401k Plan data: THE VILLAGE REHABILITATION AND CARE CENTER 401(K) PLAN plan

THE VILLAGE REHABILITATION AND CARE CENTER 401(K) PLAN 401k Plan overview

Plan Name	THE VILLAGE REHABILITATION AND CARE CENTER 401(K) PLAN
Plan identification number	001

THE VILLAGE REHABILITATION AND CARE CENTER 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

FAIR ACRES NURSING HOME, INC. DB has sponsored the creation of one or more 401k plans.

Company Name: FAIR ACRES NURSING HOME, INC. DB

Employer identification number (EIN): 382554794

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE VILLAGE REHABILITATION AND CARE CENTER 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 PAUL VERLEE PAUL VERLEE 2017-10-10
001 2015-01-01 HEIDI NICKEL-BLOMMER
001 2014-01-01 PAUL K VERLEE
001 2013-01-01 PAUL VERLEE 2014-06-24
001 2012-01-01 PAUL VERLEE 2013-06-05
001 2011-01-01 PAUL VERLEE 2012-07-20
001 2010-01-01 PAUL VERLEE 2011-10-13
001 2009-01-01 PAUL VERLEE PAUL VERLEE 2010-03-17

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2016-01-01	PAUL VERLEE		PAUL VERLEE	2017-10-10
001	2015-01-01	HEIDI NICKEL-BLOMMER
001	2014-01-01	PAUL K VERLEE
001	2013-01-01	PAUL VERLEE	2014-06-24
001	2012-01-01	PAUL VERLEE	2013-06-05
001	2011-01-01	PAUL VERLEE	2012-07-20
001	2010-01-01	PAUL VERLEE	2011-10-13
001	2009-01-01	PAUL VERLEE		PAUL VERLEE	2010-03-17

Plan Statistics for THE VILLAGE REHABILITATION AND CARE CENTER 401(K) PLAN

401k plan membership statisitcs for THE VILLAGE REHABILITATION AND CARE CENTER 401(K) PLAN

Measure Date Value
2016: THE VILLAGE REHABILITATION AND CARE CENTER 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 140
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 VILLAGE REHABILITATION AND CARE CENTER 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 130
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 122
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 15
Total of all active and inactive participants 2015-01-01 137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 137
Number of participants with account balances 2015-01-01 58
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 3
2014: THE VILLAGE REHABILITATION AND CARE CENTER 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 130
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 112
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 11
Total of all active and inactive participants 2014-01-01 123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 123
Number of participants with account balances 2014-01-01 57
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 1
2009: THE VILLAGE REHABILITATION AND CARE CENTER 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 28
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 27
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 0
Total of all active and inactive participants 2009-01-01 27
Total participants 2009-01-01 27
Number of participants with account balances 2009-01-01 27

Measure	Date	Value
2016: THE VILLAGE REHABILITATION AND CARE CENTER 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	140
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 VILLAGE REHABILITATION AND CARE CENTER 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	130
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	122
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	15
Total of all active and inactive participants	2015-01-01	137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	137
Number of participants with account balances	2015-01-01	58
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	3
2014: THE VILLAGE REHABILITATION AND CARE CENTER 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	130
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	112
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	11
Total of all active and inactive participants	2014-01-01	123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	123
Number of participants with account balances	2014-01-01	57
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	1
2009: THE VILLAGE REHABILITATION AND CARE CENTER 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	28
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	27
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	0
Total of all active and inactive participants	2009-01-01	27
Total participants	2009-01-01	27
Number of participants with account balances	2009-01-01	27

