401k Plan data: STATEN ISLAND CARE CENTER, LLC 401 K PROFIT SHARING PLAN plan

STATEN ISLAND CARE CENTER, LLC 401 K PROFIT SHARING PLAN 401k Plan overview

Plan Name	STATEN ISLAND CARE CENTER, LLC 401 K PROFIT SHARING PLAN
Plan identification number	002

STATEN ISLAND CARE CENTER, LLC 401 K PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

STATEN ISLAND CARE CENTER, LLC has sponsored the creation of one or more 401k plans.

Company Name: STATEN ISLAND CARE CENTER, LLC

Employer identification number (EIN): 133632426

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

Additional information about STATEN ISLAND CARE CENTER, LLC

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 1999-11-12

Company Identification Number: 2438750

Legal Registered Office Address: 1487
McDonald Ave
Brooklyn
United States of America (USA)
11230

More information about STATEN ISLAND CARE CENTER, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan STATEN ISLAND CARE CENTER, LLC 401 K PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2023-01-01 AARON KAUFMAN 2024-07-23
002 2022-01-01
002 2021-01-01
002 2020-01-01 AARON KAUFMAN 2021-09-30
002 2019-01-01 AARON KAUFMAN 2020-07-31
002 2018-01-01 AARON KAUFMAN 2019-07-08
002 2017-01-01 AARON KAUFMAN 2018-10-03
002 2016-01-01
002 2015-01-01
002 2014-01-01
002 2014-01-01
002 2013-01-01
002 2012-01-01 MAYER LAUFER 2013-10-11
002 2011-01-01 MAYER LAUFER 2012-09-28
002 2010-01-01 MAYER LAUFER 2011-09-05

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
002	2023-01-01	AARON KAUFMAN	2024-07-23
002	2022-01-01
002	2021-01-01
002	2020-01-01	AARON KAUFMAN	2021-09-30
002	2019-01-01	AARON KAUFMAN	2020-07-31
002	2018-01-01	AARON KAUFMAN	2019-07-08
002	2017-01-01	AARON KAUFMAN	2018-10-03
002	2016-01-01
002	2015-01-01
002	2014-01-01
002	2014-01-01
002	2013-01-01
002	2012-01-01	MAYER LAUFER	2013-10-11
002	2011-01-01	MAYER LAUFER	2012-09-28
002	2010-01-01	MAYER LAUFER	2011-09-05

Plan Statistics for STATEN ISLAND CARE CENTER, LLC 401 K PROFIT SHARING PLAN

401k plan membership statisitcs for STATEN ISLAND CARE CENTER, LLC 401 K PROFIT SHARING PLAN

Measure Date Value
2022: STATEN ISLAND CARE CENTER, LLC 401 K PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 104
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 47
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 45
Total of all active and inactive participants 2022-01-01 92
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 92
Number of participants with account balances 2022-01-01 61
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: STATEN ISLAND CARE CENTER, LLC 401 K PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 121
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 57
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 43
Total of all active and inactive participants 2021-01-01 100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 100
Number of participants with account balances 2021-01-01 63
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0

Measure	Date	Value
2022: STATEN ISLAND CARE CENTER, LLC 401 K PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	104
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	47
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	45
Total of all active and inactive participants	2022-01-01	92
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	92
Number of participants with account balances	2022-01-01	61
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: STATEN ISLAND CARE CENTER, LLC 401 K PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	121
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	57
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	43
Total of all active and inactive participants	2021-01-01	100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	100
Number of participants with account balances	2021-01-01	63
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0

Financial Data on STATEN ISLAND CARE CENTER, LLC 401 K PROFIT SHARING PLAN

Measure	Date	Value
2022 : STATEN ISLAND CARE CENTER, LLC 401 K PROFIT SHARING PLAN 2022 401k financial data
Total income from all sources (including contributions)	2022-12-31	$-507,691
Total of all expenses incurred	2022-12-31	$74,049
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$41,493
Expenses. Certain deemed distributions of participant loans	2022-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$25,360
Value of total assets at end of year	2022-12-31	$3,278,989
Value of total assets at beginning of year	2022-12-31	$3,860,729
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$32,556
Total interest from all sources	2022-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$0
Administrative expenses professional fees incurred	2022-12-31	$100
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$120,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$25,360
Participant contributions at end of year	2022-12-31	$0
Participant contributions at beginning of year	2022-12-31	$0
Participant contributions at end of year	2022-12-31	$0
Participant contributions at beginning of year	2022-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2022-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2022-12-31	$0
Total non interest bearing cash at end of year	2022-12-31	$0
Total non interest bearing cash at beginning of year	2022-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-581,740
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$3,278,989
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$3,860,729
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in pooled separate accounts at end of year	2022-12-31	$3,278,989
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$3,860,729
Interest on participant loans	2022-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2022-12-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2022-12-31	$0
Net investment gain/loss from pooled separate accounts	2022-12-31	$-533,051
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$0
Employer contributions (assets) at end of year	2022-12-31	$0
Employer contributions (assets) at beginning of year	2022-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$41,493
Contract administrator fees	2022-12-31	$32,456
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	FASTEN HALBERSTAM LLP
Accountancy firm EIN	2022-12-31	472319109
2021 : STATEN ISLAND CARE CENTER, LLC 401 K PROFIT SHARING PLAN 2021 401k financial data
Total income from all sources (including contributions)	2021-12-31	$509,921
Total of all expenses incurred	2021-12-31	$686,067
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$646,937
Expenses. Certain deemed distributions of participant loans	2021-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$36,811
Value of total assets at end of year	2021-12-31	$3,860,729
Value of total assets at beginning of year	2021-12-31	$4,036,875
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$39,130
Total interest from all sources	2021-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$0
Administrative expenses professional fees incurred	2021-12-31	$1,250
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$120,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$36,811
Participant contributions at end of year	2021-12-31	$0
Participant contributions at end of year	2021-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2021-12-31	$0
Total non interest bearing cash at end of year	2021-12-31	$0
Total non interest bearing cash at beginning of year	2021-12-31	$299
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$-176,146
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$3,860,729
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$4,036,875
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in pooled separate accounts at end of year	2021-12-31	$3,860,729
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$4,036,576
Interest on participant loans	2021-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2021-12-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2021-12-31	$0
Net investment gain/loss from pooled separate accounts	2021-12-31	$473,110
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$0
Employer contributions (assets) at end of year	2021-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$646,937
Contract administrator fees	2021-12-31	$37,880
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	FASTEN HALBERSTAM LLP
Accountancy firm EIN	2021-12-31	472319109

Form 5500 Responses for STATEN ISLAND CARE CENTER, LLC 401 K PROFIT SHARING PLAN

2022: STATEN ISLAND CARE CENTER, LLC 401 K PROFIT SHARING PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: STATEN ISLAND CARE CENTER, LLC 401 K PROFIT SHARING PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 86375 )

Policy contract number

801388

Policy instance

Insurance contract or identification number	801388
Number of Individuals Covered	45
Total amount of commissions paid to insurance broker	USD $13,728
Total amount of fees paid to insurance company	USD $1,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,728
Insurance broker organization code?	7
Amount paid for insurance broker fees	1819

JOHN HANCOCK LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 86375 )

Policy contract number

Policy instance

Number of Individuals Covered	63
Total amount of commissions paid to insurance broker	USD $15,604
Total amount of fees paid to insurance company	USD $3,204
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,604
Insurance broker organization code?	7
Amount paid for insurance broker fees	3204

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Company Name:	STATEN ISLAND CARE CENTER, LLC
Employer identification number (EIN):	133632426
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	1999-11-12
Company Identification Number:	2438750
Legal Registered Office Address:	1487 McDonald Ave Brooklyn United States of America (USA) 11230