401k Plan data: VALLEY RESIDENTIAL SERVICES 401(K) PLAN plan

VALLEY RESIDENTIAL SERVICES 401(K) PLAN 401k Plan overview

Plan Name	VALLEY RESIDENTIAL SERVICES 401(K) PLAN
Plan identification number	001

VALLEY RESIDENTIAL SERVICES 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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

401k Sponsoring company profile

VALLEY RESIDENTIAL SERVICES has sponsored the creation of one or more 401k plans.

Company Name: VALLEY RESIDENTIAL SERVICES

Employer identification number (EIN): 311645473

NAIC Classification: 531310

Additional information about VALLEY RESIDENTIAL SERVICES

Jurisdiction of Incorporation: Alaska Department Commerce, Community & Economic Development

Incorporation Date: 1998-10-15

Company Identification Number: 64982D

Legal Registered Office Address: 1075 CHECK ST STE 102

WASILLA
United States of America (USA)
99654

More information about VALLEY RESIDENTIAL SERVICES

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VALLEY RESIDENTIAL SERVICES 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 JOHN WEAVER 2023-10-19
001 2021-01-01 JOHN WEAVER 2023-02-25
001 2020-01-01 JOHN WEAVER 2021-10-15 JOHN WEAVER 2021-10-15
001 2019-01-01 JOHN WEAVER 2020-10-15 JOHN WEAVER 2020-10-15
001 2018-01-01 JOHN WEAVER 2019-10-15 JOHN WEAVER 2019-10-15
001 2017-01-01 JOHN WEAVER 2018-06-19
001 2016-01-01 JOHN WEAVER 2017-05-25
001 2015-01-01 JOHN WEAVER 2016-06-16
001 2014-01-01 JOHN WEAVER JOHN WEAVER 2015-09-03
001 2013-01-01 JOHN WEAVER JOHN WEAVER 2014-10-16
001 2012-01-01 JOHN WEAVER
001 2011-01-01 JOHN WEAVER
001 2010-01-01 SUSAN LEWIS
001 2009-01-01 SUSAN LEWIS SUSAN LEWIS 2010-10-12
001 2009-01-01 JOHN WEAVER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	JOHN WEAVER	2023-10-19
001	2021-01-01	JOHN WEAVER	2023-02-25
001	2020-01-01	JOHN WEAVER	2021-10-15	JOHN WEAVER	2021-10-15
001	2019-01-01	JOHN WEAVER	2020-10-15	JOHN WEAVER	2020-10-15
001	2018-01-01	JOHN WEAVER	2019-10-15	JOHN WEAVER	2019-10-15
001	2017-01-01	JOHN WEAVER	2018-06-19
001	2016-01-01	JOHN WEAVER	2017-05-25
001	2015-01-01	JOHN WEAVER	2016-06-16
001	2014-01-01	JOHN WEAVER		JOHN WEAVER	2015-09-03
001	2013-01-01	JOHN WEAVER		JOHN WEAVER	2014-10-16
001	2012-01-01	JOHN WEAVER
001	2011-01-01	JOHN WEAVER
001	2010-01-01	SUSAN LEWIS
001	2009-01-01	SUSAN LEWIS		SUSAN LEWIS	2010-10-12
001	2009-01-01	JOHN WEAVER

Plan Statistics for VALLEY RESIDENTIAL SERVICES 401(K) PLAN

401k plan membership statisitcs for VALLEY RESIDENTIAL SERVICES 401(K) PLAN

Measure Date Value
2014: VALLEY RESIDENTIAL SERVICES 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 11
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 9
Number of retired or separated participants receiving benefits 2014-01-01 1
Number of other retired or separated participants entitled to future benefits 2014-01-01 1
Total of all active and inactive participants 2014-01-01 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 11
Number of participants with account balances 2014-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: VALLEY RESIDENTIAL SERVICES 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 14
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 10
Number of retired or separated participants receiving benefits 2013-01-01 1
Number of other retired or separated participants entitled to future benefits 2013-01-01 1
Total of all active and inactive participants 2013-01-01 12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 12
Number of participants with account balances 2013-01-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: VALLEY RESIDENTIAL SERVICES 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 12
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 11
Number of retired or separated participants receiving benefits 2012-01-01 1
Number of other retired or separated participants entitled to future benefits 2012-01-01 1
Total of all active and inactive participants 2012-01-01 13
Total participants 2012-01-01 13
Number of participants with account balances 2012-01-01 12
2011: VALLEY RESIDENTIAL SERVICES 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 15
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 10
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 10
Number of participants with account balances 2011-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: VALLEY RESIDENTIAL SERVICES 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 12
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 12
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 2
Total of all active and inactive participants 2010-01-01 14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 14
Number of participants with account balances 2010-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: VALLEY RESIDENTIAL SERVICES 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 13
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 1
Total of all active and inactive participants 2009-01-01 14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 14
Number of participants with account balances 2009-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2014: VALLEY RESIDENTIAL SERVICES 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	11
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	9
Number of retired or separated participants receiving benefits	2014-01-01	1
Number of other retired or separated participants entitled to future benefits	2014-01-01	1
Total of all active and inactive participants	2014-01-01	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	11
Number of participants with account balances	2014-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: VALLEY RESIDENTIAL SERVICES 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	14
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	10
Number of retired or separated participants receiving benefits	2013-01-01	1
Number of other retired or separated participants entitled to future benefits	2013-01-01	1
Total of all active and inactive participants	2013-01-01	12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	12
Number of participants with account balances	2013-01-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: VALLEY RESIDENTIAL SERVICES 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	12
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	11
Number of retired or separated participants receiving benefits	2012-01-01	1
Number of other retired or separated participants entitled to future benefits	2012-01-01	1
Total of all active and inactive participants	2012-01-01	13
Total participants	2012-01-01	13
Number of participants with account balances	2012-01-01	12
2011: VALLEY RESIDENTIAL SERVICES 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	15
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	10
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	10
Number of participants with account balances	2011-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: VALLEY RESIDENTIAL SERVICES 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	12
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	12
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	2
Total of all active and inactive participants	2010-01-01	14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	14
Number of participants with account balances	2010-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: VALLEY RESIDENTIAL SERVICES 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	13
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	1
Total of all active and inactive participants	2009-01-01	14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	14
Number of participants with account balances	2009-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on VALLEY RESIDENTIAL SERVICES 401(K) PLAN

Measure	Date	Value
2014 : VALLEY RESIDENTIAL SERVICES 401(K) PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total income from all sources	2014-12-31	$8,303
Expenses. Total of all expenses incurred	2014-12-31	$2,277
Benefits paid (including direct rollovers)	2014-12-31	$1,833
Total plan assets at end of year	2014-12-31	$125,123
Total plan assets at beginning of year	2014-12-31	$119,097
Value of fidelity bond covering the plan	2014-12-31	$83,152
Total contributions received or receivable from participants	2014-12-31	$3,513
Expenses. Other expenses not covered elsewhere	2014-12-31	$444
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$4,790
Net income (gross income less expenses)	2014-12-31	$6,026
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$125,123
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$119,097
Assets. Value of participant loans	2014-12-31	$0
Total contributions received or receivable from employer(s)	2014-12-31	$0
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2014-12-31	$0
Minimum employer required contribution for this plan year	2014-12-31	$0
Amount contributed by the employer to the plan for this plan year	2014-12-31	$0
2013 : VALLEY RESIDENTIAL SERVICES 401(K) PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total income from all sources	2013-12-31	$23,625
Expenses. Total of all expenses incurred	2013-12-31	$1,975
Benefits paid (including direct rollovers)	2013-12-31	$1,550
Total plan assets at end of year	2013-12-31	$119,096
Total plan assets at beginning of year	2013-12-31	$97,446
Value of fidelity bond covering the plan	2013-12-31	$83,152
Total contributions received or receivable from participants	2013-12-31	$1,087
Expenses. Other expenses not covered elsewhere	2013-12-31	$425
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$22,538
Net income (gross income less expenses)	2013-12-31	$21,650
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$119,096
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$97,446
Assets. Value of participant loans	2013-12-31	$0
Total contributions received or receivable from employer(s)	2013-12-31	$0
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2013-12-31	$0
Minimum employer required contribution for this plan year	2013-12-31	$0
Amount contributed by the employer to the plan for this plan year	2013-12-31	$0
2012 : VALLEY RESIDENTIAL SERVICES 401(K) PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total income from all sources	2012-12-31	$15,932
Expenses. Total of all expenses incurred	2012-12-31	$7,577
Benefits paid (including direct rollovers)	2012-12-31	$7,165
Total plan assets at end of year	2012-12-31	$97,446
Total plan assets at beginning of year	2012-12-31	$89,091
Value of fidelity bond covering the plan	2012-12-31	$83,152
Total contributions received or receivable from participants	2012-12-31	$2,867
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$13,065
Net income (gross income less expenses)	2012-12-31	$8,355
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$97,446
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$89,091
Total contributions received or receivable from employer(s)	2012-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$412
2011 : VALLEY RESIDENTIAL SERVICES 401(K) PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total income from all sources	2011-12-31	$-6,603
Expenses. Total of all expenses incurred	2011-12-31	$51,553
Benefits paid (including direct rollovers)	2011-12-31	$51,144
Total plan assets at end of year	2011-12-31	$89,091
Total plan assets at beginning of year	2011-12-31	$147,247
Value of fidelity bond covering the plan	2011-12-31	$83,152
Total contributions received or receivable from participants	2011-12-31	$4,482
Expenses. Other expenses not covered elsewhere	2011-12-31	$409
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-11,085
Net income (gross income less expenses)	2011-12-31	$-58,156
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$89,091
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$147,247
Total contributions received or receivable from employer(s)	2011-12-31	$0
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2011-12-31	$0
Minimum employer required contribution for this plan year	2011-12-31	$0
Amount contributed by the employer to the plan for this plan year	2011-12-31	$0
2010 : VALLEY RESIDENTIAL SERVICES 401(K) PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total income from all sources	2010-12-31	$24,729
Expenses. Total of all expenses incurred	2010-12-31	$450
Benefits paid (including direct rollovers)	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$147,247
Total plan assets at beginning of year	2010-12-31	$122,968
Value of fidelity bond covering the plan	2010-12-31	$50,000
Total contributions received or receivable from participants	2010-12-31	$6,676
Expenses. Other expenses not covered elsewhere	2010-12-31	$450
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$18,053
Net income (gross income less expenses)	2010-12-31	$24,279
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$147,247
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$122,968
Assets. Value of participant loans	2010-12-31	$0
Total contributions received or receivable from employer(s)	2010-12-31	$0
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
2009 : VALLEY RESIDENTIAL SERVICES 401(K) PLAN 2009 401k financial data
Funding deficiency by the employer to the plan for this plan year	2009-12-31	$0
Minimum employer required contribution for this plan year	2009-12-31	$0
Amount contributed by the employer to the plan for this plan year	2009-12-31	$0

Form 5500 Responses for VALLEY RESIDENTIAL SERVICES 401(K) PLAN

2014: VALLEY RESIDENTIAL SERVICES 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: VALLEY RESIDENTIAL SERVICES 401(K) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: VALLEY RESIDENTIAL SERVICES 401(K) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	First time form 5500 has been submitted	Yes
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: VALLEY RESIDENTIAL SERVICES 401(K) PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	First time form 5500 has been submitted	Yes
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
2010: VALLEY RESIDENTIAL SERVICES 401(K) PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	Yes
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
2009: VALLEY RESIDENTIAL SERVICES 401(K) PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

GA-806745

Policy instance

Insurance contract or identification number	GA-806745
Number of Individuals Covered	8
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $339
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 $339
Insurance broker organization code?	3
Insurance broker name	UBS FINANCIAL SERVICES

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

Policy contract number

GA-806745

Policy instance

Insurance contract or identification number	GA-806745
Number of Individuals Covered	7
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $269
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 $269
Insurance broker organization code?	3
Insurance broker name	UBS FINANCIAL SVCS INS AGCY

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

Policy contract number

GA806745

Policy instance

Insurance contract or identification number	GA806745
Number of Individuals Covered	12
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $262
Total amount of fees paid to insurance company	USD $0
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
Amount paid for insurance broker fees	262
Insurance broker organization code?	3
Insurance broker name	UBS FINANCIAL SVCS INS AGCY

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

Policy contract number

GA-806745

Policy instance

Insurance contract or identification number	GA-806745
Number of Individuals Covered	6
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $403
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Welfare Benefit Premiums Paid to Carrier	USD $0
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-806745

Policy instance

Insurance contract or identification number	GA-806745
Number of Individuals Covered	8
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $380
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 $380
Insurance broker organization code?	3
Insurance broker name	UBS FINANCIAL SVCS INS AGCY

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Company Name:	VALLEY RESIDENTIAL SERVICES
Employer identification number (EIN):	311645473
NAIC Classification:	531310

Jurisdiction of Incorporation:	Alaska Department Commerce, Community & Economic Development
Incorporation Date:	1998-10-15
Company Identification Number:	64982D
Legal Registered Office Address:	1075 CHECK ST STE 102 WASILLA United States of America (USA) 99654