401k Plan data: THE CARING PLACE 401K PLAN plan

THE CARING PLACE 401K PLAN 401k Plan overview

Plan Name	THE CARING PLACE 401K PLAN
Plan identification number	002

THE CARING PLACE 401K 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

GROVE MANOR has sponsored the creation of one or more 401k plans.

Company Name: GROVE MANOR

Employer identification number (EIN): 251201255

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE CARING PLACE 401K PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2018-01-01 PAULA NOTARFRANCISCO 2019-10-09
002 2017-01-01
002 2016-01-01
002 2015-01-01
002 2014-01-01 NANCY IANDIMARINO 2015-09-23
002 2013-01-01 NANCY IANDIMARINO 2014-06-09
002 2012-01-01 NANCY IANDIMARINO 2013-10-02
002 2011-01-01 NANCY IANDIMARINO 2012-10-05
002 2010-01-01 GERALD EICHER 2011-10-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
002	2018-01-01	PAULA NOTARFRANCISCO	2019-10-09
002	2017-01-01
002	2016-01-01
002	2015-01-01
002	2014-01-01	NANCY IANDIMARINO	2015-09-23
002	2013-01-01	NANCY IANDIMARINO	2014-06-09
002	2012-01-01	NANCY IANDIMARINO	2013-10-02
002	2011-01-01	NANCY IANDIMARINO	2012-10-05
002	2010-01-01	GERALD EICHER	2011-10-13

Plan Statistics for THE CARING PLACE 401K PLAN

401k plan membership statisitcs for THE CARING PLACE 401K PLAN

Measure Date Value
2018: THE CARING PLACE 401K PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 124
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 0
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 0
Number of participants with account balances 2018-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 21
2017: THE CARING PLACE 401K PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 121
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 111
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 12
Total of all active and inactive participants 2017-01-01 123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 123
Number of participants with account balances 2017-01-01 73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 10

Measure	Date	Value
2018: THE CARING PLACE 401K PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	124
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	0
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	0
Number of participants with account balances	2018-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	21
2017: THE CARING PLACE 401K PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	121
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	111
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	12
Total of all active and inactive participants	2017-01-01	123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	123
Number of participants with account balances	2017-01-01	73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	10

Financial Data on THE CARING PLACE 401K PLAN

Measure	Date	Value
2018 : THE CARING PLACE 401K PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total transfer of assets from this plan	2018-12-31	$960,523
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$917
Total income from all sources (including contributions)	2018-12-31	$169,986
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$104,027
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$98,883
Value of total corrective distributions	2018-12-31	$783
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$230,118
Value of total assets at end of year	2018-12-31	$0
Value of total assets at beginning of year	2018-12-31	$895,481
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$4,361
Total interest from all sources	2018-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$32,270
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$32,270
Administrative expenses professional fees incurred	2018-12-31	$300
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$89,457
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$125,946
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$1,430
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2018-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2018-12-31	$0
Liabilities. Value of operating payables at end of year	2018-12-31	$0
Liabilities. Value of operating payables at beginning of year	2018-12-31	$917
Total non interest bearing cash at end of year	2018-12-31	$0
Total non interest bearing cash at beginning of year	2018-12-31	$760
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$65,959
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$894,564
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Investment advisory and management fees	2018-12-31	$4,061
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$894,721
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-92,402
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$102,742
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$98,883
Did the plan have assets held for investment	2018-12-31	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	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	BAKER TILLY VIRCHOW KRAUSE, LLP
Accountancy firm EIN	2018-12-31	390859910
2017 : THE CARING PLACE 401K PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$917
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$151
Total income from all sources (including contributions)	2017-12-31	$286,449
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$95,543
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$83,327
Value of total corrective distributions	2017-12-31	$917
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$169,147
Value of total assets at end of year	2017-12-31	$895,481
Value of total assets at beginning of year	2017-12-31	$703,809
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$11,299
Total interest from all sources	2017-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Administrative expenses professional fees incurred	2017-12-31	$3,693
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$70,366
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$85,466
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$19,515
Liabilities. Value of operating payables at end of year	2017-12-31	$917
Liabilities. Value of operating payables at beginning of year	2017-12-31	$151
Total non interest bearing cash at end of year	2017-12-31	$760
Total non interest bearing cash at beginning of year	2017-12-31	$3,114
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$190,906
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$894,564
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$703,658
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$894,721
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$700,695
Net investment gain/loss from pooled separate accounts	2017-12-31	$117,302
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$64,166
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$83,327
Contract administrator fees	2017-12-31	$7,606
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	BAKER TILLY VIRCHOW KRAUSE, LLP
Accountancy firm EIN	2017-12-31	390859910

Form 5500 Responses for THE CARING PLACE 401K PLAN

2018: THE CARING PLACE 401K PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	Yes
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: THE CARING PLACE 401K PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

62425

Policy instance

Insurance contract or identification number	62425
Number of Individuals Covered	0
Insurance policy start date	2018-01-01
Insurance policy end date	2018-03-12
Total amount of commissions paid to insurance broker	USD $756
Total amount of fees paid to insurance company	USD $164
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	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 $756
Insurance broker organization code?	3
Amount paid for insurance broker fees	164
Additional information about fees paid to insurance broker	TPA FORUM COMPENSATION

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

Policy contract number

62425

Policy instance

Insurance contract or identification number	62425
Number of Individuals Covered	165
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,039
Total amount of fees paid to insurance company	USD $400
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	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 $4,039
Insurance broker organization code?	3
Amount paid for insurance broker fees	400
Additional information about fees paid to insurance broker	TPA FORUM COMPENSATION
Insurance broker name	WALKER BENEFITS, LLC

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Company Name:	GROVE MANOR
Employer identification number (EIN):	251201255
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities