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FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN 401k Plan overview

Plan NameFIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN
Plan identification number 001

FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN Benefits

401k Plan TypeDefined 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

FIRST AMERICAN CARE FACILITIES, INC. has sponsored the creation of one or more 401k plans.

Company Name:FIRST AMERICAN CARE FACILITIES, INC.
Employer identification number (EIN):411246084
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012015-01-01MICHAEL E. KING
0012014-01-01MICHAEL KING

Plan Statistics for FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN

401k plan membership statisitcs for FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN

Measure Date Value
2015: FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01209
Total number of active participants reported on line 7a of the Form 55002015-01-01188
Number of retired or separated participants receiving benefits2015-01-011
Number of other retired or separated participants entitled to future benefits2015-01-0117
Total of all active and inactive participants2015-01-01206
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-01206
Number of participants with account balances2015-01-0184
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01203
Total number of active participants reported on line 7a of the Form 55002014-01-01174
Number of retired or separated participants receiving benefits2014-01-016
Number of other retired or separated participants entitled to future benefits2014-01-013
Total of all active and inactive participants2014-01-01183
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-01183
Number of participants with account balances2014-01-0181
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010

Financial Data on FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN

Measure Date Value
2015 : FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$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$156,248
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$120,793
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$100,971
Value of total corrective distributions2015-12-31$14,480
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$160,429
Value of total assets at end of year2015-12-31$1,500,148
Value of total assets at beginning of year2015-12-31$1,464,693
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$5,342
Total interest from all sources2015-12-31$953
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$11,542
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2015-12-31$11,542
Administrative expenses professional fees incurred2015-12-31$0
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$500,000
If this is an individual account plan, was there a blackout period2015-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$135,225
Participant contributions at end of year2015-12-31$15,545
Participant contributions at beginning of year2015-12-31$24,472
Participant contributions at end of year2015-12-31$0
Participant contributions at beginning of year2015-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-12-31$0
Other income not declared elsewhere2015-12-31$32
Total non interest bearing cash at end of year2015-12-31$0
Total non interest bearing cash at beginning of year2015-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$35,455
Value of net assets at end of year (total assets less liabilities)2015-12-31$1,500,148
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$1,464,693
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$875,259
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$20,846
Value of interest in pooled separate accounts at end of year2015-12-31$224,051
Value of interest in pooled separate accounts at beginning of year2015-12-31$15,335
Interest on participant loans2015-12-31$953
Value of interest in common/collective trusts at end of year2015-12-31$385,293
Value of interest in common/collective trusts at beginning of year2015-12-31$1,404,040
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-60,452
Net investment gain/loss from pooled separate accounts2015-12-31$-6,056
Net investment gain or loss from common/collective trusts2015-12-31$49,800
Net gain/loss from 103.12 investment entities2015-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$25,204
Employer contributions (assets) at end of year2015-12-31$0
Employer contributions (assets) at beginning of year2015-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$100,971
Contract administrator fees2015-12-31$5,342
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31BERGANKDV, LTD
Accountancy firm EIN2015-12-31411431613
2014 : FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN 2014 401k financial data
Unrealized appreciation/depreciation of real estate assets2014-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2014-12-31$0
Total unrealized appreciation/depreciation of assets2014-12-31$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$228,822
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$183,648
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$178,645
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$157,707
Value of total assets at end of year2014-12-31$1,464,693
Value of total assets at beginning of year2014-12-31$1,419,519
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$5,003
Total interest from all sources2014-12-31$1,522
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$221
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2014-12-31$221
Administrative expenses professional fees incurred2014-12-31$265
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$500,000
If this is an individual account plan, was there a blackout period2014-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$133,595
Participant contributions at end of year2014-12-31$24,472
Participant contributions at beginning of year2014-12-31$35,637
Participant contributions at end of year2014-12-31$0
Participant contributions at beginning of year2014-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2014-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-12-31$0
Other income not declared elsewhere2014-12-31$40
Administrative expenses (other) incurred2014-12-31$0
Total non interest bearing cash at end of year2014-12-31$0
Total non interest bearing cash at beginning of year2014-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$45,174
Value of net assets at end of year (total assets less liabilities)2014-12-31$1,464,693
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$1,419,519
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Investment advisory and management fees2014-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$20,846
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$0
Value of interest in pooled separate accounts at end of year2014-12-31$15,335
Value of interest in pooled separate accounts at beginning of year2014-12-31$1,383,882
Interest on participant loans2014-12-31$1,522
Income. Interest from loans (other than to participants)2014-12-31$0
Interest earned on other investments2014-12-31$0
Income. Interest from US Government securities2014-12-31$0
Income. Interest from corporate debt instruments2014-12-31$0
Value of interest in common/collective trusts at end of year2014-12-31$1,404,040
Value of interest in common/collective trusts at beginning of year2014-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2014-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$-348
Net investment gain/loss from pooled separate accounts2014-12-31$60,536
Net investment gain or loss from common/collective trusts2014-12-31$9,144
Net gain/loss from 103.12 investment entities2014-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31Yes
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$24,112
Employer contributions (assets) at end of year2014-12-31$0
Employer contributions (assets) at beginning of year2014-12-31$0
Income. Dividends from preferred stock2014-12-31$0
Income. Dividends from common stock2014-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$178,645
Contract administrator fees2014-12-31$4,738
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Aggregate proceeds on sale of assets2014-12-31$0
Aggregate carrying amount (costs) on sale of assets2014-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31BERGANKDV, LTD
Accountancy firm EIN2014-12-31411431613

Form 5500 Responses for FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN

2015: FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number618342
Policy instance 1
Insurance contract or identification number618342
Number of Individuals Covered169
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $586
Total amount of fees paid to insurance companyUSD $59
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $586
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Insurance broker nameGOLDLEAF PARTNERS
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number618342
Policy instance 1
Insurance contract or identification number618342
Number of Individuals Covered272
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $5,299
Total amount of fees paid to insurance companyUSD $992
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $5,299
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Insurance broker nameGOLDLEAF PARTNERS

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