401k Plan data: SAFETY HARBOR RESORT & SPA 401(K) PLAN plan

SAFETY HARBOR RESORT & SPA 401(K) PLAN 401k Plan overview

Plan Name	SAFETY HARBOR RESORT & SPA 401(K) PLAN
Plan identification number	001

SAFETY HARBOR RESORT & SPA 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

SAFETY HARBOR RESORT & SPA, LLC has sponsored the creation of one or more 401k plans.

Company Name: SAFETY HARBOR RESORT & SPA, LLC

Employer identification number (EIN): 465147419

NAIC Classification: 721110
NAIC Description: Hotels (except Casino Hotels) and Motels

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SAFETY HARBOR RESORT & SPA 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 AJITH DISSANAYAKE 2023-09-06
001 2021-01-01 AJITH DISSANAYAKE 2022-08-26
001 2020-01-01 AJITH DISSANAYAKE 2021-09-07
001 2019-01-01 AJITH DISSANAYAKE 2020-10-10
001 2018-01-01 AJITH DISSANAYAKE 2019-10-11
001 2017-01-01
001 2016-05-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-01-01	AJITH DISSANAYAKE	2023-09-06
001	2021-01-01	AJITH DISSANAYAKE	2022-08-26
001	2020-01-01	AJITH DISSANAYAKE	2021-09-07
001	2019-01-01	AJITH DISSANAYAKE	2020-10-10
001	2018-01-01	AJITH DISSANAYAKE	2019-10-11
001	2017-01-01
001	2016-05-01

Plan Statistics for SAFETY HARBOR RESORT & SPA 401(K) PLAN

401k plan membership statisitcs for SAFETY HARBOR RESORT & SPA 401(K) PLAN

Measure Date Value
2022: SAFETY HARBOR RESORT & SPA 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 125
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 138
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 1
Total of all active and inactive participants 2022-01-01 139
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 139
Number of participants with account balances 2022-01-01 13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: SAFETY HARBOR RESORT & SPA 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 155
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 115
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 2
Total of all active and inactive participants 2021-01-01 117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 117
Number of participants with account balances 2021-01-01 12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: SAFETY HARBOR RESORT & SPA 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 156
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 154
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 1
Total of all active and inactive participants 2020-01-01 155
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 155
Number of participants with account balances 2020-01-01 13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: SAFETY HARBOR RESORT & SPA 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 172
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 145
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 1
Total of all active and inactive participants 2019-01-01 146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 146
Number of participants with account balances 2019-01-01 14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: SAFETY HARBOR RESORT & SPA 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 159
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 163
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 4
Total of all active and inactive participants 2018-01-01 167
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 167
Number of participants with account balances 2018-01-01 18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: SAFETY HARBOR RESORT & SPA 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 150
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 157
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 1
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 18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: SAFETY HARBOR RESORT & SPA 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-05-01 140
Total number of active participants reported on line 7a of the Form 5500 2016-05-01 138
Number of retired or separated participants receiving benefits 2016-05-01 0
Number of other retired or separated participants entitled to future benefits 2016-05-01 7
Total of all active and inactive participants 2016-05-01 145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-05-01 0
Total participants 2016-05-01 145
Number of participants with account balances 2016-05-01 25
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-05-01 0

Measure	Date	Value
2022: SAFETY HARBOR RESORT & SPA 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	125
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	138
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	1
Total of all active and inactive participants	2022-01-01	139
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	139
Number of participants with account balances	2022-01-01	13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: SAFETY HARBOR RESORT & SPA 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	155
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	115
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	2
Total of all active and inactive participants	2021-01-01	117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	117
Number of participants with account balances	2021-01-01	12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: SAFETY HARBOR RESORT & SPA 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	156
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	154
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	1
Total of all active and inactive participants	2020-01-01	155
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	155
Number of participants with account balances	2020-01-01	13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: SAFETY HARBOR RESORT & SPA 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	172
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	145
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	1
Total of all active and inactive participants	2019-01-01	146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	146
Number of participants with account balances	2019-01-01	14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: SAFETY HARBOR RESORT & SPA 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	159
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	163
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	4
Total of all active and inactive participants	2018-01-01	167
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	167
Number of participants with account balances	2018-01-01	18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: SAFETY HARBOR RESORT & SPA 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	150
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	157
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	1
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	18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: SAFETY HARBOR RESORT & SPA 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-05-01	140
Total number of active participants reported on line 7a of the Form 5500	2016-05-01	138
Number of retired or separated participants receiving benefits	2016-05-01	0
Number of other retired or separated participants entitled to future benefits	2016-05-01	7
Total of all active and inactive participants	2016-05-01	145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-05-01	0
Total participants	2016-05-01	145
Number of participants with account balances	2016-05-01	25
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-05-01	0

Financial Data on SAFETY HARBOR RESORT & SPA 401(K) PLAN

Measure	Date	Value
2022 : SAFETY HARBOR RESORT & SPA 401(K) 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	$44,676
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$24,244
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$21,778
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$77,796
Value of total assets at end of year	2022-12-31	$227,456
Value of total assets at beginning of year	2022-12-31	$207,024
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$2,466
Total interest from all sources	2022-12-31	$93
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$3,870
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$3,870
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$100,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$29,904
Participant contributions at end of year	2022-12-31	$0
Participant contributions at beginning of year	2022-12-31	$1,000
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$47,892
Other income not declared elsewhere	2022-12-31	$690
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	$20,432
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$227,456
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$207,024
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
Investment advisory and management fees	2022-12-31	$690
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$101,571
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$60,849
Interest on participant loans	2022-12-31	$21
Interest earned on other investments	2022-12-31	$72
Value of interest in common/collective trusts at end of year	2022-12-31	$118,046
Value of interest in common/collective trusts at beginning of year	2022-12-31	$137,650
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$7,839
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$7,525
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-37,773
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$21,778
Contract administrator fees	2022-12-31	$1,776
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	PDR CPAS & ADVISORS INC
Accountancy firm EIN	2022-12-31	591687531
2021 : SAFETY HARBOR RESORT & SPA 401(K) 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	$36,374
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$84,601
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$82,945
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$20,453
Value of total assets at end of year	2021-12-31	$207,024
Value of total assets at beginning of year	2021-12-31	$255,251
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$1,656
Total interest from all sources	2021-12-31	$59
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$3,571
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$3,571
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$100,000
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
Participant contributions at end of year	2021-12-31	$1,000
Participant contributions at beginning of year	2021-12-31	$0
Participant contributions at end of year	2021-12-31	$0
Participant contributions at beginning of year	2021-12-31	$589
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	$-48,227
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$207,024
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$255,251
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	$60,849
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$50,434
Interest earned on other investments	2021-12-31	$59
Value of interest in common/collective trusts at end of year	2021-12-31	$137,650
Value of interest in common/collective trusts at beginning of year	2021-12-31	$198,276
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$7,525
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$5,952
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$12,291
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	$20,453
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$82,945
Contract administrator fees	2021-12-31	$1,656
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	PDR CPAS & ADVISORS INC
Accountancy firm EIN	2021-12-31	591687531
2020 : SAFETY HARBOR RESORT & SPA 401(K) 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	$38,942
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$21,695
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$19,995
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$14,798
Value of total assets at end of year	2020-12-31	$255,251
Value of total assets at beginning of year	2020-12-31	$238,004
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$1,700
Total interest from all sources	2020-12-31	$61
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$1,508
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$1,508
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$100,000
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	$14,798
Participant contributions at end of year	2020-12-31	$589
Participant contributions at beginning of year	2020-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$17,247
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$255,251
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$238,004
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	$50,434
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$42,375
Interest earned on other investments	2020-12-31	$61
Value of interest in common/collective trusts at end of year	2020-12-31	$198,276
Value of interest in common/collective trusts at beginning of year	2020-12-31	$189,821
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$5,952
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$5,808
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$22,575
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$19,995
Contract administrator fees	2020-12-31	$1,700
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	Disclaimer
Accountancy firm name	2020-12-31	PDR CPAS & ADVISORS INC
Accountancy firm EIN	2020-12-31	591687531
2019 : SAFETY HARBOR RESORT & SPA 401(K) 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	$50,198
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$52,676
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$50,559
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$17,253
Value of total assets at end of year	2019-12-31	$238,004
Value of total assets at beginning of year	2019-12-31	$240,482
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$2,117
Total interest from all sources	2019-12-31	$110
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$1,436
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$1,436
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$100,000
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	$17,253
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$3,980
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	$-2,478
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$238,004
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$240,482
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	$42,375
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$60,086
Interest on participant loans	2019-12-31	$41
Interest earned on other investments	2019-12-31	$69
Value of interest in common/collective trusts at end of year	2019-12-31	$189,821
Value of interest in common/collective trusts at beginning of year	2019-12-31	$169,117
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$5,808
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$7,299
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$31,399
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	Yes
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$50,559
Contract administrator fees	2019-12-31	$2,117
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	PDR CPAS & ADVISORS INC
Accountancy firm EIN	2019-12-31	591687531
2018 : SAFETY HARBOR RESORT & SPA 401(K) 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	$8,862
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$70,694
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$68,335
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$24,535
Value of total assets at end of year	2018-12-31	$240,482
Value of total assets at beginning of year	2018-12-31	$302,314
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$2,359
Total interest from all sources	2018-12-31	$318
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$4,064
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$4,064
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$100,000
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	$21,368
Participant contributions at end of year	2018-12-31	$3,980
Participant contributions at beginning of year	2018-12-31	$3,556
Participant contributions at end of year	2018-12-31	$0
Participant contributions at beginning of year	2018-12-31	$840
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	$-61,832
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$240,482
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$302,314
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	$60,086
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$290,507
Interest on participant loans	2018-12-31	$235
Interest earned on other investments	2018-12-31	$83
Value of interest in common/collective trusts at end of year	2018-12-31	$169,117
Value of interest in common/collective trusts at beginning of year	2018-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$7,299
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$7,411
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-20,055
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	$3,167
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$68,335
Contract administrator fees	2018-12-31	$2,359
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	2018-12-31	No
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	PDR CPAS & ADVISORS INC
Accountancy firm EIN	2018-12-31	591687531
2017 : SAFETY HARBOR RESORT & SPA 401(K) 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	$52,931
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$33,713
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$31,679
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$22,030
Value of total assets at end of year	2017-12-31	$302,314
Value of total assets at beginning of year	2017-12-31	$283,096
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$2,034
Total interest from all sources	2017-12-31	$363
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$2,832
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$2,832
Was this plan covered by a fidelity bond	2017-12-31	No
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$22,030
Participant contributions at end of year	2017-12-31	$3,556
Participant contributions at beginning of year	2017-12-31	$7,837
Participant contributions at end of year	2017-12-31	$840
Participant contributions at beginning of year	2017-12-31	$925
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	$19,218
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$302,314
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$283,096
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	$290,507
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$269,035
Interest on participant loans	2017-12-31	$291
Interest earned on other investments	2017-12-31	$72
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$7,411
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$5,299
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$27,706
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$31,679
Contract administrator fees	2017-12-31	$2,034
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	2017-12-31	No
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	PDR CPAS & ADVISORS INC
Accountancy firm EIN	2017-12-31	591687531
2016 : SAFETY HARBOR RESORT & SPA 401(K) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total transfer of assets to this plan	2016-12-31	$363,340
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	$27,568
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$107,812
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$107,192
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$18,151
Value of total assets at end of year	2016-12-31	$283,096
Value of total assets at beginning of year	2016-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$620
Total interest from all sources	2016-12-31	$432
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$1,002
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$1,002
Administrative expenses professional fees incurred	2016-12-31	$620
Was this plan covered by a fidelity bond	2016-12-31	No
If this is an individual account plan, was there a blackout period	2016-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$13,178
Participant contributions at end of year	2016-12-31	$7,837
Participant contributions at beginning of year	2016-12-31	$0
Participant contributions at end of year	2016-12-31	$925
Participant contributions at beginning of year	2016-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$4,973
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	$-80,244
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$283,096
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$0
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	$269,035
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$0
Interest on participant loans	2016-12-31	$343
Interest earned on other investments	2016-12-31	$89
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$5,299
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$7,983
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$107,192
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	2016-12-31	Yes
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	PDR CPAS & ADVISORS INC
Accountancy firm EIN	2016-12-31	591687531

Form 5500 Responses for SAFETY HARBOR RESORT & SPA 401(K) PLAN

2022: SAFETY HARBOR RESORT & SPA 401(K) 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: SAFETY HARBOR RESORT & SPA 401(K) 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: SAFETY HARBOR RESORT & SPA 401(K) 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: SAFETY HARBOR RESORT & SPA 401(K) 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: SAFETY HARBOR RESORT & SPA 401(K) 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: SAFETY HARBOR RESORT & SPA 401(K) 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: SAFETY HARBOR RESORT & SPA 401(K) PLAN 2016 form 5500 responses
2016-05-01	Type of plan entity	Single employer plan
2016-05-01	First time form 5500 has been submitted	Yes
2016-05-01	Submission has been amended	No
2016-05-01	This submission is the final filing	No
2016-05-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2016-05-01	Plan is a collectively bargained plan	No
2016-05-01	Plan funding arrangement – Insurance	Yes
2016-05-01	Plan funding arrangement – Trust	Yes
2016-05-01	Plan benefit arrangement – Insurance	Yes
2016-05-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

500114-01

Policy instance

Insurance contract or identification number	500114-01
Number of Individuals Covered	1
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $9
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 $9
Insurance broker organization code?	3

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

500114-01

Policy instance

Insurance contract or identification number	500114-01
Number of Individuals Covered	12
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $38
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 $38
Insurance broker organization code?	3

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

500114-01

Policy instance

Insurance contract or identification number	500114-01
Number of Individuals Covered	13
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $27
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 $27
Insurance broker organization code?	3

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

500114-01

Policy instance

Insurance contract or identification number	500114-01
Number of Individuals Covered	14
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $28
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 $28
Insurance broker organization code?	3

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

500114-01

Policy instance

Insurance contract or identification number	500114-01
Number of Individuals Covered	5
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $47
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 $47
Insurance broker organization code?	3

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

500114-01

Policy instance

Insurance contract or identification number	500114-01
Number of Individuals Covered	18
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $35
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 $35
Insurance broker organization code?	3
Insurance broker name	UBS FINANCIAL SVCS INS AGCY INC

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Company Name:	SAFETY HARBOR RESORT & SPA, LLC
Employer identification number (EIN):	465147419
NAIC Classification:	721110
NAIC Description:	Hotels (except Casino Hotels) and Motels