401k Plan data: QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING PLAN plan

QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING PLAN
Plan identification number	001

QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
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

QUALITY RESIDENTIAL ALTERNATIVES has sponsored the creation of one or more 401k plans.

Company Name: QUALITY RESIDENTIAL ALTERNATIVES

Employer identification number (EIN): 311391410

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 KATHY JAMES 2016-09-15 KATHY JAMES 2016-09-15
001 2015-01-01 KATHY JAMES 2016-06-22 KATHY JAMES 2016-06-22
001 2014-01-01 KATHY JAMES 2015-10-14
001 2013-01-01 KATHY JAMES
001 2012-01-01 KATHY JAMES
001 2011-01-01 KATHY JAMES
001 2010-01-01 KATHY JAMES
001 2009-01-01 KATHY JAMES

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2016-01-01	KATHY JAMES	2016-09-15	KATHY JAMES	2016-09-15
001	2015-01-01	KATHY JAMES	2016-06-22	KATHY JAMES	2016-06-22
001	2014-01-01	KATHY JAMES	2015-10-14
001	2013-01-01	KATHY JAMES
001	2012-01-01	KATHY JAMES
001	2011-01-01	KATHY JAMES
001	2010-01-01	KATHY JAMES
001	2009-01-01	KATHY JAMES

Plan Statistics for QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING PLAN

Measure Date Value
2013: QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 73
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 56
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 10
Total of all active and inactive participants 2013-01-01 66
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 66
Number of participants with account balances 2013-01-01 28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 82
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 63
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 10
Total of all active and inactive participants 2012-01-01 73
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 73
Number of participants with account balances 2012-01-01 31
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 71
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 71
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 11
Total of all active and inactive participants 2011-01-01 82
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 82
Number of participants with account balances 2011-01-01 35
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 103
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 62
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 33
Total of all active and inactive participants 2010-01-01 95
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 95
Number of participants with account balances 2010-01-01 56
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 107
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 84
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 19
Total of all active and inactive participants 2009-01-01 103
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 103
Number of participants with account balances 2009-01-01 45
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2013: QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	73
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	56
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	10
Total of all active and inactive participants	2013-01-01	66
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	66
Number of participants with account balances	2013-01-01	28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	82
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	63
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	10
Total of all active and inactive participants	2012-01-01	73
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	73
Number of participants with account balances	2012-01-01	31
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	71
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	71
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	11
Total of all active and inactive participants	2011-01-01	82
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	82
Number of participants with account balances	2011-01-01	35
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	103
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	62
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	33
Total of all active and inactive participants	2010-01-01	95
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	95
Number of participants with account balances	2010-01-01	56
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	107
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	84
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	19
Total of all active and inactive participants	2009-01-01	103
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	103
Number of participants with account balances	2009-01-01	45
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2013 : QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$95,088
Expenses. Total of all expenses incurred	2013-12-31	$101,823
Benefits paid (including direct rollovers)	2013-12-31	$87,932
Total plan assets at end of year	2013-12-31	$542,307
Total plan assets at beginning of year	2013-12-31	$549,042
Value of fidelity bond covering the plan	2013-12-31	$60,000
Total contributions received or receivable from participants	2013-12-31	$14,702
Contributions received from other sources (not participants or employers)	2013-12-31	$23,937
Other income received	2013-12-31	$56,449
Net income (gross income less expenses)	2013-12-31	$-6,735
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$542,307
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$549,042
Assets. Value of participant loans	2013-12-31	$102,918
Value of certain deemed distributions of participant loans	2013-12-31	$10,943
Value of corrective distributions	2013-12-31	$2,948
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$38,575
Expenses. Total of all expenses incurred	2012-12-31	$14,137
Benefits paid (including direct rollovers)	2012-12-31	$11,940
Total plan assets at end of year	2012-12-31	$549,042
Total plan assets at beginning of year	2012-12-31	$524,604
Value of fidelity bond covering the plan	2012-12-31	$20,000
Total contributions received or receivable from participants	2012-12-31	$16,851
Other income received	2012-12-31	$21,724
Net income (gross income less expenses)	2012-12-31	$24,438
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$549,042
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$524,604
Assets. Value of participant loans	2012-12-31	$81,431
Value of certain deemed distributions of participant loans	2012-12-31	$1,974
Value of corrective distributions	2012-12-31	$223
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$8,130
Expenses. Total of all expenses incurred	2011-12-31	$18,309
Benefits paid (including direct rollovers)	2011-12-31	$1,139
Total plan assets at end of year	2011-12-31	$524,604
Total plan assets at beginning of year	2011-12-31	$534,783
Value of fidelity bond covering the plan	2011-12-31	$60,000
Total contributions received or receivable from participants	2011-12-31	$21,189
Other income received	2011-12-31	$-13,059
Net income (gross income less expenses)	2011-12-31	$-10,179
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$524,604
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$534,783
Assets. Value of participant loans	2011-12-31	$85,076
Value of certain deemed distributions of participant loans	2011-12-31	$17,170
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	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	$51,121
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$73,134
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$73,134
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$23,543
Value of total assets at end of year	2010-12-31	$534,783
Value of total assets at beginning of year	2010-12-31	$556,796
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$0
Total interest from all sources	2010-12-31	$2,772
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	$25,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	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	$23,543
Participant contributions at end of year	2010-12-31	$98,013
Participant contributions at beginning of year	2010-12-31	$70,161
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
Other income not declared elsewhere	2010-12-31	$3,388
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	$-22,013
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$534,783
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$556,796
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	$234,359
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$373,025
Interest on participant loans	2010-12-31	$3,008
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$81,007
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$-236
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$121,404
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$113,610
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$21,418
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
Contributions received in cash from employer	2010-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$73,134
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	KLESHINSKI, MORRISON & MORRIS, LLP
Accountancy firm EIN	2010-12-31	341568021
2009 : QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING PLAN

2013: QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING 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 – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING 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
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
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
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: QUALITY RESIDENTIAL ALTERNATIVES 401(K) PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
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
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

GAP-B2-MM72

Policy instance

Insurance contract or identification number	GAP-B2-MM72
Number of Individuals Covered	28
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,270
Total amount of fees paid to insurance company	USD $318
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?	Yes
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 $823
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	INVESTMENTS
Insurance broker organization code?	3
Insurance broker name	INVEST FINANCIAL CORPORATION

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

GAP-B2-MM72

Policy instance

Insurance contract or identification number	GAP-B2-MM72
Number of Individuals Covered	31
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $421
Total amount of fees paid to insurance company	USD $105
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?	Yes
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 $421
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	INVESTMENTS
Insurance broker organization code?	3
Insurance broker name	EDWARD SOMMER

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

GAP-B2-MM72

Policy instance

Insurance contract or identification number	GAP-B2-MM72
Number of Individuals Covered	35
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $221
Total amount of fees paid to insurance company	USD $55
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?	Yes
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

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

420-80037

Policy instance

Insurance contract or identification number	420-80037
Number of Individuals Covered	95
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $171
Total amount of fees paid to insurance company	USD $42
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?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	42
Additional information about fees paid to insurance broker	INVESTMENTS
Insurance broker organization code?	3
Insurance broker name	INVEST FINANCIAL CORPORATION

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Company Name:	QUALITY RESIDENTIAL ALTERNATIVES
Employer identification number (EIN):	311391410
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities