401k Plan data: THE ROOMSTORE 401(K) PLAN plan

THE ROOMSTORE 401(K) PLAN 401k Plan overview

Plan Name	THE ROOMSTORE 401(K) PLAN
Plan identification number	001

THE ROOMSTORE 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.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Plan covering Self-Employed individuals.
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

THE ROOMSTORES OF PHOENIX, L.L.C. has sponsored the creation of one or more 401k plans.

Company Name: THE ROOMSTORES OF PHOENIX, L.L.C.

Employer identification number (EIN): 860732711

NAIC Classification: 442110
NAIC Description: Furniture Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE ROOMSTORE 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01
001 2015-01-01
001 2014-01-01 CAROL SHERIDAN
001 2014-01-01
001 2013-01-01 CAROL SHERIDAN
001 2012-01-01 CAROL SHERIDAN
001 2011-01-01 CAROL SHERIDAN
001 2010-01-01 CAROL SHERIDAN
001 2009-01-01 CAROL SHERIDAN

Plan Statistics for THE ROOMSTORE 401(K) PLAN

401k plan membership statisitcs for THE ROOMSTORE 401(K) PLAN

Measure Date Value
2016: THE ROOMSTORE 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 322
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 0
Number of participants with account balances 2016-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: THE ROOMSTORE 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 321
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 295
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 21
Total of all active and inactive participants 2015-01-01 316
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 316
Number of participants with account balances 2015-01-01 68
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: THE ROOMSTORE 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 351
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 293
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 17
Total of all active and inactive participants 2014-01-01 310
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 310
Number of participants with account balances 2014-01-01 66
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: THE ROOMSTORE 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 360
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 320
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 21
Total of all active and inactive participants 2013-01-01 341
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 341
Number of participants with account balances 2013-01-01 76
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 1
2012: THE ROOMSTORE 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 368
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 317
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 28
Total of all active and inactive participants 2012-01-01 345
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 345
Number of participants with account balances 2012-01-01 90
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 28
2011: THE ROOMSTORE 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 382
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 332
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 29
Total of all active and inactive participants 2011-01-01 361
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 361
Number of participants with account balances 2011-01-01 97
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 3
2010: THE ROOMSTORE 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 391
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 337
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 36
Total of all active and inactive participants 2010-01-01 373
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 373
Number of participants with account balances 2010-01-01 107
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 5
2009: THE ROOMSTORE 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 422
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 349
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 38
Total of all active and inactive participants 2009-01-01 387
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 387
Number of participants with account balances 2009-01-01 116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 4

Measure	Date	Value
2016: THE ROOMSTORE 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	322
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	0
Number of participants with account balances	2016-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: THE ROOMSTORE 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	321
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	295
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	21
Total of all active and inactive participants	2015-01-01	316
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	316
Number of participants with account balances	2015-01-01	68
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: THE ROOMSTORE 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	351
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	293
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	17
Total of all active and inactive participants	2014-01-01	310
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	310
Number of participants with account balances	2014-01-01	66
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: THE ROOMSTORE 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	360
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	320
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	21
Total of all active and inactive participants	2013-01-01	341
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	341
Number of participants with account balances	2013-01-01	76
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	1
2012: THE ROOMSTORE 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	368
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	317
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	28
Total of all active and inactive participants	2012-01-01	345
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	345
Number of participants with account balances	2012-01-01	90
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	28
2011: THE ROOMSTORE 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	382
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	332
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	29
Total of all active and inactive participants	2011-01-01	361
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	361
Number of participants with account balances	2011-01-01	97
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	3
2010: THE ROOMSTORE 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	391
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	337
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	36
Total of all active and inactive participants	2010-01-01	373
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	373
Number of participants with account balances	2010-01-01	107
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	5
2009: THE ROOMSTORE 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	422
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	349
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	38
Total of all active and inactive participants	2009-01-01	387
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	387
Number of participants with account balances	2009-01-01	116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	4

Financial Data on THE ROOMSTORE 401(K) PLAN

Measure	Date	Value
2016 : THE ROOMSTORE 401(K) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-11-10	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-11-10	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-11-10	$0
Total income from all sources (including contributions)	2016-11-10	$63,234
Total loss/gain on sale of assets	2016-11-10	$0
Total of all expenses incurred	2016-11-10	$2,143,742
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-11-10	$2,097,518
Value of total corrective distributions	2016-11-10	$1,384
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-11-10	$14,729
Value of total assets at end of year	2016-11-10	$0
Value of total assets at beginning of year	2016-11-10	$2,080,508
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-11-10	$44,840
Total interest from all sources	2016-11-10	$22
Total dividends received (eg from common stock, registered investment company shares)	2016-11-10	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-11-10	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2016-11-10	$0
Was this plan covered by a fidelity bond	2016-11-10	Yes
Value of fidelity bond cover	2016-11-10	$405,000
If this is an individual account plan, was there a blackout period	2016-11-10	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-11-10	$0
Were there any nonexempt tranactions with any party-in-interest	2016-11-10	No
Contributions received from participants	2016-11-10	$14,729
Participant contributions at end of year	2016-11-10	$0
Participant contributions at beginning of year	2016-11-10	$2,859
Administrative expenses (other) incurred	2016-11-10	$44,840
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-11-10	No
Value of net income/loss	2016-11-10	$-2,080,508
Value of net assets at end of year (total assets less liabilities)	2016-11-10	$0
Value of net assets at beginning of year (total assets less liabilities)	2016-11-10	$2,080,508
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-11-10	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-11-10	No
Were any leases to which the plan was party in default or uncollectible	2016-11-10	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-11-10	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-11-10	$2,075,714
Interest earned on other investments	2016-11-10	$22
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-11-10	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-11-10	$1,935
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-11-10	$48,483
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-11-10	No
Was there a failure to transmit to the plan any participant contributions	2016-11-10	Yes
Has the plan failed to provide any benefit when due under the plan	2016-11-10	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-11-10	$2,097,518
Did the plan have assets held for investment	2016-11-10	No
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	2016-11-10	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-11-10	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-11-10	Yes
Opinion of an independent qualified public accountant for this plan	2016-11-10	Disclaimer
Accountancy firm name	2016-11-10	WALLACE, PLESE & DREHER, LLP
Accountancy firm EIN	2016-11-10	860841383
2015 : THE ROOMSTORE 401(K) 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	$63,757
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$148,668
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$145,916
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$105,710
Value of total assets at end of year	2015-12-31	$2,080,508
Value of total assets at beginning of year	2015-12-31	$2,165,419
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$2,752
Total interest from all sources	2015-12-31	$18
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	$405,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$105,710
Participant contributions at end of year	2015-12-31	$2,859
Participant contributions at beginning of year	2015-12-31	$0
Administrative expenses (other) incurred	2015-12-31	$2,752
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	$-84,911
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$2,080,508
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$2,165,419
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	$2,075,714
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$2,163,738
Interest earned on other investments	2015-12-31	$18
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$1,935
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$1,681
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-41,971
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	Yes
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$145,916
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	DENNIS, SCHMICH & CO., LTD.
Accountancy firm EIN	2015-12-31	860670260
2014 : THE ROOMSTORE 401(K) 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	$240,792
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$203,223
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$199,678
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$116,630
Value of total assets at end of year	2014-12-31	$2,165,419
Value of total assets at beginning of year	2014-12-31	$2,127,850
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$3,545
Total interest from all sources	2014-12-31	$48
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	$405,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$116,630
Other income not declared elsewhere	2014-12-31	$7
Administrative expenses (other) incurred	2014-12-31	$3,545
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	$37,569
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$2,165,419
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$2,127,850
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	$2,163,738
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$2,121,315
Interest earned on other investments	2014-12-31	$48
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$1,681
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$6,535
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$124,107
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	$116,630
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$199,678
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	DENNIS, SCHMICH & CO., LTD.
Accountancy firm EIN	2014-12-31	860670260
2013 : THE ROOMSTORE 401(K) 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	$459,055
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$448,298
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$436,489
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$113,664
Value of total assets at end of year	2013-12-31	$2,127,850
Value of total assets at beginning of year	2013-12-31	$2,117,093
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$11,809
Total interest from all sources	2013-12-31	$43
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	$405,000
If this is an individual account plan, was there a blackout period	2013-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$113,664
Other income not declared elsewhere	2013-12-31	$-275
Administrative expenses (other) incurred	2013-12-31	$11,809
Total non interest bearing cash at end of year	2013-12-31	$0
Total non interest bearing cash at beginning of year	2013-12-31	$6,415
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	$10,757
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$2,127,850
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$2,117,093
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	$2,121,315
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$2,094,064
Interest earned on other investments	2013-12-31	$43
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$6,535
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$16,614
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$345,623
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$436,489
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	2013-12-31	Yes
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	DENNIS, SCHMICH & CO., LTD.
Accountancy firm EIN	2013-12-31	860670260
2012 : THE ROOMSTORE 401(K) 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	$384,652
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$123,768
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$97,186
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$119,069
Value of total assets at end of year	2012-12-31	$2,117,093
Value of total assets at beginning of year	2012-12-31	$1,856,209
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$26,582
Total interest from all sources	2012-12-31	$140
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	$405,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$119,069
Participant contributions at end of year	2012-12-31	$0
Participant contributions at beginning of year	2012-12-31	$2,440
Other income not declared elsewhere	2012-12-31	$112
Administrative expenses (other) incurred	2012-12-31	$26,582
Total non interest bearing cash at end of year	2012-12-31	$6,415
Total non interest bearing cash at beginning of year	2012-12-31	$5,179
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	$260,884
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$2,117,093
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$1,856,209
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	$2,094,064
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$1,832,289
Interest earned on other investments	2012-12-31	$140
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$16,614
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$16,301
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$265,331
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$97,186
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	DENNIS, SCHMICH & CO., LTD.
Accountancy firm EIN	2012-12-31	860670260
2011 : THE ROOMSTORE 401(K) 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	$61,346
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$237,454
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$208,525
Value of total corrective distributions	2011-12-31	$2,323
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$130,235
Value of total assets at end of year	2011-12-31	$1,856,209
Value of total assets at beginning of year	2011-12-31	$2,032,317
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$26,606
Total interest from all sources	2011-12-31	$190
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	$405,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$130,235
Participant contributions at end of year	2011-12-31	$2,440
Other income not declared elsewhere	2011-12-31	$198
Administrative expenses (other) incurred	2011-12-31	$26,606
Total non interest bearing cash at end of year	2011-12-31	$5,179
Total non interest bearing cash at beginning of year	2011-12-31	$3,521
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	$-176,108
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$1,856,209
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$2,032,317
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	$1,832,289
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$2,011,931
Interest earned on other investments	2011-12-31	$190
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$16,301
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$16,865
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-69,277
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$208,525
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	DENNIS, SCHMICH & CO., LTD.
Accountancy firm EIN	2011-12-31	860670260
2010 : THE ROOMSTORE 401(K) PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$403,976
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$442,692
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$405,247
Value of total corrective distributions	2010-12-31	$12,140
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$129,806
Value of total assets at end of year	2010-12-31	$2,032,317
Value of total assets at beginning of year	2010-12-31	$2,071,033
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$25,305
Total interest from all sources	2010-12-31	$474
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$405,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$129,806
Other income not declared elsewhere	2010-12-31	$-632
Total non interest bearing cash at end of year	2010-12-31	$3,521
Total non interest bearing cash at beginning of year	2010-12-31	$2,994
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$-38,716
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$2,032,317
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$2,071,033
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$2,011,931
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$2,044,655
Interest earned on other investments	2010-12-31	$474
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$16,865
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$23,384
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$274,328
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$405,247
Contract administrator fees	2010-12-31	$25,305
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	DENNIS SCHMICH & CO., LTD.
Accountancy firm EIN	2010-12-31	860670260
2009 : THE ROOMSTORE 401(K) PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for THE ROOMSTORE 401(K) PLAN

2016: THE ROOMSTORE 401(K) 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	Yes
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
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 - Trust	Yes
2015: THE ROOMSTORE 401(K) 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 - Trust	Yes
2014: THE ROOMSTORE 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	Yes
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 - Trust	Yes
2013: THE ROOMSTORE 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 - Trust	Yes
2012: THE ROOMSTORE 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 - Trust	Yes
2011: THE ROOMSTORE 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 - Trust	Yes
2010: THE ROOMSTORE 401(K) PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: THE ROOMSTORE 401(K) PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

GA-832815

Policy instance

Insurance contract or identification number	GA-832815
Number of Individuals Covered	69
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $11,009
Total amount of fees paid to insurance company	USD $1,101
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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,009
Amount paid for insurance broker fees	1101
Additional information about fees paid to insurance broker	ADMINISTRATIVE ALLOWANACE
Insurance broker organization code?	5
Insurance broker name	CBIZ BENEFITS & INSURANCE SERVICES

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

Policy contract number

GA-832815

Policy instance

Insurance contract or identification number	GA-832815
Number of Individuals Covered	66
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $7,184
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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,923
Insurance broker organization code?	5
Insurance broker name	CBIZ FINANCIAL SOLUTIONS

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

16401

Policy instance

Insurance contract or identification number	16401
Number of Individuals Covered	0
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $7,053
Total amount of fees paid to insurance company	USD $532
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,053
Amount paid for insurance broker fees	532
Additional information about fees paid to insurance broker	TPA COMPENSATION
Insurance broker organization code?	5
Insurance broker name	CBIZ BENEFIT & INSURANCE SERVICES

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

Policy contract number

GA-832815

Policy instance

Insurance contract or identification number	GA-832815
Number of Individuals Covered	74
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $37,572
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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,059
Insurance broker organization code?	5
Insurance broker name	CBIZ FINANCIAL SOLUTIONS

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

16401

Policy instance

Insurance contract or identification number	16401
Number of Individuals Covered	89
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $19,791
Total amount of fees paid to insurance company	USD $988
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,791
Amount paid for insurance broker fees	988
Additional information about fees paid to insurance broker	TPA COMPENSATION
Insurance broker organization code?	5
Insurance broker name	CBIZ BENEFIT & INSURANCE SERVICES

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

16401

Policy instance

Insurance contract or identification number	16401
Number of Individuals Covered	123
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $20,216
Total amount of fees paid to insurance company	USD $1,027
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

16401

Policy instance

Insurance contract or identification number	16401
Number of Individuals Covered	131
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $18,737
Total amount of fees paid to insurance company	USD $728
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $18,737
Amount paid for insurance broker fees	728
Additional information about fees paid to insurance broker	TPA FORUM COMPENSATION
Insurance broker organization code?	5
Insurance broker name	CBIZ BENEFIT & INSURANCE SERVICES

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Company Name:	THE ROOMSTORES OF PHOENIX, L.L.C.
Employer identification number (EIN):	860732711
NAIC Classification:	442110
NAIC Description:	Furniture Stores