401k Plan data: LAKEWAY CENTER FOR THE HANDICAPPED, INC. 401(K) PLAN plan

LAKEWAY CENTER FOR THE HANDICAPPED, INC. 401(K) PLAN 401k Plan overview

Plan Name	LAKEWAY CENTER FOR THE HANDICAPPED, INC. 401(K) PLAN
Plan identification number	002

LAKEWAY CENTER FOR THE HANDICAPPED, INC. 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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

401k Sponsoring company profile

LAKEWAY CTR FOR THE HANDICAPPED has sponsored the creation of one or more 401k plans.

Company Name: LAKEWAY CTR FOR THE HANDICAPPED

Employer identification number (EIN): 621059541

NAIC Classification: 621330
NAIC Description: Offices of Mental Health Practitioners (except Physicians)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LAKEWAY CENTER FOR THE HANDICAPPED, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2022-01-01 VICKI HUGHES 2023-10-05
002 2021-01-01 VICKI HUGHES 2022-10-17
002 2020-01-01 VICKI HUGHES 2021-09-20
002 2019-01-01 VICKI HUGHES 2020-06-30
002 2018-01-01 VICKI HUGHES 2019-07-01
002 2017-01-01 VICKI HUGHES 2018-07-09
002 2016-01-01 VICKI HUGHES 2017-06-12
002 2015-01-01 VICKI HUGHES 2016-06-01
002 2014-01-01 VICKI HUGHES
002 2013-01-01 VICKI HUGHES
002 2012-01-01 VICKI HUGHES
002 2011-01-01 VICKI HUGHES

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
002	2022-01-01	VICKI HUGHES	2023-10-05
002	2021-01-01	VICKI HUGHES	2022-10-17
002	2020-01-01	VICKI HUGHES	2021-09-20
002	2019-01-01	VICKI HUGHES	2020-06-30
002	2018-01-01	VICKI HUGHES	2019-07-01
002	2017-01-01	VICKI HUGHES	2018-07-09
002	2016-01-01	VICKI HUGHES	2017-06-12
002	2015-01-01	VICKI HUGHES	2016-06-01
002	2014-01-01	VICKI HUGHES
002	2013-01-01	VICKI HUGHES
002	2012-01-01	VICKI HUGHES
002	2011-01-01	VICKI HUGHES

Plan Statistics for LAKEWAY CENTER FOR THE HANDICAPPED, INC. 401(K) PLAN

401k plan membership statisitcs for LAKEWAY CENTER FOR THE HANDICAPPED, INC. 401(K) PLAN

Measure Date Value
2014: LAKEWAY CENTER FOR THE HANDICAPPED, INC. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 82
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 64
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 14
Total of all active and inactive participants 2014-01-01 78
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 78
Number of participants with account balances 2014-01-01 30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 4
2013: LAKEWAY CENTER FOR THE HANDICAPPED, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 61
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 47
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 13
Total of all active and inactive participants 2013-01-01 60
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 60
Number of participants with account balances 2013-01-01 30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 3
2012: LAKEWAY CENTER FOR THE HANDICAPPED, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 44
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 28
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 13
Total of all active and inactive participants 2012-01-01 41
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 1
Total participants 2012-01-01 42
Number of participants with account balances 2012-01-01 29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 3
2011: LAKEWAY CENTER FOR THE HANDICAPPED, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 56
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 33
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 33
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 33
Number of participants with account balances 2011-01-01 24
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0

Measure	Date	Value
2014: LAKEWAY CENTER FOR THE HANDICAPPED, INC. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	82
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	64
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	14
Total of all active and inactive participants	2014-01-01	78
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	78
Number of participants with account balances	2014-01-01	30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	4
2013: LAKEWAY CENTER FOR THE HANDICAPPED, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	61
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	47
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	13
Total of all active and inactive participants	2013-01-01	60
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	60
Number of participants with account balances	2013-01-01	30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	3
2012: LAKEWAY CENTER FOR THE HANDICAPPED, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	44
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	28
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	13
Total of all active and inactive participants	2012-01-01	41
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	1
Total participants	2012-01-01	42
Number of participants with account balances	2012-01-01	29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	3
2011: LAKEWAY CENTER FOR THE HANDICAPPED, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	56
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	33
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	33
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	33
Number of participants with account balances	2011-01-01	24
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0

Financial Data on LAKEWAY CENTER FOR THE HANDICAPPED, INC. 401(K) PLAN

Measure	Date	Value
2014 : LAKEWAY CENTER FOR THE HANDICAPPED, INC. 401(K) PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total income from all sources	2014-12-31	$31,503
Expenses. Total of all expenses incurred	2014-12-31	$4,555
Benefits paid (including direct rollovers)	2014-12-31	$4,523
Total plan assets at end of year	2014-12-31	$159,992
Total plan assets at beginning of year	2014-12-31	$133,044
Value of fidelity bond covering the plan	2014-12-31	$50,000
Total contributions received or receivable from participants	2014-12-31	$13,200
Expenses. Other expenses not covered elsewhere	2014-12-31	$32
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$6,514
Net income (gross income less expenses)	2014-12-31	$26,948
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$159,992
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$133,044
Assets. Value of participant loans	2014-12-31	$11,012
Total contributions received or receivable from employer(s)	2014-12-31	$11,789
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2014-12-31	$0
Minimum employer required contribution for this plan year	2014-12-31	$0
Amount contributed by the employer to the plan for this plan year	2014-12-31	$0
2013 : LAKEWAY CENTER FOR THE HANDICAPPED, INC. 401(K) PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total income from all sources	2013-12-31	$29,664
Expenses. Total of all expenses incurred	2013-12-31	$26,327
Benefits paid (including direct rollovers)	2013-12-31	$26,295
Total plan assets at end of year	2013-12-31	$133,044
Total plan assets at beginning of year	2013-12-31	$129,707
Value of fidelity bond covering the plan	2013-12-31	$50,000
Total contributions received or receivable from participants	2013-12-31	$11,636
Expenses. Other expenses not covered elsewhere	2013-12-31	$32
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$9,760
Net income (gross income less expenses)	2013-12-31	$3,337
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$133,044
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$129,707
Assets. Value of participant loans	2013-12-31	$11,596
Total contributions received or receivable from employer(s)	2013-12-31	$8,268
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2013-12-31	$0
Minimum employer required contribution for this plan year	2013-12-31	$0
Amount contributed by the employer to the plan for this plan year	2013-12-31	$0
2012 : LAKEWAY CENTER FOR THE HANDICAPPED, INC. 401(K) PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total income from all sources	2012-12-31	$25,069
Expenses. Total of all expenses incurred	2012-12-31	$41,803
Benefits paid (including direct rollovers)	2012-12-31	$41,767
Total plan assets at end of year	2012-12-31	$129,706
Total plan assets at beginning of year	2012-12-31	$146,440
Value of fidelity bond covering the plan	2012-12-31	$50,000
Total contributions received or receivable from participants	2012-12-31	$7,875
Expenses. Other expenses not covered elsewhere	2012-12-31	$36
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$8,361
Net income (gross income less expenses)	2012-12-31	$-16,734
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$129,706
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$146,440
Assets. Value of participant loans	2012-12-31	$11,596
Total contributions received or receivable from employer(s)	2012-12-31	$8,833
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2012-12-31	$0
Minimum employer required contribution for this plan year	2012-12-31	$0
Amount contributed by the employer to the plan for this plan year	2012-12-31	$0
2011 : LAKEWAY CENTER FOR THE HANDICAPPED, INC. 401(K) PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$-98
Total income from all sources	2011-12-31	$23,900
Expenses. Total of all expenses incurred	2011-12-31	$23,148
Benefits paid (including direct rollovers)	2011-12-31	$23,128
Total plan assets at end of year	2011-12-31	$146,440
Total plan assets at beginning of year	2011-12-31	$145,786
Value of fidelity bond covering the plan	2011-12-31	$50,000
Total contributions received or receivable from participants	2011-12-31	$11,720
Expenses. Other expenses not covered elsewhere	2011-12-31	$20
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$2,749
Net income (gross income less expenses)	2011-12-31	$752
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$146,440
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$145,786
Assets. Value of participant loans	2011-12-31	$13,150
Total contributions received or receivable from employer(s)	2011-12-31	$9,431
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2011-12-31	$0
Minimum employer required contribution for this plan year	2011-12-31	$0
Amount contributed by the employer to the plan for this plan year	2011-12-31	$0
2010 : LAKEWAY CENTER FOR THE HANDICAPPED, INC. 401(K) PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total income from all sources	2010-12-31	$27,916
Expenses. Total of all expenses incurred	2010-12-31	$14,826
Benefits paid (including direct rollovers)	2010-12-31	$14,826
Total plan assets at end of year	2010-12-31	$145,786
Total plan assets at beginning of year	2010-12-31	$132,696
Value of fidelity bond covering the plan	2010-12-31	$50,000
Total contributions received or receivable from participants	2010-12-31	$13,288
Expenses. Other expenses not covered elsewhere	2010-12-31	$0
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$-27,452
Net income (gross income less expenses)	2010-12-31	$13,090
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$145,786
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$132,696
Assets. Value of participant loans	2010-12-31	$1,302
Total contributions received or receivable from employer(s)	2010-12-31	$42,080
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2010-12-31	$0
Minimum employer required contribution for this plan year	2010-12-31	$0
Amount contributed by the employer to the plan for this plan year	2010-12-31	$0

Form 5500 Responses for LAKEWAY CENTER FOR THE HANDICAPPED, INC. 401(K) PLAN

2014: LAKEWAY CENTER FOR THE HANDICAPPED, INC. 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: LAKEWAY CENTER FOR THE HANDICAPPED, INC. 401(K) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: LAKEWAY CENTER FOR THE HANDICAPPED, INC. 401(K) 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
2011: LAKEWAY CENTER FOR THE HANDICAPPED, INC. 401(K) PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

GA-017481

Policy instance

Insurance contract or identification number	GA-017481
Number of Individuals Covered	30
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $571
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $571
Insurance broker organization code?	3
Insurance broker name	EDWARD D JONES & CO L P.

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

Policy contract number

GA-017481

Policy instance

Insurance contract or identification number	GA-017481
Number of Individuals Covered	30
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $474
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $474
Insurance broker organization code?	3
Insurance broker name	EDWARD D JONES & CO

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

Policy contract number

GA-017481

Policy instance

Insurance contract or identification number	GA-017481
Number of Individuals Covered	29
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $482
Total amount of fees paid to insurance company	USD $126
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $482
Insurance broker organization code?	3
Amount paid for insurance broker fees	126
Additional information about fees paid to insurance broker	SALES/MARKETING
Insurance broker name	EDWARD D JONES & CO

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

Policy contract number

GA-017481

Policy instance

Insurance contract or identification number	GA-017481
Number of Individuals Covered	24
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $584
Total amount of fees paid to insurance company	USD $121
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

GA-017481

Policy instance

Insurance contract or identification number	GA-017481
Number of Individuals Covered	29
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $599
Total amount of fees paid to insurance company	USD $301
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	LAKEWAY CTR FOR THE HANDICAPPED
Employer identification number (EIN):	621059541
NAIC Classification:	621330
NAIC Description:	Offices of Mental Health Practitioners (except Physicians)