Financial Data on THE VILLAGE REHABILITATION AND CARE CENTER 401(K) PLAN

Measure	Date	Value
2016 : THE VILLAGE REHABILITATION AND CARE CENTER 401(K) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total transfer of assets to this plan	2016-12-31	$0
Total transfer of assets from this plan	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$159,137
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$1,490,917
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$1,483,027
Value of total corrective distributions	2016-12-31	$770
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$78,747
Value of total assets at end of year	2016-12-31	$0
Value of total assets at beginning of year	2016-12-31	$1,331,780
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$7,120
Total interest from all sources	2016-12-31	$249
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$5,785
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2016-12-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$5,785
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$134,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$53,711
Participant contributions at beginning of year	2016-12-31	$3,060
Participant contributions at beginning of year	2016-12-31	$3,660
Other income not declared elsewhere	2016-12-31	$23
Administrative expenses (other) incurred	2016-12-31	$7,120
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$-1,331,780
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$1,331,780
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$1,014,242
Interest on participant loans	2016-12-31	$249
Value of interest in common/collective trusts at beginning of year	2016-12-31	$308,956
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$56,938
Net investment gain or loss from common/collective trusts	2016-12-31	$17,395
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$25,036
Employer contributions (assets) at beginning of year	2016-12-31	$1,862
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$1,483,027
Did the plan have assets held for investment	2016-12-31	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	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	PLANTE MORAN, PLLC
Accountancy firm EIN	2016-12-31	381357951
2015 : THE VILLAGE REHABILITATION AND CARE CENTER 401(K) PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total transfer of assets to this plan	2015-12-31	$0
Total transfer of assets from this plan	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	$117,569
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$11,508
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$8,517
Expenses. Certain deemed distributions of participant loans	2015-12-31	$13
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$129,042
Value of total assets at end of year	2015-12-31	$1,331,780
Value of total assets at beginning of year	2015-12-31	$1,225,719
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$2,978
Total interest from all sources	2015-12-31	$193
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$42,409
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$42,409
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$123,000
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	$83,950
Participant contributions at end of year	2015-12-31	$3,060
Participant contributions at beginning of year	2015-12-31	$3,990
Participant contributions at end of year	2015-12-31	$3,660
Participant contributions at beginning of year	2015-12-31	$3,240
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$376
Other income not declared elsewhere	2015-12-31	$5
Administrative expenses (other) incurred	2015-12-31	$2,978
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	$106,061
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$1,331,780
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$1,225,719
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	$1,014,242
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$926,122
Interest on participant loans	2015-12-31	$193
Value of interest in common/collective trusts at end of year	2015-12-31	$308,956
Value of interest in common/collective trusts at beginning of year	2015-12-31	$290,644
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-54,875
Net investment gain or loss from common/collective trusts	2015-12-31	$795
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	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$44,716
Employer contributions (assets) at end of year	2015-12-31	$1,862
Employer contributions (assets) at beginning of year	2015-12-31	$1,723
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$8,517
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	PLANTE MORAN, PLLC
Accountancy firm EIN	2015-12-31	381357951
2014 : THE VILLAGE REHABILITATION AND CARE CENTER 401(K) PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total transfer of assets to this plan	2014-12-31	$0
Total transfer of assets from this plan	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	$197,044
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$5,718
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$515
Expenses. Certain deemed distributions of participant loans	2014-12-31	$0
Value of total corrective distributions	2014-12-31	$2,009
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$138,991
Value of total assets at end of year	2014-12-31	$1,225,719
Value of total assets at beginning of year	2014-12-31	$1,034,393
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$3,194
Total interest from all sources	2014-12-31	$51
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$37,984
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$37,984
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$104,000
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	$89,615
Participant contributions at end of year	2014-12-31	$3,990
Participant contributions at end of year	2014-12-31	$3,240
Administrative expenses (other) incurred	2014-12-31	$3,194
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	$191,326
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$1,225,719
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$1,034,393
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	$926,122
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$780,308
Interest on participant loans	2014-12-31	$51
Value of interest in common/collective trusts at end of year	2014-12-31	$290,644
Value of interest in common/collective trusts at beginning of year	2014-12-31	$254,085
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$-1,304
Net investment gain or loss from common/collective trusts	2014-12-31	$21,322
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	$49,376
Employer contributions (assets) at end of year	2014-12-31	$1,723
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$515
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	PLANTE MARON, PLLC
Accountancy firm EIN	2014-12-31	381357951
2009 : THE VILLAGE REHABILITATION AND CARE CENTER 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	$91,299

Form 5500 Responses for THE VILLAGE REHABILITATION AND CARE CENTER 401(K) PLAN

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

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Company Name:	FAIR ACRES NURSING HOME, INC. DB
Employer identification number (EIN):	382554794
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities