$2,984,416
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-06-30	$225,708
Value of total assets at end of year	2013-06-30	$326,572
Value of total assets at beginning of year	2013-06-30	$2,675,665
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-06-30	$11,831
Total interest from all sources	2013-06-30	$7,464
Total dividends received (eg from common stock, registered investment company shares)	2013-06-30	$45,447
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-06-30	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2013-06-30	$0
Total dividends received from registered investment company shares (eg mutual funds)	2013-06-30	$45,447
Administrative expenses professional fees incurred	2013-06-30	$116
Was this plan covered by a fidelity bond	2013-06-30	Yes
Value of fidelity bond cover	2013-06-30	$500,000
If this is an individual account plan, was there a blackout period	2013-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2013-06-30	No
Contributions received from participants	2013-06-30	$0
Participant contributions at end of year	2013-06-30	$0
Participant contributions at beginning of year	2013-06-30	$107
Income. Received or receivable in cash from other sources (including rollovers)	2013-06-30	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-06-30	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-06-30	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-06-30	$99,505
Total non interest bearing cash at end of year	2013-06-30	$0
Total non interest bearing cash at beginning of year	2013-06-30	$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	2013-06-30	No
Value of net income/loss	2013-06-30	$-2,448,598
Value of net assets at end of year (total assets less liabilities)	2013-06-30	$227,067
Value of net assets at beginning of year (total assets less liabilities)	2013-06-30	$2,675,665
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 end of year	2013-06-30	$99,412
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-06-30	$2,281,558
Interest earned on other investments	2013-06-30	$7,464
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-06-30	$227,160
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-06-30	$393,811
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-06-30	$269,030
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	$225,708
Employer contributions (assets) at end of year	2013-06-30	$0
Employer contributions (assets) at beginning of year	2013-06-30	$189
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-06-30	$2,984,416
Contract administrator fees	2013-06-30	$11,715
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	POMARES BEARRY AN ACCOUNTANCY CORP
Accountancy firm EIN	2013-06-30	942689573
2012 : COMMUNICARE HEALTH CENTER RETIREMENT PLAN 2012 401k financial data
Total income from all sources (including contributions)	2012-06-30	$238,443
Total of all expenses incurred	2012-06-30	$212,106
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-06-30	$199,336
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-06-30	$266,224
Value of total assets at end of year	2012-06-30	$2,675,665
Value of total assets at beginning of year	2012-06-30	$2,649,328
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-06-30	$12,770
Total interest from all sources	2012-06-30	$12,219
Total dividends received (eg from common stock, registered investment company shares)	2012-06-30	$38,796
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-06-30	$38,796
Administrative expenses professional fees incurred	2012-06-30	$120
Was this plan covered by a fidelity bond	2012-06-30	Yes
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	Yes
Were there any nonexempt tranactions with any party-in-interest	2012-06-30	No
Contributions received from participants	2012-06-30	$0
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	$293
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-06-30	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-06-30	$0
Administrative expenses (other) incurred	2012-06-30	$38
Total non interest bearing cash at end of year	2012-06-30	$0
Total non interest bearing cash at beginning of year	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
Value of net income/loss	2012-06-30	$26,337
Value of net assets at end of year (total assets less liabilities)	2012-06-30	$2,675,665
Value of net assets at beginning of year (total assets less liabilities)	2012-06-30	$2,649,328
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	$2,281,558
Value of interest in pooled separate accounts at beginning of year	2012-06-30	$2,105,997
Interest earned on other investments	2012-06-30	$12,219
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-06-30	$393,811
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-06-30	$522,035
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-06-30	$-61,408
Net investment gain/loss from pooled separate accounts	2012-06-30	$-17,388
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	$265,931
Employer contributions (assets) at end of year	2012-06-30	$296
Employer contributions (assets) at beginning of year	2012-06-30	$21,296
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-06-30	$199,336
Contract administrator fees	2012-06-30	$12,612
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	2012-06-30	Yes
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	POMARES BEARRY AN ACCOUNTANCY CORP
Accountancy firm EIN	2012-06-30	942689573
2011 : COMMUNICARE HEALTH CENTER RETIREMENT PLAN 2011 401k financial data
Total income from all sources (including contributions)	2011-06-30	$660,068
Total of all expenses incurred	2011-06-30	$161,032
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-06-30	$159,907
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-06-30	$244,855
Value of total assets at end of year	2011-06-30	$2,649,328
Value of total assets at beginning of year	2011-06-30	$2,150,292
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-06-30	$1,125
Total interest from all sources	2011-06-30	$21,968
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-06-30	No
Administrative expenses professional fees incurred	2011-06-30	$1,125
Was this plan covered by a fidelity bond	2011-06-30	Yes
Value of fidelity bond cover	2011-06-30	$250,000
If this is an individual account plan, was there a blackout period	2011-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2011-06-30	No
Other income not declared elsewhere	2011-06-30	$1,441
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-06-30	No
Value of net income/loss	2011-06-30	$499,036
Value of net assets at end of year (total assets less liabilities)	2011-06-30	$2,649,328
Value of net assets at beginning of year (total assets less liabilities)	2011-06-30	$2,150,292
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-06-30	No
Were any leases to which the plan was party in default or uncollectible	2011-06-30	No
Value of interest in pooled separate accounts at end of year	2011-06-30	$2,105,997
Value of interest in pooled separate accounts at beginning of year	2011-06-30	$1,465,702
Interest earned on other investments	2011-06-30	$21,968
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-06-30	$522,035
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-06-30	$670,137
Net investment gain/loss from pooled separate accounts	2011-06-30	$391,804
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-06-30	Yes
Was there a failure to transmit to the plan any participant contributions	2011-06-30	No
Has the plan failed to provide any benefit when due under the plan	2011-06-30	No
Contributions received in cash from employer	2011-06-30	$244,855
Employer contributions (assets) at end of year	2011-06-30	$21,296
Employer contributions (assets) at beginning of year	2011-06-30	$14,453
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-06-30	$159,907
Did the plan have assets held for investment	2011-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2011-06-30	Disclaimer
Accountancy firm name	2011-06-30	POMARES BEARRY AN ACCOUNTANCY CORP
Accountancy firm EIN	2011-06-30	942689573
2010 : COMMUNICARE HEALTH CENTER RETIREMENT PLAN 2010 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-06-30	$0

Form 5500 Responses for COMMUNICARE HEALTH CENTER RETIREMENT PLAN

2012: COMMUNICARE HEALTH CENTER RETIREMENT PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan funding arrangement – Trust	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement - Trust	Yes
2011: COMMUNICARE HEALTH CENTER RETIREMENT PLAN 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan funding arrangement – Trust	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement - Trust	Yes
2010: COMMUNICARE HEALTH CENTER RETIREMENT PLAN 2010 form 5500 responses
2010-07-01	Type of plan entity	Single employer plan
2010-07-01	Plan funding arrangement – Insurance	Yes
2010-07-01	Plan funding arrangement – Trust	Yes
2010-07-01	Plan benefit arrangement – Insurance	Yes
2010-07-01	Plan benefit arrangement - Trust	Yes
2009: COMMUNICARE HEALTH CENTER RETIREMENT PLAN 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	Submission has been amended	No
2009-07-01	This submission is the final filing	No
2009-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-07-01	Plan is a collectively bargained plan	No
2009-07-01	Plan funding arrangement – Insurance	Yes
2009-07-01	Plan funding arrangement – Trust	Yes
2009-07-01	Plan benefit arrangement – Insurance	Yes
2009-07-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	0
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $12,097
Total amount of fees paid to insurance company	USD $2,610
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 $12,097
Amount paid for insurance broker fees	495
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	3
Insurance broker name	POLYCOMP ADMINISTRATIVE SERVICES IN

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VFC014

Policy instance

Insurance contract or identification number	VFC014
Number of Individuals Covered	25
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
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

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	171
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $7,370
Total amount of fees paid to insurance company	USD $3,345
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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VFC014

Policy instance

Insurance contract or identification number	VFC014
Number of Individuals Covered	29
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VFC014

Policy instance

Insurance contract or identification number	VFC014
Number of Individuals Covered	221
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $11,968
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

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Company Name:	COMMUNICARE HEALTH CENTERS, INC.
Employer identification number (EIN):	942188574
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:
Company Identification Number:	C0676670