401k Plan data: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN plan

WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 401k Plan overview

Plan Name	WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN
Plan identification number	001

WELLINGTON PLACE EMPLOYEE RETIREMENT 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 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
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

ONEOTA RIVERVIEW CARE FACILITY, INC has sponsored the creation of one or more 401k plans.

Company Name: ONEOTA RIVERVIEW CARE FACILITY, INC

Employer identification number (EIN): 411316873

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01 AMY TRESSEL
001 2016-01-01 AMY TRESSEL
001 2015-01-01 AMY TRESSEL
001 2014-01-01 AMY TRESSEL
001 2013-01-01 AMY TRESSEL
001 2012-01-01 AMY TRESSEL
001 2011-01-01 AMY TRESSEL
001 2010-01-01 AMY TRESSEL 2011-10-17
001 2007-07-01 AMY K. TRESSEL
001 2007-07-01 2010-04-14
001 2006-07-01 AMY K. TRESSEL
001 2006-07-01 2010-04-14
001 2005-07-01 2010-04-14
001 2005-07-01 AMY K. TRESSEL
001 2004-07-01 AMY K. TRESSEL
001 2004-07-01 2010-04-14
001 2003-07-01 AMY K. TRESSEL
001 2003-07-01 2010-04-14
001 2002-07-01 2010-04-14
001 2002-07-01 AMY K. TRESSEL
001 2001-07-01 2010-04-14
001 2001-07-01 AMY K. TRESSEL
001 2001-01-01 2010-04-14
001 2001-01-01 AMY K. TRESSEL

Plan Statistics for WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN

401k plan membership statisitcs for WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN

Measure Date Value
2022: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 152
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 127
Number of retired or separated participants receiving benefits 2022-01-01 4
Number of other retired or separated participants entitled to future benefits 2022-01-01 30
Total of all active and inactive participants 2022-01-01 161
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 161
Number of participants with account balances 2022-01-01 65
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 149
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 97
Number of retired or separated participants receiving benefits 2021-01-01 10
Number of other retired or separated participants entitled to future benefits 2021-01-01 44
Total of all active and inactive participants 2021-01-01 151
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 151
Number of participants with account balances 2021-01-01 86
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 146
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 91
Number of retired or separated participants receiving benefits 2020-01-01 8
Number of other retired or separated participants entitled to future benefits 2020-01-01 48
Total of all active and inactive participants 2020-01-01 147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 147
Number of participants with account balances 2020-01-01 91
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 147
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 84
Number of retired or separated participants receiving benefits 2019-01-01 5
Number of other retired or separated participants entitled to future benefits 2019-01-01 53
Total of all active and inactive participants 2019-01-01 142
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 142
Number of participants with account balances 2019-01-01 91
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 155
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 80
Number of retired or separated participants receiving benefits 2018-01-01 4
Number of other retired or separated participants entitled to future benefits 2018-01-01 58
Total of all active and inactive participants 2018-01-01 142
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 142
Number of participants with account balances 2018-01-01 101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 162
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 93
Number of retired or separated participants receiving benefits 2017-01-01 2
Number of other retired or separated participants entitled to future benefits 2017-01-01 63
Total of all active and inactive participants 2017-01-01 158
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 158
Number of participants with account balances 2017-01-01 107
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 162
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 109
Number of retired or separated participants receiving benefits 2016-01-01 3
Number of other retired or separated participants entitled to future benefits 2016-01-01 50
Total of all active and inactive participants 2016-01-01 162
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 162
Number of participants with account balances 2016-01-01 102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 149
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 89
Number of retired or separated participants receiving benefits 2015-01-01 4
Number of other retired or separated participants entitled to future benefits 2015-01-01 53
Total of all active and inactive participants 2015-01-01 146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 146
Number of participants with account balances 2015-01-01 107
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 139
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 86
Number of retired or separated participants receiving benefits 2014-01-01 4
Number of other retired or separated participants entitled to future benefits 2014-01-01 46
Total of all active and inactive participants 2014-01-01 136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 136
Number of participants with account balances 2014-01-01 105
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 129
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 88
Number of retired or separated participants receiving benefits 2013-01-01 5
Number of other retired or separated participants entitled to future benefits 2013-01-01 34
Total of all active and inactive participants 2013-01-01 127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 127
Number of participants with account balances 2013-01-01 99
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 132
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 92
Number of retired or separated participants receiving benefits 2012-01-01 5
Number of other retired or separated participants entitled to future benefits 2012-01-01 33
Total of all active and inactive participants 2012-01-01 130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 130
Number of participants with account balances 2012-01-01 98
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 125
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 91
Number of retired or separated participants receiving benefits 2011-01-01 5
Number of other retired or separated participants entitled to future benefits 2011-01-01 37
Total of all active and inactive participants 2011-01-01 133
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 133
Number of participants with account balances 2011-01-01 102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2007: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2007 401k membership
Total of all active and inactive participants 2007-07-01 0
Total participants 2007-07-01 0
2006: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2006 401k membership
Total of all active and inactive participants 2006-07-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2006-07-01 0
Total participants 2006-07-01 0
2005: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2005 401k membership
Total of all active and inactive participants 2005-07-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2005-07-01 0
Total participants 2005-07-01 0
2004: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2004 401k membership
Total of all active and inactive participants 2004-07-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2004-07-01 0
Total participants 2004-07-01 0
2003: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2003 401k membership
Total of all active and inactive participants 2003-07-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2003-07-01 0
Total participants 2003-07-01 0
2002: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2002 401k membership
Total of all active and inactive participants 2002-07-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2002-07-01 0
Total participants 2002-07-01 0
2001: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2001 401k membership
Total of all active and inactive participants 2001-07-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2001-07-01 0
Total participants 2001-07-01 0
Total of all active and inactive participants 2001-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2001-01-01 0
Total participants 2001-01-01 0

Measure	Date	Value
2022: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	152
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	127
Number of retired or separated participants receiving benefits	2022-01-01	4
Number of other retired or separated participants entitled to future benefits	2022-01-01	30
Total of all active and inactive participants	2022-01-01	161
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	161
Number of participants with account balances	2022-01-01	65
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	149
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	97
Number of retired or separated participants receiving benefits	2021-01-01	10
Number of other retired or separated participants entitled to future benefits	2021-01-01	44
Total of all active and inactive participants	2021-01-01	151
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	151
Number of participants with account balances	2021-01-01	86
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	146
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	91
Number of retired or separated participants receiving benefits	2020-01-01	8
Number of other retired or separated participants entitled to future benefits	2020-01-01	48
Total of all active and inactive participants	2020-01-01	147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	147
Number of participants with account balances	2020-01-01	91
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	147
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	84
Number of retired or separated participants receiving benefits	2019-01-01	5
Number of other retired or separated participants entitled to future benefits	2019-01-01	53
Total of all active and inactive participants	2019-01-01	142
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	142
Number of participants with account balances	2019-01-01	91
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	155
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	80
Number of retired or separated participants receiving benefits	2018-01-01	4
Number of other retired or separated participants entitled to future benefits	2018-01-01	58
Total of all active and inactive participants	2018-01-01	142
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	142
Number of participants with account balances	2018-01-01	101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	162
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	93
Number of retired or separated participants receiving benefits	2017-01-01	2
Number of other retired or separated participants entitled to future benefits	2017-01-01	63
Total of all active and inactive participants	2017-01-01	158
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	158
Number of participants with account balances	2017-01-01	107
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	162
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	109
Number of retired or separated participants receiving benefits	2016-01-01	3
Number of other retired or separated participants entitled to future benefits	2016-01-01	50
Total of all active and inactive participants	2016-01-01	162
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	162
Number of participants with account balances	2016-01-01	102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	149
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	89
Number of retired or separated participants receiving benefits	2015-01-01	4
Number of other retired or separated participants entitled to future benefits	2015-01-01	53
Total of all active and inactive participants	2015-01-01	146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	146
Number of participants with account balances	2015-01-01	107
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	139
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	86
Number of retired or separated participants receiving benefits	2014-01-01	4
Number of other retired or separated participants entitled to future benefits	2014-01-01	46
Total of all active and inactive participants	2014-01-01	136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	136
Number of participants with account balances	2014-01-01	105
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	129
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	88
Number of retired or separated participants receiving benefits	2013-01-01	5
Number of other retired or separated participants entitled to future benefits	2013-01-01	34
Total of all active and inactive participants	2013-01-01	127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	127
Number of participants with account balances	2013-01-01	99
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	132
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	92
Number of retired or separated participants receiving benefits	2012-01-01	5
Number of other retired or separated participants entitled to future benefits	2012-01-01	33
Total of all active and inactive participants	2012-01-01	130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	130
Number of participants with account balances	2012-01-01	98
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	125
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	91
Number of retired or separated participants receiving benefits	2011-01-01	5
Number of other retired or separated participants entitled to future benefits	2011-01-01	37
Total of all active and inactive participants	2011-01-01	133
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	133
Number of participants with account balances	2011-01-01	102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2007: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2007 401k membership
Total of all active and inactive participants	2007-07-01	0
Total participants	2007-07-01	0
2006: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2006 401k membership
Total of all active and inactive participants	2006-07-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2006-07-01	0
Total participants	2006-07-01	0
2005: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2005 401k membership
Total of all active and inactive participants	2005-07-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2005-07-01	0
Total participants	2005-07-01	0
2004: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2004 401k membership
Total of all active and inactive participants	2004-07-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2004-07-01	0
Total participants	2004-07-01	0
2003: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2003 401k membership
Total of all active and inactive participants	2003-07-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2003-07-01	0
Total participants	2003-07-01	0
2002: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2002 401k membership
Total of all active and inactive participants	2002-07-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2002-07-01	0
Total participants	2002-07-01	0
2001: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2001 401k membership
Total of all active and inactive participants	2001-07-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2001-07-01	0
Total participants	2001-07-01	0
Total of all active and inactive participants	2001-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2001-01-01	0
Total participants	2001-01-01	0

Financial Data on WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN

Measure	Date	Value
2022 : WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-45,579
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$256,109
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$254,023
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$73,908
Value of total assets at end of year	2022-12-31	$857,772
Value of total assets at beginning of year	2022-12-31	$1,159,460
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$2,086
Total interest from all sources	2022-12-31	$9,521
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$200,000
If this is an individual account plan, was there a blackout period	2022-12-31	Yes
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$52,453
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$3,163
Administrative expenses (other) incurred	2022-12-31	$2,086
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-301,688
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$857,772
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$1,159,460
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$577,227
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$801,356
Interest on participant loans	2022-12-31	$123
Interest earned on other investments	2022-12-31	$9,398
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$262,253
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$340,702
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-115,044
Net investment gain/loss from pooled separate accounts	2022-12-31	$-13,964
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$18,292
Employer contributions (assets) at end of year	2022-12-31	$18,292
Employer contributions (assets) at beginning of year	2022-12-31	$17,402
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$254,023
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	2022-12-31	Yes
Did the plan have assets held for investment	2022-12-31	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	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	EIDE BAILLY, LLP
Accountancy firm EIN	2022-12-31	450250958
2021 : WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$157,996
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$87,147
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$87,055
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$69,552
Value of total assets at end of year	2021-12-31	$1,159,460
Value of total assets at beginning of year	2021-12-31	$1,088,611
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$92
Total interest from all sources	2021-12-31	$10,377
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$200,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$52,150
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$70,849
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$1,159,460
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$1,088,611
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$801,356
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$706,553
Interest on participant loans	2021-12-31	$230
Interest earned on other investments	2021-12-31	$10,147
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$340,702
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$358,832
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$63,950
Net investment gain/loss from pooled separate accounts	2021-12-31	$14,117
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$17,402
Employer contributions (assets) at end of year	2021-12-31	$17,402
Employer contributions (assets) at beginning of year	2021-12-31	$23,226
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$87,055
Contract administrator fees	2021-12-31	$92
Did the plan have assets held for investment	2021-12-31	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	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	EIDE BAILLY, LLP
Accountancy firm EIN	2021-12-31	450250958
2020 : WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$172,988
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$224,126
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$223,970
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$85,162
Value of total assets at end of year	2020-12-31	$1,088,611
Value of total assets at beginning of year	2020-12-31	$1,139,749
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$156
Total interest from all sources	2020-12-31	$12,108
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$200,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$61,936
Participant contributions at beginning of year	2020-12-31	$1,806
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$-51,138
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$1,088,611
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$1,139,749
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$706,553
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$691,063
Interest on participant loans	2020-12-31	$682
Interest earned on other investments	2020-12-31	$11,426
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$358,832
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$427,586
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$67,373
Net investment gain/loss from pooled separate accounts	2020-12-31	$8,345
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$23,226
Employer contributions (assets) at end of year	2020-12-31	$23,226
Employer contributions (assets) at beginning of year	2020-12-31	$19,294
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$223,970
Contract administrator fees	2020-12-31	$156
Did the plan have assets held for investment	2020-12-31	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	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Unqualified
Accountancy firm name	2020-12-31	CLIFTONLARSONALLEN, LLP
Accountancy firm EIN	2020-12-31	410746749
2019 : WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$244,019
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$212,580
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$212,304
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$134,649
Value of total assets at end of year	2019-12-31	$1,139,749
Value of total assets at beginning of year	2019-12-31	$1,108,310
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$276
Total interest from all sources	2019-12-31	$14,602
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$200,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$55,695
Participant contributions at end of year	2019-12-31	$1,806
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$59,660
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$31,439
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$1,139,749
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$1,108,310
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$691,063
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$545,903
Interest on participant loans	2019-12-31	$1,485
Interest earned on other investments	2019-12-31	$13,117
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$427,586
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$538,185
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$61,015
Net investment gain/loss from pooled separate accounts	2019-12-31	$33,753
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$19,294
Employer contributions (assets) at end of year	2019-12-31	$19,294
Employer contributions (assets) at beginning of year	2019-12-31	$24,222
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$212,304
Contract administrator fees	2019-12-31	$276
Did the plan have assets held for investment	2019-12-31	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	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	CLIFTONLARSONALLEN, LLP
Accountancy firm EIN	2019-12-31	410746749
2018 : WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$76,080
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$26,247
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$26,093
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$94,430
Value of total assets at end of year	2018-12-31	$1,108,310
Value of total assets at beginning of year	2018-12-31	$1,058,477
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$154
Total interest from all sources	2018-12-31	$23,054
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$200,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$57,529
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$12,679
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$49,833
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$1,108,310
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$1,058,477
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$545,903
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$498,745
Interest on participant loans	2018-12-31	$2,412
Interest earned on other investments	2018-12-31	$20,642
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$538,185
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$537,407
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-22,020
Net investment gain/loss from pooled separate accounts	2018-12-31	$-19,384
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$24,222
Employer contributions (assets) at end of year	2018-12-31	$24,222
Employer contributions (assets) at beginning of year	2018-12-31	$22,325
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$26,093
Contract administrator fees	2018-12-31	$154
Did the plan have assets held for investment	2018-12-31	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	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	CLIFTONLARSONALLEN, LLP
Accountancy firm EIN	2018-12-31	410746749
2017 : WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$190,396
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$71,044
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$70,881
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$122,845
Value of total assets at end of year	2017-12-31	$1,058,477
Value of total assets at beginning of year	2017-12-31	$939,125
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$163
Total interest from all sources	2017-12-31	$25,512
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$200,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$48,759
Participant contributions at end of year	2017-12-31	$0
Participant contributions at beginning of year	2017-12-31	$2,064
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$51,761
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$119,352
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$1,058,477
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$939,125
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$498,745
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$378,704
Interest on participant loans	2017-12-31	$2,876
Interest earned on other investments	2017-12-31	$22,636
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$537,407
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$537,205
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$23,937
Net investment gain/loss from pooled separate accounts	2017-12-31	$18,102
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$22,325
Employer contributions (assets) at end of year	2017-12-31	$22,325
Employer contributions (assets) at beginning of year	2017-12-31	$21,152
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$70,881
Contract administrator fees	2017-12-31	$163
Did the plan have assets held for investment	2017-12-31	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	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	CLIFTONLARSONALLEN, LLP
Accountancy firm EIN	2017-12-31	410746749
2016 : WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$96,918
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$90,604
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$90,604
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$65,918
Value of total assets at end of year	2016-12-31	$939,125
Value of total assets at beginning of year	2016-12-31	$932,811
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$0
Total interest from all sources	2016-12-31	$13,597
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$200,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$44,766
Participant contributions at end of year	2016-12-31	$2,064
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2016-12-31	$370
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$6,314
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$939,125
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$932,811
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$378,704
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$392,846
Interest on participant loans	2016-12-31	$3,383
Interest earned on other investments	2016-12-31	$10,214
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$537,205
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$522,825
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$3,888
Net investment gain/loss from pooled separate accounts	2016-12-31	$13,515
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$21,152
Employer contributions (assets) at end of year	2016-12-31	$21,152
Employer contributions (assets) at beginning of year	2016-12-31	$17,140
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$90,234
Did the plan have assets held for investment	2016-12-31	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	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	CLIFTONLARSONALLEN, LLP
Accountancy firm EIN	2016-12-31	410746749
2015 : WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$87,052
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$46,148
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$45,647
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$75,881
Value of total assets at end of year	2015-12-31	$932,811
Value of total assets at beginning of year	2015-12-31	$891,907
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$501
Total interest from all sources	2015-12-31	$13,560
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$200,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$55,846
Participant contributions at beginning of year	2015-12-31	$1,861
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$2,895
Other income not declared elsewhere	2015-12-31	$2,080
Administrative expenses (other) incurred	2015-12-31	$501
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$40,904
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$932,811
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$891,907
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$392,846
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$322,555
Interest earned on other investments	2015-12-31	$13,560
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$522,825
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$537,386
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-3,260
Net investment gain/loss from pooled separate accounts	2015-12-31	$-1,209
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$17,140
Employer contributions (assets) at end of year	2015-12-31	$17,140
Employer contributions (assets) at beginning of year	2015-12-31	$30,105
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$45,647
Did the plan have assets held for investment	2015-12-31	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	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	CLIFTONLARSONALLEN, LLP
Accountancy firm EIN	2015-12-31	410746749
2014 : WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$161,160
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$82,808
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$82,582
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$122,732
Value of total assets at end of year	2014-12-31	$891,907
Value of total assets at beginning of year	2014-12-31	$813,555
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$226
Total interest from all sources	2014-12-31	$22,784
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$200,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$57,913
Participant contributions at end of year	2014-12-31	$1,861
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$35,200
Other income not declared elsewhere	2014-12-31	$2,386
Administrative expenses (other) incurred	2014-12-31	$226
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$78,352
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$891,907
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$813,555
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$322,555
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$311,851
Interest earned on other investments	2014-12-31	$22,784
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$537,386
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$470,559
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$13,258
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$29,619
Employer contributions (assets) at end of year	2014-12-31	$30,105
Employer contributions (assets) at beginning of year	2014-12-31	$31,145
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$82,582
Did the plan have assets held for investment	2014-12-31	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	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2014-12-31	410746749
2013 : WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$154,141
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$151,024
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$150,953
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$84,036
Value of total assets at end of year	2013-12-31	$813,555
Value of total assets at beginning of year	2013-12-31	$810,438
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$71
Total interest from all sources	2013-12-31	$37,527
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$200,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$52,335
Participant contributions at end of year	2013-12-31	$0
Participant contributions at beginning of year	2013-12-31	$1,774
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$2,491
Administrative expenses (other) incurred	2013-12-31	$71
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$3,117
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$813,555
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$810,438
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$311,851
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$300,714
Interest earned on other investments	2013-12-31	$37,527
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$470,559
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$477,806
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$32,578
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$29,210
Employer contributions (assets) at end of year	2013-12-31	$31,145
Employer contributions (assets) at beginning of year	2013-12-31	$30,144
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$150,953
Did the plan have assets held for investment	2013-12-31	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	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2013-12-31	410746749
2012 : WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$144,029
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$63,457
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$63,390
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$94,382
Value of total assets at end of year	2012-12-31	$810,438
Value of total assets at beginning of year	2012-12-31	$729,866
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$67
Total interest from all sources	2012-12-31	$36,046
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$200,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$64,238
Participant contributions at end of year	2012-12-31	$1,774
Participant contributions at beginning of year	2012-12-31	$1,687
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$0
Administrative expenses (other) incurred	2012-12-31	$67
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$80,572
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$810,438
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$729,866
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$300,714
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$280,704
Interest earned on other investments	2012-12-31	$36,046
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$477,806
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$418,919
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$13,601
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$30,144
Employer contributions (assets) at end of year	2012-12-31	$30,144
Employer contributions (assets) at beginning of year	2012-12-31	$28,556
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$63,390
Did the plan have assets held for investment	2012-12-31	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	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2012-12-31	410746749
2011 : WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$100,615
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$116,284
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$116,284
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$88,792
Value of total assets at end of year	2011-12-31	$726,719
Value of total assets at beginning of year	2011-12-31	$742,388
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$0
Total interest from all sources	2011-12-31	$1,830
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$100,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$59,702
Participant contributions at end of year	2011-12-31	$20,940
Participant contributions at beginning of year	2011-12-31	$36,203
Participant contributions at end of year	2011-12-31	$1,687
Other income not declared elsewhere	2011-12-31	$6,177
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$-15,669
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$726,719
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$742,388
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$258,851
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$299,775
Income. Interest from loans (other than to participants)	2011-12-31	$1,830
Interest earned on other investments	2011-12-31	$9,040
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$418,373
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$375,465
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$9,993
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$29,090
Employer contributions (assets) at end of year	2011-12-31	$28,555
Employer contributions (assets) at beginning of year	2011-12-31	$30,945
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$116,284
Did the plan have assets held for investment	2011-12-31	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	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	CLIFTONLARSONALLEN, LLP
Accountancy firm EIN	2011-12-31	410746749

Form 5500 Responses for WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN

2022: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: WELLINGTON PLACE EMPLOYEE RETIREMENT 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
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: WELLINGTON PLACE EMPLOYEE RETIREMENT 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: WELLINGTON PLACE EMPLOYEE RETIREMENT 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: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	Yes
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
2007: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2007 form 5500 responses
2007-07-01	Type of plan entity	Single employer plan
2007-07-01	Submission has been amended	Yes
2007-07-01	This submission is the final filing	No
2007-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2007-07-01	Plan is a collectively bargained plan	No
2006: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2006 form 5500 responses
2006-07-01	Type of plan entity	Single employer plan
2006-07-01	Submission has been amended	Yes
2006-07-01	This submission is the final filing	No
2006-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2006-07-01	Plan is a collectively bargained plan	No
2005: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2005 form 5500 responses
2005-07-01	Type of plan entity	Single employer plan
2005-07-01	Submission has been amended	No
2005-07-01	This submission is the final filing	No
2005-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2005-07-01	Plan is a collectively bargained plan	No
2004: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2004 form 5500 responses
2004-07-01	Type of plan entity	Single employer plan
2004-07-01	Submission has been amended	Yes
2004-07-01	This submission is the final filing	No
2004-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2004-07-01	Plan is a collectively bargained plan	No
2003: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2003 form 5500 responses
2003-07-01	Type of plan entity	Single employer plan
2003-07-01	Submission has been amended	Yes
2003-07-01	This submission is the final filing	No
2003-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2003-07-01	Plan is a collectively bargained plan	No
2002: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2002 form 5500 responses
2002-07-01	Type of plan entity	Single employer plan
2002-07-01	Submission has been amended	No
2002-07-01	This submission is the final filing	No
2002-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2002-07-01	Plan is a collectively bargained plan	No
2001: WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN 2001 form 5500 responses
2001-07-01	Type of plan entity	Single employer plan
2001-07-01	Submission has been amended	No
2001-07-01	This submission is the final filing	No
2001-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2001-07-01	Plan is a collectively bargained plan	No
2001-01-01	Type of plan entity	Single employer plan
2001-01-01	Submission has been amended	No
2001-01-01	This submission is the final filing	No
2001-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2001-01-01	Plan is a collectively bargained plan	No

Insurance Providers Used on plan

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

JE25

Policy instance

Insurance contract or identification number	JE25
Number of Individuals Covered	10
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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 $2
Insurance broker organization code?	3

GREAT AMERICAN (National Association of Insurance Commissioners NAIC id number: 63312 )

Policy contract number

VARIOUS

Policy instance

Insurance contract or identification number	VARIOUS
Number of Individuals Covered	18
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $128
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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 $128
Insurance broker organization code?	3

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

JE25

Policy instance

Insurance contract or identification number	JE25
Number of Individuals Covered	17
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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
Commission paid to Insurance Broker	USD $2
Insurance broker organization code?	3

GREAT AMERICAN (National Association of Insurance Commissioners NAIC id number: 63312 )

Policy contract number

VARIOUS

Policy instance

Insurance contract or identification number	VARIOUS
Number of Individuals Covered	18
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $585
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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
Commission paid to Insurance Broker	USD $585
Insurance broker organization code?	3

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

JE25

Policy instance

Insurance contract or identification number	JE25
Number of Individuals Covered	19
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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
Commission paid to Insurance Broker	USD $2
Insurance broker organization code?	3

GREAT AMERICAN (National Association of Insurance Commissioners NAIC id number: 63312 )

Policy contract number

VARIOUS

Policy instance

Insurance contract or identification number	VARIOUS
Number of Individuals Covered	24
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $432
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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
Commission paid to Insurance Broker	USD $432
Insurance broker organization code?	3

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

JE25

Policy instance

Insurance contract or identification number	JE25
Number of Individuals Covered	18
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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
Commission paid to Insurance Broker	USD $3
Insurance broker organization code?	3

GREAT AMERICAN (National Association of Insurance Commissioners NAIC id number: 63312 )

Policy contract number

VARIOUS

Policy instance

Insurance contract or identification number	VARIOUS
Number of Individuals Covered	32
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,351
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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
Commission paid to Insurance Broker	USD $1,351
Insurance broker organization code?	3

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

JE25

Policy instance

Insurance contract or identification number	JE25
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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
Commission paid to Insurance Broker	USD $2
Insurance broker organization code?	3

GREAT AMERICAN (National Association of Insurance Commissioners NAIC id number: 63312 )

Policy contract number

VARIOUS

Policy instance

Insurance contract or identification number	VARIOUS
Number of Individuals Covered	38
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $677
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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
Commission paid to Insurance Broker	USD $668
Insurance broker organization code?	3

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

JE25

Policy instance

Insurance contract or identification number	JE25
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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
Commission paid to Insurance Broker	USD $2
Insurance broker organization code?	3
Insurance broker name	ALLEN KNOX ASSOCIATES

GREAT AMERICAN (National Association of Insurance Commissioners NAIC id number: 63312 )

Policy contract number

VARIOUS

Policy instance

Insurance contract or identification number	VARIOUS
Number of Individuals Covered	45
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $669
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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
Commission paid to Insurance Broker	USD $669
Insurance broker organization code?	3
Insurance broker name	ALLEN KNOX ASSOCIATES

GREAT AMERICAN (National Association of Insurance Commissioners NAIC id number: 63312 )

Policy contract number

VARIOUS

Policy instance

Insurance contract or identification number	VARIOUS
Number of Individuals Covered	50
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $790
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
Commission paid to Insurance Broker	USD $760
Insurance broker organization code?	3
Insurance broker name	STEVEN A JACOBSON

ZURICH AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90537 )

Policy contract number

W2468/2468/2469

Policy instance

Insurance contract or identification number	W2468/2468/2469
Number of Individuals Covered	19
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $232
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
Commission paid to Insurance Broker	USD $232
Insurance broker organization code?	3
Insurance broker name	ALLEN KNOX ASSOCIATES

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

JE25

Policy instance

Insurance contract or identification number	JE25
Number of Individuals Covered	21
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $223
Total amount of fees paid to insurance company	USD $1
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
Commission paid to Insurance Broker	USD $138
Amount paid for insurance broker fees	1
Additional information about fees paid to insurance broker	SUPPLEMENTAL CASH PAYMENTS
Insurance broker organization code?	3
Insurance broker name	RODNEY EUGENE FORTUNE

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

JE25

Policy instance

Insurance contract or identification number	JE25
Number of Individuals Covered	43
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,069
Total amount of fees paid to insurance company	USD $8
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
Commission paid to Insurance Broker	USD $316
Amount paid for insurance broker fees	8
Additional information about fees paid to insurance broker	SUPPLEMENTAL CASH PAYMENTS
Insurance broker organization code?	3
Insurance broker name	RODNEY EUGENE FORTUNE

GREAT AMERICAN (National Association of Insurance Commissioners NAIC id number: 63312 )

Policy contract number

VARIOUS

Policy instance

Insurance contract or identification number	VARIOUS
Number of Individuals Covered	55
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,498
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
Commission paid to Insurance Broker	USD $2,466
Insurance broker organization code?	3
Insurance broker name	STEVEN A JACOBSON

ZURICH AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90537 )

Policy contract number

W2468

Policy instance

Insurance contract or identification number	W2468
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $219
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
Commission paid to Insurance Broker	USD $219
Insurance broker organization code?	3
Insurance broker name	ALLEN KNOX ASSOCIATES

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

JE25

Policy instance

Insurance contract or identification number	JE25
Number of Individuals Covered	43
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,655
Total amount of fees paid to insurance company	USD $214
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
Commission paid to Insurance Broker	USD $746
Amount paid for insurance broker fees	214
Additional information about fees paid to insurance broker	SUPPLEMENTAL CASH PAYMENTS
Insurance broker organization code?	3
Insurance broker name	RODNEY EUGENE FORTUNE

ZURICH AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90537 )

Policy contract number

W2468

Policy instance

Insurance contract or identification number	W2468
Number of Individuals Covered	24
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $170
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
Commission paid to Insurance Broker	USD $170
Insurance broker organization code?	3
Insurance broker name	ALLEN KNOX ASSOCIATES

GREAT AMERICAN (National Association of Insurance Commissioners NAIC id number: 63312 )

Policy contract number

VARIOUS

Policy instance

Insurance contract or identification number	VARIOUS
Number of Individuals Covered	48
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,200
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
Commission paid to Insurance Broker	USD $2,251
Insurance broker organization code?	3
Insurance broker name	STEVEN A JACOBSON

ZURICH AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90537 )

Policy contract number

W2468

Policy instance

Insurance contract or identification number	W2468
Number of Individuals Covered	10
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $191
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
Commission paid to Insurance Broker	USD $191
Insurance broker organization code?	3
Insurance broker name	ALLEN KNOX ASSOCIATES

GREAT AMERICAN (National Association of Insurance Commissioners NAIC id number: 63312 )

Policy contract number

VARIOUS

Policy instance

Insurance contract or identification number	VARIOUS
Number of Individuals Covered	52
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,487
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
Commission paid to Insurance Broker	USD $3,490
Insurance broker organization code?	3
Insurance broker name	STEVEN A JACOBSON

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

JE25

Policy instance

Insurance contract or identification number	JE25
Number of Individuals Covered	44
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,830
Total amount of fees paid to insurance company	USD $4
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
Commission paid to Insurance Broker	USD $1,323
Amount paid for insurance broker fees	4
Additional information about fees paid to insurance broker	SUPPLEMENTAL CASH PAYMENTS
Insurance broker organization code?	3
Insurance broker name	RODNEY EUGENE FORTUNE

ZURICH AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90537 )

Policy contract number

W2468

Policy instance

Insurance contract or identification number	W2468
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $301
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

GREAT AMERICAN (National Association of Insurance Commissioners NAIC id number: 63312 )

Policy contract number

VARIOUS

Policy instance

Insurance contract or identification number	VARIOUS
Number of Individuals Covered	51
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,947
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

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

JE25

Policy instance

Insurance contract or identification number	JE25
Number of Individuals Covered	39
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,816
Total amount of fees paid to insurance company	USD $4,220
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

Potentially related plans

WELLINGTON PLACE EMPLOYEE RETIREMENT PLAN [EIN = 421316873]

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Company Name:	ONEOTA RIVERVIEW CARE FACILITY, INC
Employer identification number (EIN):	411316873
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities