401k Plan data: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN plan

HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 401k Plan overview

Plan Name	HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN
Plan identification number	001

HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
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.
Prototype plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion or notification letter; and under which a seperate funding medium (for example, a seperate trust or custodial account) is established for the use of each adopting employer.

401k Sponsoring company profile

HENRY COUNTY NURSING HOME has sponsored the creation of one or more 401k plans.

Company Name: HENRY COUNTY NURSING HOME

Employer identification number (EIN): 630962057

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2023-01-01 CHARLIE HOUSTON 2024-10-11 CHARLIE HOUSTON 2024-10-11
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01 CHRISTY BENNETT CHRISTY BENNETT 2018-10-15
001 2016-01-01 CHRISTY BENNETT CHRISTY BENNETT 2017-10-12
001 2015-01-01 CHRISTY BENNETT CHRISTY BENNETT 2016-10-12
001 2014-01-01 CHRISTY BENNETT CHRISTY BENNETT 2015-10-15
001 2014-01-01 CHRISTY BENNETT CHRISTY BENNETT 2015-10-15
001 2013-01-01 CHRISTY BENNETT CHRISTY BENNETT 2014-10-12
001 2012-01-01 CHRISTY BENNETT CHRISTY BENNETT 2013-10-11
001 2011-01-01 CHRISTY BENNETT
001 2010-01-01 CHRISTY BENNETT
001 2009-01-01 CHUCK HOUSTON CHUCK HOUSTON 2010-10-14
001 2008-01-01 CHRISTY BENNETT
001 2007-01-01 CHRISTY BENNETT
001 2006-01-01 CHRISTY BENNETT
001 2005-01-01 CHRISTY BENNETT
001 2004-01-01 CHRISTY BENNETT

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2023-01-01	CHARLIE HOUSTON	2024-10-11	CHARLIE HOUSTON	2024-10-11
001	2022-01-01
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2017-01-01	CHRISTY BENNETT		CHRISTY BENNETT	2018-10-15
001	2016-01-01	CHRISTY BENNETT		CHRISTY BENNETT	2017-10-12
001	2015-01-01	CHRISTY BENNETT		CHRISTY BENNETT	2016-10-12
001	2014-01-01	CHRISTY BENNETT		CHRISTY BENNETT	2015-10-15
001	2014-01-01	CHRISTY BENNETT		CHRISTY BENNETT	2015-10-15
001	2013-01-01	CHRISTY BENNETT		CHRISTY BENNETT	2014-10-12
001	2012-01-01	CHRISTY BENNETT		CHRISTY BENNETT	2013-10-11
001	2011-01-01	CHRISTY BENNETT
001	2010-01-01	CHRISTY BENNETT
001	2009-01-01	CHUCK HOUSTON		CHUCK HOUSTON	2010-10-14
001	2008-01-01	CHRISTY BENNETT
001	2007-01-01	CHRISTY BENNETT
001	2006-01-01	CHRISTY BENNETT
001	2005-01-01	CHRISTY BENNETT
001	2004-01-01	CHRISTY BENNETT

Plan Statistics for HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN

401k plan membership statisitcs for HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN

Measure Date Value
2022: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 181
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 125
Number of retired or separated participants receiving benefits 2022-01-01 1
Number of other retired or separated participants entitled to future benefits 2022-01-01 22
Total of all active and inactive participants 2022-01-01 148
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 2
Total participants 2022-01-01 150
Number of participants with account balances 2022-01-01 75
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 1
2021: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 212
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 154
Number of retired or separated participants receiving benefits 2021-01-01 1
Number of other retired or separated participants entitled to future benefits 2021-01-01 19
Total of all active and inactive participants 2021-01-01 174
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 1
Total participants 2021-01-01 175
Number of participants with account balances 2021-01-01 72
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 242
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 189
Number of retired or separated participants receiving benefits 2020-01-01 1
Number of other retired or separated participants entitled to future benefits 2020-01-01 20
Total of all active and inactive participants 2020-01-01 210
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 1
Total participants 2020-01-01 211
Number of participants with account balances 2020-01-01 80
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 1
2019: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 286
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 260
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 19
Total of all active and inactive participants 2019-01-01 279
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 1
Total participants 2019-01-01 280
Number of participants with account balances 2019-01-01 85
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 8
2018: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 288
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 277
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 31
Total of all active and inactive participants 2018-01-01 308
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 1
Total participants 2018-01-01 309
Number of participants with account balances 2018-01-01 200
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 4
2017: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 211
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 198
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 16
Total of all active and inactive participants 2017-01-01 214
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 214
Number of participants with account balances 2017-01-01 82
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 3
2016: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 225
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 194
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 22
Total of all active and inactive participants 2016-01-01 216
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 216
Number of participants with account balances 2016-01-01 86
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 1
2015: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 200
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 207
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 12
Total of all active and inactive participants 2015-01-01 219
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 219
Number of participants with account balances 2015-01-01 84
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 2
2014: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 258
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 220
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 10
Total of all active and inactive participants 2014-01-01 230
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 230
Number of participants with account balances 2014-01-01 86
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 254
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 303
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 9
Total of all active and inactive participants 2013-01-01 312
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 312
Number of participants with account balances 2013-01-01 83
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 2
2012: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 237
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 229
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 12
Total of all active and inactive participants 2012-01-01 241
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 241
Number of participants with account balances 2012-01-01 92
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 3
2011: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 251
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 192
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 11
Total of all active and inactive participants 2011-01-01 203
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 203
Number of participants with account balances 2011-01-01 102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 258
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 221
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 5
Total of all active and inactive participants 2010-01-01 226
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 226
Number of participants with account balances 2010-01-01 88
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 11
2009: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 191
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 196
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 11
Total of all active and inactive participants 2009-01-01 207
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 207
Number of participants with account balances 2009-01-01 90
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 3

Measure	Date	Value
2022: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	181
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	125
Number of retired or separated participants receiving benefits	2022-01-01	1
Number of other retired or separated participants entitled to future benefits	2022-01-01	22
Total of all active and inactive participants	2022-01-01	148
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	2
Total participants	2022-01-01	150
Number of participants with account balances	2022-01-01	75
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	1
2021: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	212
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	154
Number of retired or separated participants receiving benefits	2021-01-01	1
Number of other retired or separated participants entitled to future benefits	2021-01-01	19
Total of all active and inactive participants	2021-01-01	174
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	1
Total participants	2021-01-01	175
Number of participants with account balances	2021-01-01	72
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	242
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	189
Number of retired or separated participants receiving benefits	2020-01-01	1
Number of other retired or separated participants entitled to future benefits	2020-01-01	20
Total of all active and inactive participants	2020-01-01	210
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	1
Total participants	2020-01-01	211
Number of participants with account balances	2020-01-01	80
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	1
2019: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	286
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	260
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	19
Total of all active and inactive participants	2019-01-01	279
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	1
Total participants	2019-01-01	280
Number of participants with account balances	2019-01-01	85
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	8
2018: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	288
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	277
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	31
Total of all active and inactive participants	2018-01-01	308
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	1
Total participants	2018-01-01	309
Number of participants with account balances	2018-01-01	200
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	4
2017: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	211
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	198
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	16
Total of all active and inactive participants	2017-01-01	214
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	214
Number of participants with account balances	2017-01-01	82
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	3
2016: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	225
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	194
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	22
Total of all active and inactive participants	2016-01-01	216
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	216
Number of participants with account balances	2016-01-01	86
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	1
2015: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	200
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	207
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	12
Total of all active and inactive participants	2015-01-01	219
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	219
Number of participants with account balances	2015-01-01	84
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	2
2014: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	258
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	220
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	10
Total of all active and inactive participants	2014-01-01	230
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	230
Number of participants with account balances	2014-01-01	86
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	254
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	303
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	9
Total of all active and inactive participants	2013-01-01	312
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	312
Number of participants with account balances	2013-01-01	83
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	2
2012: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	237
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	229
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	12
Total of all active and inactive participants	2012-01-01	241
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	241
Number of participants with account balances	2012-01-01	92
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	3
2011: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	251
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	192
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	11
Total of all active and inactive participants	2011-01-01	203
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	203
Number of participants with account balances	2011-01-01	102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	258
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	221
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	5
Total of all active and inactive participants	2010-01-01	226
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	226
Number of participants with account balances	2010-01-01	88
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	11
2009: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	191
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	196
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	11
Total of all active and inactive participants	2009-01-01	207
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	207
Number of participants with account balances	2009-01-01	90
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	3

Financial Data on HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN

Measure	Date	Value
2022 : HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-467,216
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$171,646
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$156,369
Expenses. Certain deemed distributions of participant loans	2022-12-31	$12,278
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$215,129
Value of total assets at end of year	2022-12-31	$3,510,170
Value of total assets at beginning of year	2022-12-31	$4,149,032
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$2,999
Total interest from all sources	2022-12-31	$7,642
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$30,436
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	$30,436
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
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	$103,101
Participant contributions at end of year	2022-12-31	$185,895
Participant contributions at beginning of year	2022-12-31	$139,612
Participant contributions at end of year	2022-12-31	$3,285
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$32,356
Other income not declared elsewhere	2022-12-31	$147
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	$-638,862
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$3,510,170
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$4,149,032
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 registered invesment companies (eg mutual funds) at end of year	2022-12-31	$2,838,801
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$3,526,026
Value of interest in pooled separate accounts at end of year	2022-12-31	$270,738
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$305,865
Interest on participant loans	2022-12-31	$5,033
Interest earned on other investments	2022-12-31	$2,609
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$208,667
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$177,529
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-687,231
Net investment gain/loss from pooled separate accounts	2022-12-31	$-33,339
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	Yes
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	$79,672
Employer contributions (assets) at end of year	2022-12-31	$2,784
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$156,369
Contract administrator fees	2022-12-31	$2,999
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	Disclaimer
Accountancy firm name	2022-12-31	MCDANIEL AND ASSOCIATES PC
Accountancy firm EIN	2022-12-31	630921974
2021 : HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$828,745
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$448,523
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$428,773
Expenses. Certain deemed distributions of participant loans	2021-12-31	$1,421
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$176,940
Value of total assets at end of year	2021-12-31	$4,149,032
Value of total assets at beginning of year	2021-12-31	$3,768,810
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$18,329
Total interest from all sources	2021-12-31	$9,706
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$44,911
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	$44,911
Administrative expenses professional fees incurred	2021-12-31	$15,000
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$250,000
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	$99,450
Participant contributions at end of year	2021-12-31	$139,612
Participant contributions at beginning of year	2021-12-31	$139,823
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	$380,222
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$4,149,032
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$3,768,810
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 registered invesment companies (eg mutual funds) at end of year	2021-12-31	$3,526,026
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$3,199,589
Value of interest in pooled separate accounts at end of year	2021-12-31	$305,865
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$259,499
Interest on participant loans	2021-12-31	$6,982
Interest earned on other investments	2021-12-31	$2,724
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$177,529
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$169,899
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$597,188
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	Yes
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	$77,490
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$428,773
Contract administrator fees	2021-12-31	$3,329
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	Disclaimer
Accountancy firm name	2021-12-31	MCDANIEL AND ASSOCIATES, PC
Accountancy firm EIN	2021-12-31	630921974
2020 : HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2020 401k financial data
Unrealized appreciation/depreciation of real estate assets	2020-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2020-12-31	$0
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total transfer of assets to this plan	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Expenses. Interest paid	2020-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$649,802
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$241,267
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$223,340
Expenses. Certain deemed distributions of participant loans	2020-12-31	$0
Value of total corrective distributions	2020-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$188,434
Value of total assets at end of year	2020-12-31	$3,768,810
Value of total assets at beginning of year	2020-12-31	$3,360,275
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$17,927
Total income from rents	2020-12-31	$0
Total interest from all sources	2020-12-31	$9,897
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$30,552
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$30,552
Administrative expenses professional fees incurred	2020-12-31	$15,000
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$250,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Amount of non-exempt transactions with any party-in-interest	2020-12-31	$0
Contributions received from participants	2020-12-31	$106,474
Participant contributions at end of year	2020-12-31	$139,823
Participant contributions at beginning of year	2020-12-31	$173,724
Participant contributions at end of year	2020-12-31	$0
Participant contributions at beginning of year	2020-12-31	$5,440
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2020-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2020-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2020-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-12-31	$0
Other income not declared elsewhere	2020-12-31	$0
Administrative expenses (other) incurred	2020-12-31	$0
Liabilities. Value of operating payables at beginning of year	2020-12-31	$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	2020-12-31	No
Income. Non cash contributions	2020-12-31	$0
Value of net income/loss	2020-12-31	$408,535
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$3,768,810
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$3,360,275
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2020-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2020-12-31	$0
Investment advisory and management fees	2020-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$3,199,589
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$2,758,373
Value of interest in pooled separate accounts at end of year	2020-12-31	$259,499
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$241,840
Interest on participant loans	2020-12-31	$7,007
Income. Interest from loans (other than to participants)	2020-12-31	$0
Interest earned on other investments	2020-12-31	$2,890
Income. Interest from US Government securities	2020-12-31	$0
Income. Interest from corporate debt instruments	2020-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$169,899
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$176,406
Expenses. Payments to insurance carriers foe the provision of benefits	2020-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$406,071
Net investment gain/loss from pooled separate accounts	2020-12-31	$14,848
Net investment gain or loss from common/collective trusts	2020-12-31	$0
Net gain/loss from 103.12 investment entities	2020-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$81,960
Employer contributions (assets) at end of year	2020-12-31	$0
Employer contributions (assets) at beginning of year	2020-12-31	$4,492
Income. Dividends from preferred stock	2020-12-31	$0
Income. Dividends from common stock	2020-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$223,340
Contract administrator fees	2020-12-31	$2,927
Liabilities. Value of benefit claims payable at beginning of year	2020-12-31	$0
Did the plan have assets held for investment	2020-12-31	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	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Aggregate proceeds on sale of assets	2020-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2020-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2020-12-31	$0
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	MCDANIEL & ASSOCIATES, PC
Accountancy firm EIN	2020-12-31	630921974
2019 : HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2019 401k financial data
Unrealized appreciation/depreciation of real estate assets	2019-12-31	$0
Unrealized appreciation/depreciation of real estate assets	2019-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2019-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2019-12-31	$0
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total transfer of assets to this plan	2019-12-31	$0
Total transfer of assets to this plan	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Expenses. Interest paid	2019-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2019-12-31	$0
Expenses. Interest paid	2019-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$798,202
Total income from all sources (including contributions)	2019-12-31	$798,202
Total loss/gain on sale of assets	2019-12-31	$0
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$57,220
Total of all expenses incurred	2019-12-31	$57,220
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$50,133
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$50,133
Expenses. Certain deemed distributions of participant loans	2019-12-31	$0
Expenses. Certain deemed distributions of participant loans	2019-12-31	$0
Value of total corrective distributions	2019-12-31	$0
Value of total corrective distributions	2019-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$159,468
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$159,468
Value of total assets at end of year	2019-12-31	$3,360,275
Value of total assets at end of year	2019-12-31	$3,360,275
Value of total assets at beginning of year	2019-12-31	$2,619,293
Value of total assets at beginning of year	2019-12-31	$2,619,293
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$7,087
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$7,087
Total income from rents	2019-12-31	$0
Total income from rents	2019-12-31	$0
Total interest from all sources	2019-12-31	$8,448
Total interest from all sources	2019-12-31	$8,448
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$34,803
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$34,803
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$34,803
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$34,803
Administrative expenses professional fees incurred	2019-12-31	$4,231
Administrative expenses professional fees incurred	2019-12-31	$4,231
Was this plan covered by a fidelity bond	2019-12-31	Yes
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$250,000
Value of fidelity bond cover	2019-12-31	$250,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Amount of non-exempt transactions with any party-in-interest	2019-12-31	$0
Amount of non-exempt transactions with any party-in-interest	2019-12-31	$0
Contributions received from participants	2019-12-31	$65,324
Contributions received from participants	2019-12-31	$65,324
Participant contributions at end of year	2019-12-31	$173,724
Participant contributions at end of year	2019-12-31	$173,724
Participant contributions at beginning of year	2019-12-31	$153,575
Participant contributions at beginning of year	2019-12-31	$153,575
Participant contributions at end of year	2019-12-31	$5,440
Participant contributions at end of year	2019-12-31	$5,440
Participant contributions at beginning of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$33,284
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$33,284
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2019-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2019-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$0
Other income not declared elsewhere	2019-12-31	$0
Other income not declared elsewhere	2019-12-31	$0
Administrative expenses (other) incurred	2019-12-31	$0
Administrative expenses (other) incurred	2019-12-31	$0
Liabilities. Value of operating payables at beginning of year	2019-12-31	$0
Liabilities. Value of operating payables at beginning of year	2019-12-31	$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	2019-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Income. Non cash contributions	2019-12-31	$0
Income. Non cash contributions	2019-12-31	$0
Value of net income/loss	2019-12-31	$740,982
Value of net income/loss	2019-12-31	$740,982
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$3,360,275
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$3,360,275
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$2,619,293
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$2,619,293
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2019-12-31	$0
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2019-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2019-12-31	$0
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2019-12-31	$0
Investment advisory and management fees	2019-12-31	$0
Investment advisory and management fees	2019-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$2,758,373
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$2,758,373
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$2,103,787
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$2,103,787
Value of interest in pooled separate accounts at end of year	2019-12-31	$241,840
Value of interest in pooled separate accounts at end of year	2019-12-31	$241,840
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$188,498
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$188,498
Interest on participant loans	2019-12-31	$5,075
Interest on participant loans	2019-12-31	$5,075
Income. Interest from loans (other than to participants)	2019-12-31	$0
Income. Interest from loans (other than to participants)	2019-12-31	$0
Interest earned on other investments	2019-12-31	$3,373
Interest earned on other investments	2019-12-31	$3,373
Income. Interest from US Government securities	2019-12-31	$0
Income. Interest from US Government securities	2019-12-31	$0
Income. Interest from corporate debt instruments	2019-12-31	$0
Income. Interest from corporate debt instruments	2019-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$176,406
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$176,406
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$173,433
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$173,433
Expenses. Payments to insurance carriers foe the provision of benefits	2019-12-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2019-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$541,712
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$541,712
Net investment gain/loss from pooled separate accounts	2019-12-31	$53,771
Net investment gain/loss from pooled separate accounts	2019-12-31	$53,771
Net investment gain or loss from common/collective trusts	2019-12-31	$0
Net investment gain or loss from common/collective trusts	2019-12-31	$0
Net gain/loss from 103.12 investment entities	2019-12-31	$0
Net gain/loss from 103.12 investment entities	2019-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$60,860
Contributions received in cash from employer	2019-12-31	$60,860
Employer contributions (assets) at end of year	2019-12-31	$4,492
Employer contributions (assets) at end of year	2019-12-31	$4,492
Employer contributions (assets) at beginning of year	2019-12-31	$0
Employer contributions (assets) at beginning of year	2019-12-31	$0
Income. Dividends from preferred stock	2019-12-31	$0
Income. Dividends from preferred stock	2019-12-31	$0
Income. Dividends from common stock	2019-12-31	$0
Income. Dividends from common stock	2019-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$50,133
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$50,133
Contract administrator fees	2019-12-31	$2,856
Contract administrator fees	2019-12-31	$2,856
Liabilities. Value of benefit claims payable at beginning of year	2019-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2019-12-31	$0
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan have assets held for investment	2019-12-31	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	2019-12-31	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	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Aggregate proceeds on sale of assets	2019-12-31	$0
Aggregate proceeds on sale of assets	2019-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2019-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2019-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2019-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2019-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	MCDANIEL & ASSOCIATES P.C.
Accountancy firm name	2019-12-31	MCDANIEL & ASSOCIATES P.C.
Accountancy firm EIN	2019-12-31	630921974
Accountancy firm EIN	2019-12-31	630921974
2018 : HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2018 401k financial data
Unrealized appreciation/depreciation of real estate assets	2018-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2018-12-31	$0
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total transfer of assets to this plan	2018-12-31	$0
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	$0
Expenses. Interest paid	2018-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$-33,508
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$207,738
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$183,410
Expenses. Certain deemed distributions of participant loans	2018-12-31	$0
Value of total corrective distributions	2018-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$157,108
Value of total assets at end of year	2018-12-31	$2,619,293
Value of total assets at beginning of year	2018-12-31	$2,860,539
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$24,328
Total income from rents	2018-12-31	$0
Total interest from all sources	2018-12-31	$8,088
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$30,115
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	$30,115
Administrative expenses professional fees incurred	2018-12-31	$18,998
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$250,000
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
Amount of non-exempt transactions with any party-in-interest	2018-12-31	$0
Contributions received from participants	2018-12-31	$83,295
Participant contributions at end of year	2018-12-31	$153,575
Participant contributions at beginning of year	2018-12-31	$159,391
Participant contributions at end of year	2018-12-31	$0
Participant contributions at beginning of year	2018-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2018-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2018-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2018-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2018-12-31	$0
Other income not declared elsewhere	2018-12-31	$0
Administrative expenses (other) incurred	2018-12-31	$0
Liabilities. Value of operating payables at beginning of year	2018-12-31	$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	2018-12-31	No
Income. Non cash contributions	2018-12-31	$0
Value of net income/loss	2018-12-31	$-241,246
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$2,619,293
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$2,860,539
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
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2018-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2018-12-31	$0
Investment advisory and management fees	2018-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$2,103,787
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$2,323,353
Value of interest in pooled separate accounts at end of year	2018-12-31	$188,498
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$212,076
Interest on participant loans	2018-12-31	$4,796
Income. Interest from loans (other than to participants)	2018-12-31	$0
Interest earned on other investments	2018-12-31	$3,292
Income. Interest from US Government securities	2018-12-31	$0
Income. Interest from corporate debt instruments	2018-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$173,433
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$165,719
Expenses. Payments to insurance carriers foe the provision of benefits	2018-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-213,045
Net investment gain/loss from pooled separate accounts	2018-12-31	$-15,774
Net investment gain or loss from common/collective trusts	2018-12-31	$0
Net gain/loss from 103.12 investment entities	2018-12-31	$0
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	$73,813
Employer contributions (assets) at end of year	2018-12-31	$0
Employer contributions (assets) at beginning of year	2018-12-31	$0
Income. Dividends from preferred stock	2018-12-31	$0
Income. Dividends from common stock	2018-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$183,410
Contract administrator fees	2018-12-31	$5,330
Liabilities. Value of benefit claims payable at beginning of year	2018-12-31	$0
Did the plan have assets held for investment	2018-12-31	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	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	No
Aggregate proceeds on sale of assets	2018-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2018-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2018-12-31	$0
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	JAMES Q WHITEHEAD, CPA INC
Accountancy firm EIN	2018-12-31	202114822
2017 : HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2017 401k financial data
Unrealized appreciation/depreciation of real estate assets	2017-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2017-12-31	$0
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total transfer of assets to this plan	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Expenses. Interest paid	2017-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$572,134
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$221,113
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$207,076
Expenses. Certain deemed distributions of participant loans	2017-12-31	$0
Value of total corrective distributions	2017-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$164,912
Value of total assets at end of year	2017-12-31	$2,860,539
Value of total assets at beginning of year	2017-12-31	$2,509,518
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$14,037
Total income from rents	2017-12-31	$0
Total interest from all sources	2017-12-31	$8,496
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$29,046
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$29,046
Administrative expenses professional fees incurred	2017-12-31	$8,867
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$250,000
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
Amount of non-exempt transactions with any party-in-interest	2017-12-31	$0
Contributions received from participants	2017-12-31	$86,749
Participant contributions at end of year	2017-12-31	$159,391
Participant contributions at beginning of year	2017-12-31	$142,310
Participant contributions at end of year	2017-12-31	$0
Participant contributions at beginning of year	2017-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2017-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2017-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2017-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2017-12-31	$0
Other income not declared elsewhere	2017-12-31	$0
Administrative expenses (other) incurred	2017-12-31	$0
Liabilities. Value of operating payables at beginning of year	2017-12-31	$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	2017-12-31	No
Income. Non cash contributions	2017-12-31	$0
Value of net income/loss	2017-12-31	$351,021
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$2,860,539
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$2,509,518
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
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2017-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2017-12-31	$0
Investment advisory and management fees	2017-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$2,323,353
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$1,944,460
Value of interest in pooled separate accounts at end of year	2017-12-31	$212,076
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$186,213
Interest on participant loans	2017-12-31	$4,780
Income. Interest from loans (other than to participants)	2017-12-31	$0
Interest earned on other investments	2017-12-31	$3,716
Income. Interest from US Government securities	2017-12-31	$0
Income. Interest from corporate debt instruments	2017-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$165,719
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$236,535
Expenses. Payments to insurance carriers foe the provision of benefits	2017-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$339,615
Net investment gain/loss from pooled separate accounts	2017-12-31	$30,065
Net investment gain or loss from common/collective trusts	2017-12-31	$0
Net gain/loss from 103.12 investment entities	2017-12-31	$0
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	$78,163
Employer contributions (assets) at end of year	2017-12-31	$0
Employer contributions (assets) at beginning of year	2017-12-31	$0
Income. Dividends from preferred stock	2017-12-31	$0
Income. Dividends from common stock	2017-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$207,076
Contract administrator fees	2017-12-31	$5,170
Liabilities. Value of benefit claims payable at beginning of year	2017-12-31	$0
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
Aggregate proceeds on sale of assets	2017-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2017-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2017-12-31	$0
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	JAMES Q WHITEHEAD, CPA INC
Accountancy firm EIN	2017-12-31	202114822
2016 : HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2016 401k financial data
Unrealized appreciation/depreciation of real estate assets	2016-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2016-12-31	$0
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total transfer of assets to 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
Expenses. Interest paid	2016-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$356,629
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$298,942
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$280,372
Expenses. Certain deemed distributions of participant loans	2016-12-31	$7,134
Value of total corrective distributions	2016-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$188,538
Value of total assets at end of year	2016-12-31	$2,509,518
Value of total assets at beginning of year	2016-12-31	$2,451,831
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$11,436
Total income from rents	2016-12-31	$0
Total interest from all sources	2016-12-31	$9,521
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$21,796
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$21,796
Administrative expenses professional fees incurred	2016-12-31	$8,291
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$250,000
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
Amount of non-exempt transactions with any party-in-interest	2016-12-31	$0
Contributions received from participants	2016-12-31	$100,333
Participant contributions at end of year	2016-12-31	$142,310
Participant contributions at beginning of year	2016-12-31	$164,967
Participant contributions at end of year	2016-12-31	$0
Participant contributions at beginning of year	2016-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$7,351
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2016-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2016-12-31	$0
Other income not declared elsewhere	2016-12-31	$0
Administrative expenses (other) incurred	2016-12-31	$0
Liabilities. Value of operating payables at beginning of year	2016-12-31	$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	2016-12-31	No
Income. Non cash contributions	2016-12-31	$0
Value of net income/loss	2016-12-31	$57,687
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$2,509,518
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$2,451,831
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
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2016-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2016-12-31	$0
Investment advisory and management fees	2016-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$1,944,460
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$1,900,354
Value of interest in pooled separate accounts at end of year	2016-12-31	$186,213
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$214,549
Interest on participant loans	2016-12-31	$5,212
Income. Interest from loans (other than to participants)	2016-12-31	$0
Interest earned on other investments	2016-12-31	$4,309
Income. Interest from US Government securities	2016-12-31	$0
Income. Interest from corporate debt instruments	2016-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$236,535
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$171,132
Expenses. Payments to insurance carriers foe the provision of benefits	2016-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$123,538
Net investment gain/loss from pooled separate accounts	2016-12-31	$13,236
Net investment gain or loss from common/collective trusts	2016-12-31	$0
Net gain/loss from 103.12 investment entities	2016-12-31	$0
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	$80,854
Employer contributions (assets) at end of year	2016-12-31	$0
Employer contributions (assets) at beginning of year	2016-12-31	$829
Income. Dividends from preferred stock	2016-12-31	$0
Income. Dividends from common stock	2016-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$280,372
Contract administrator fees	2016-12-31	$3,145
Liabilities. Value of benefit claims payable at beginning of year	2016-12-31	$0
Did the plan have assets held for investment	2016-12-31	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	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	No
Aggregate proceeds on sale of assets	2016-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2016-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2016-12-31	$0
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	JAMES Q WHITEHEAD, CPA INC.
Accountancy firm EIN	2016-12-31	202114822
2015 : HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2015 401k financial data
Unrealized appreciation/depreciation of real estate assets	2015-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2015-12-31	$0
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total transfer of assets to 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
Expenses. Interest paid	2015-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$318,829
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$244,973
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$234,489
Expenses. Certain deemed distributions of participant loans	2015-12-31	$0
Value of total corrective distributions	2015-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$318,793
Value of total assets at end of year	2015-12-31	$2,451,831
Value of total assets at beginning of year	2015-12-31	$2,377,975
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$10,484
Total income from rents	2015-12-31	$0
Total interest from all sources	2015-12-31	$10,151
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$18,921
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	$18,921
Administrative expenses professional fees incurred	2015-12-31	$7,402
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$250,000
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
Amount of non-exempt transactions with any party-in-interest	2015-12-31	$0
Contributions received from participants	2015-12-31	$111,245
Participant contributions at end of year	2015-12-31	$164,967
Participant contributions at beginning of year	2015-12-31	$152,280
Participant contributions at end of year	2015-12-31	$0
Participant contributions at beginning of year	2015-12-31	$4,045
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$105,071
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2015-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$0
Other income not declared elsewhere	2015-12-31	$4
Administrative expenses (other) incurred	2015-12-31	$0
Liabilities. Value of operating payables at beginning of year	2015-12-31	$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	2015-12-31	No
Income. Non cash contributions	2015-12-31	$0
Value of net income/loss	2015-12-31	$73,856
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$2,451,831
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$2,377,975
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
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2015-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2015-12-31	$0
Investment advisory and management fees	2015-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$1,900,354
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$1,743,585
Value of interest in pooled separate accounts at end of year	2015-12-31	$214,549
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$292,047
Interest on participant loans	2015-12-31	$5,736
Income. Interest from loans (other than to participants)	2015-12-31	$0
Interest earned on other investments	2015-12-31	$4,415
Income. Interest from US Government securities	2015-12-31	$0
Income. Interest from corporate debt instruments	2015-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$171,132
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$182,117
Expenses. Payments to insurance carriers foe the provision of benefits	2015-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-25,718
Net investment gain/loss from pooled separate accounts	2015-12-31	$-3,322
Net investment gain or loss from common/collective trusts	2015-12-31	$0
Net gain/loss from 103.12 investment entities	2015-12-31	$0
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
Contributions received in cash from employer	2015-12-31	$102,477
Employer contributions (assets) at end of year	2015-12-31	$829
Employer contributions (assets) at beginning of year	2015-12-31	$3,901
Income. Dividends from preferred stock	2015-12-31	$0
Income. Dividends from common stock	2015-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$234,489
Contract administrator fees	2015-12-31	$3,082
Liabilities. Value of benefit claims payable at beginning of year	2015-12-31	$0
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
Aggregate proceeds on sale of assets	2015-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2015-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2015-12-31	$0
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	JAMES Q WHITEHEAD, CPA INC.
Accountancy firm EIN	2015-12-31	202114822
2014 : HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2014 401k financial data
Unrealized appreciation/depreciation of real estate assets	2014-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2014-12-31	$0
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total transfer of assets to 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
Expenses. Interest paid	2014-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$365,656
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$282,294
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$272,953
Expenses. Certain deemed distributions of participant loans	2014-12-31	$0
Value of total corrective distributions	2014-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$213,453
Value of total assets at end of year	2014-12-31	$2,377,975
Value of total assets at beginning of year	2014-12-31	$2,294,613
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$9,341
Total income from rents	2014-12-31	$0
Total interest from all sources	2014-12-31	$9,632
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$22,880
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	$22,880
Administrative expenses professional fees incurred	2014-12-31	$6,500
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$250,000
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
Amount of non-exempt transactions with any party-in-interest	2014-12-31	$0
Contributions received from participants	2014-12-31	$109,096
Participant contributions at end of year	2014-12-31	$152,280
Participant contributions at beginning of year	2014-12-31	$121,774
Participant contributions at end of year	2014-12-31	$4,045
Participant contributions at beginning of year	2014-12-31	$4,058
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 year	2014-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$0
Other income not declared elsewhere	2014-12-31	$550
Administrative expenses (other) incurred	2014-12-31	$0
Liabilities. Value of operating payables at beginning of year	2014-12-31	$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	2014-12-31	No
Income. Non cash contributions	2014-12-31	$0
Value of net income/loss	2014-12-31	$83,362
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$2,377,975
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$2,294,613
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
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2014-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2014-12-31	$0
Investment advisory and management fees	2014-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$1,743,585
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$1,615,151
Value of interest in pooled separate accounts at end of year	2014-12-31	$292,047
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$316,462
Interest on participant loans	2014-12-31	$3,900
Income. Interest from loans (other than to participants)	2014-12-31	$0
Interest earned on other investments	2014-12-31	$5,732
Income. Interest from US Government securities	2014-12-31	$0
Income. Interest from corporate debt instruments	2014-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$182,117
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$233,332
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$86,753
Net investment gain/loss from pooled separate accounts	2014-12-31	$32,388
Net investment gain or loss from common/collective trusts	2014-12-31	$0
Net gain/loss from 103.12 investment entities	2014-12-31	$0
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	Yes
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	$104,357
Employer contributions (assets) at end of year	2014-12-31	$3,901
Employer contributions (assets) at beginning of year	2014-12-31	$3,836
Income. Dividends from preferred stock	2014-12-31	$0
Income. Dividends from common stock	2014-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$272,953
Contract administrator fees	2014-12-31	$2,841
Liabilities. Value of benefit claims payable at beginning of year	2014-12-31	$0
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
Aggregate proceeds on sale of assets	2014-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2014-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2014-12-31	$0
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	Qualified
Accountancy firm name	2014-12-31	JAMES Q WHITEHEAD, CPA INC.
Accountancy firm EIN	2014-12-31	202114822
2013 : HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2013 401k financial data
Unrealized appreciation/depreciation of real estate assets	2013-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2013-12-31	$0
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total transfer of assets to this plan	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
Expenses. Interest paid	2013-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$604,155
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$289,178
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$277,622
Expenses. Certain deemed distributions of participant loans	2013-12-31	$3,245
Value of total corrective distributions	2013-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$212,486
Value of total assets at end of year	2013-12-31	$2,294,613
Value of total assets at beginning of year	2013-12-31	$1,979,636
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$8,311
Total income from rents	2013-12-31	$0
Total interest from all sources	2013-12-31	$11,714
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$17,814
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-12-31	$17,814
Administrative expenses professional fees incurred	2013-12-31	$5,800
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$250,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
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
Amount of non-exempt transactions with any party-in-interest	2013-12-31	$0
Contributions received from participants	2013-12-31	$110,881
Participant contributions at end of year	2013-12-31	$121,774
Participant contributions at beginning of year	2013-12-31	$135,338
Participant contributions at end of year	2013-12-31	$4,058
Participant contributions at beginning of year	2013-12-31	$4,225
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2013-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-12-31	$0
Other income not declared elsewhere	2013-12-31	$0
Administrative expenses (other) incurred	2013-12-31	$0
Liabilities. Value of operating payables at beginning of year	2013-12-31	$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	2013-12-31	No
Income. Non cash contributions	2013-12-31	$0
Value of net income/loss	2013-12-31	$314,977
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$2,294,613
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$1,979,636
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
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2013-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2013-12-31	$0
Investment advisory and management fees	2013-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$1,615,151
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$1,272,504
Value of interest in pooled separate accounts at end of year	2013-12-31	$316,462
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$278,313
Interest on participant loans	2013-12-31	$3,925
Income. Interest from loans (other than to participants)	2013-12-31	$0
Interest earned on other investments	2013-12-31	$7,789
Income. Interest from US Government securities	2013-12-31	$0
Income. Interest from corporate debt instruments	2013-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$233,332
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$285,405
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$282,101
Net investment gain/loss from pooled separate accounts	2013-12-31	$80,040
Net investment gain or loss from common/collective trusts	2013-12-31	$0
Net gain/loss from 103.12 investment entities	2013-12-31	$0
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	Yes
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$101,605
Employer contributions (assets) at end of year	2013-12-31	$3,836
Employer contributions (assets) at beginning of year	2013-12-31	$3,851
Income. Dividends from preferred stock	2013-12-31	$0
Income. Dividends from common stock	2013-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$277,622
Contract administrator fees	2013-12-31	$2,511
Liabilities. Value of benefit claims payable at beginning of year	2013-12-31	$0
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
Aggregate proceeds on sale of assets	2013-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2013-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2013-12-31	$0
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	JAMES Q WHITEHEAD
Accountancy firm EIN	2013-12-31	202114822
2012 : HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2012 401k financial data
Unrealized appreciation/depreciation of real estate assets	2012-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2012-12-31	$0
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total transfer of assets to this plan	2012-12-31	$0
Total transfer of assets from this plan	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
Expenses. Interest paid	2012-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$435,425
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$181,236
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$173,567
Expenses. Certain deemed distributions of participant loans	2012-12-31	$0
Value of total corrective distributions	2012-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$220,295
Value of total assets at end of year	2012-12-31	$1,979,636
Value of total assets at beginning of year	2012-12-31	$1,725,447
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$7,669
Total income from rents	2012-12-31	$0
Total interest from all sources	2012-12-31	$12,775
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$18,405
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$18,405
Administrative expenses professional fees incurred	2012-12-31	$4,842
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$100,000
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
Amount of non-exempt transactions with any party-in-interest	2012-12-31	$0
Contributions received from participants	2012-12-31	$114,799
Participant contributions at end of year	2012-12-31	$135,338
Participant contributions at beginning of year	2012-12-31	$136,583
Participant contributions at end of year	2012-12-31	$4,225
Participant contributions at beginning of year	2012-12-31	$9,344
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2012-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$0
Other income not declared elsewhere	2012-12-31	$0
Administrative expenses (other) incurred	2012-12-31	$0
Liabilities. Value of operating payables at beginning of year	2012-12-31	$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	2012-12-31	No
Income. Non cash contributions	2012-12-31	$0
Value of net income/loss	2012-12-31	$254,189
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$1,979,636
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$1,725,447
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
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2012-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2012-12-31	$0
Investment advisory and management fees	2012-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$1,272,504
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$571,160
Value of interest in pooled separate accounts at end of year	2012-12-31	$278,313
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$741,627
Interest on participant loans	2012-12-31	$4,606
Income. Interest from loans (other than to participants)	2012-12-31	$0
Interest earned on other investments	2012-12-31	$8,169
Income. Interest from US Government securities	2012-12-31	$0
Income. Interest from corporate debt instruments	2012-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$285,405
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$258,031
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$105,094
Net investment gain/loss from pooled separate accounts	2012-12-31	$78,856
Net investment gain or loss from common/collective trusts	2012-12-31	$0
Net gain/loss from 103.12 investment entities	2012-12-31	$0
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	Yes
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$105,496
Employer contributions (assets) at end of year	2012-12-31	$3,851
Employer contributions (assets) at beginning of year	2012-12-31	$8,702
Income. Dividends from preferred stock	2012-12-31	$0
Income. Dividends from common stock	2012-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$173,567
Contract administrator fees	2012-12-31	$2,827
Liabilities. Value of benefit claims payable at beginning of year	2012-12-31	$0
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
Aggregate proceeds on sale of assets	2012-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2012-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2012-12-31	$0
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	JAMES Q WHITEHEAD, CPA, INC
Accountancy firm EIN	2012-12-31	202114822
2011 : HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2011 401k financial data
Unrealized appreciation/depreciation of real estate assets	2011-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2011-12-31	$0
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total transfer of assets to this plan	2011-12-31	$0
Total transfer of assets from this plan	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
Expenses. Interest paid	2011-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$231,418
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$233,035
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$226,065
Expenses. Certain deemed distributions of participant loans	2011-12-31	$0
Value of total corrective distributions	2011-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$241,459
Value of total assets at end of year	2011-12-31	$1,725,447
Value of total assets at beginning of year	2011-12-31	$1,727,064
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$6,970
Total income from rents	2011-12-31	$0
Total interest from all sources	2011-12-31	$11,269
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$7,043
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$7,043
Administrative expenses professional fees incurred	2011-12-31	$4,888
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$100,000
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
Amount of non-exempt transactions with any party-in-interest	2011-12-31	$0
Contributions received from participants	2011-12-31	$125,154
Participant contributions at end of year	2011-12-31	$136,583
Participant contributions at beginning of year	2011-12-31	$97,349
Participant contributions at end of year	2011-12-31	$9,344
Participant contributions at beginning of year	2011-12-31	$12,820
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2011-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$0
Other income not declared elsewhere	2011-12-31	$0
Administrative expenses (other) incurred	2011-12-31	$0
Liabilities. Value of operating payables at beginning of year	2011-12-31	$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	2011-12-31	No
Income. Non cash contributions	2011-12-31	$0
Value of net income/loss	2011-12-31	$-1,617
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$1,725,447
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$1,727,064
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
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2011-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2011-12-31	$0
Investment advisory and management fees	2011-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$571,160
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$566,210
Value of interest in pooled separate accounts at end of year	2011-12-31	$741,627
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$742,326
Interest on participant loans	2011-12-31	$3,778
Income. Interest from loans (other than to participants)	2011-12-31	$0
Interest earned on other investments	2011-12-31	$7,491
Income. Interest from US Government securities	2011-12-31	$0
Income. Interest from corporate debt instruments	2011-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$258,031
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$296,604
Expenses. Payments to insurance carriers foe the provision of benefits	2011-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-29,795
Net investment gain/loss from pooled separate accounts	2011-12-31	$1,442
Net investment gain or loss from common/collective trusts	2011-12-31	$0
Net gain/loss from 103.12 investment entities	2011-12-31	$0
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	Yes
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$116,305
Employer contributions (assets) at end of year	2011-12-31	$8,702
Employer contributions (assets) at beginning of year	2011-12-31	$11,755
Income. Dividends from preferred stock	2011-12-31	$0
Income. Dividends from common stock	2011-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$226,065
Contract administrator fees	2011-12-31	$2,082
Liabilities. Value of benefit claims payable at beginning of year	2011-12-31	$0
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
Aggregate proceeds on sale of assets	2011-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2011-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2011-12-31	$0
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	JAMES Q WHITEHEAD, CPA INC
Accountancy firm EIN	2011-12-31	202114822
2010 : HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2010 401k financial data
Unrealized appreciation/depreciation of real estate assets	2010-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2010-12-31	$0
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total transfer of assets to this plan	2010-12-31	$0
Total transfer of assets from this plan	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
Expenses. Interest paid	2010-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$432,988
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$287,404
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$280,541
Expenses. Certain deemed distributions of participant loans	2010-12-31	$0
Value of total corrective distributions	2010-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$251,329
Value of total assets at end of year	2010-12-31	$1,727,064
Value of total assets at beginning of year	2010-12-31	$1,581,480
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$6,863
Total income from rents	2010-12-31	$0
Total interest from all sources	2010-12-31	$14,618
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$5,600
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2010-12-31	$5,600
Administrative expenses professional fees incurred	2010-12-31	$4,899
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$100,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Amount of non-exempt transactions with any party-in-interest	2010-12-31	$0
Contributions received from participants	2010-12-31	$130,409
Participant contributions at end of year	2010-12-31	$97,349
Participant contributions at beginning of year	2010-12-31	$124,781
Participant contributions at end of year	2010-12-31	$12,820
Participant contributions at beginning of year	2010-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$3,656
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2010-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$0
Other income not declared elsewhere	2010-12-31	$0
Administrative expenses (other) incurred	2010-12-31	$0
Liabilities. Value of operating payables at beginning of year	2010-12-31	$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	2010-12-31	No
Income. Non cash contributions	2010-12-31	$0
Value of net income/loss	2010-12-31	$145,584
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$1,727,064
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$1,581,480
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
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2010-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2010-12-31	$0
Investment advisory and management fees	2010-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$566,210
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$440,870
Value of interest in pooled separate accounts at end of year	2010-12-31	$742,326
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$697,018
Interest on participant loans	2010-12-31	$4,563
Income. Interest from loans (other than to participants)	2010-12-31	$0
Interest earned on other investments	2010-12-31	$10,055
Income. Interest from US Government securities	2010-12-31	$0
Income. Interest from corporate debt instruments	2010-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$296,604
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$318,811
Expenses. Payments to insurance carriers foe the provision of benefits	2010-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$71,482
Net investment gain/loss from pooled separate accounts	2010-12-31	$89,959
Net investment gain or loss from common/collective trusts	2010-12-31	$0
Net gain/loss from 103.12 investment entities	2010-12-31	$0
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	Yes
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$117,264
Employer contributions (assets) at end of year	2010-12-31	$11,755
Employer contributions (assets) at beginning of year	2010-12-31	$0
Income. Dividends from preferred stock	2010-12-31	$0
Income. Dividends from common stock	2010-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$280,541
Contract administrator fees	2010-12-31	$1,964
Liabilities. Value of benefit claims payable at beginning of year	2010-12-31	$0
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
Aggregate proceeds on sale of assets	2010-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2010-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2010-12-31	$0
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	JAMES Q WHITEHEAD, CPA, INC
Accountancy firm EIN	2010-12-31	202114822
2009 : HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT 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 HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN

2022: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	This submission is the final filing	No
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: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
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
2016: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	This submission is the final filing	No
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 – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
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 – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT 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 – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
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 – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
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 – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	Yes
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 – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	Yes
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 – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
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 – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes
2008: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2008 form 5500 responses
2008-01-01	Type of plan entity	Single employer plan
2008-01-01	Submission has been amended	No
2008-01-01	This submission is the final filing	No
2008-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-01-01	Plan is a collectively bargained plan	No
2007: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2007 form 5500 responses
2007-01-01	Type of plan entity	Single employer plan
2007-01-01	Submission has been amended	No
2007-01-01	This submission is the final filing	No
2007-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2007-01-01	Plan is a collectively bargained plan	No
2006: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2006 form 5500 responses
2006-01-01	Type of plan entity	Single employer plan
2006-01-01	Submission has been amended	No
2006-01-01	This submission is the final filing	No
2006-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2006-01-01	Plan is a collectively bargained plan	No
2005: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2005 form 5500 responses
2005-01-01	Type of plan entity	Single employer plan
2005-01-01	Submission has been amended	No
2005-01-01	This submission is the final filing	No
2005-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2005-01-01	Plan is a collectively bargained plan	No
2004: HENRY COUNTY NURSING HOME AND REHABILITATION FACILITY RETIREMENT PLAN 2004 form 5500 responses
2004-01-01	Type of plan entity	Single employer plan
2004-01-01	Submission has been amended	No
2004-01-01	This submission is the final filing	No
2004-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2004-01-01	Plan is a collectively bargained plan	No

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441750

Policy instance

Insurance contract or identification number	441750
Number of Individuals Covered	150
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $170
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	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 $170
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441465

Policy instance

Insurance contract or identification number	441465
Number of Individuals Covered	150
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $108
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $108
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441750

Policy instance

Insurance contract or identification number	441750
Number of Individuals Covered	175
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $162
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	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 $162
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441465

Policy instance

Insurance contract or identification number	441465
Number of Individuals Covered	175
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $102
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $102
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441465

Policy instance

Insurance contract or identification number	441465
Number of Individuals Covered	211
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $105
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $105
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441750

Policy instance

Insurance contract or identification number	441750
Number of Individuals Covered	211
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $131
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	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 $131
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441750

Policy instance

Insurance contract or identification number	441750
Number of Individuals Covered	280
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $126
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	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 $126
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441465

Policy instance

Insurance contract or identification number	441465
Number of Individuals Covered	280
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $104
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $104
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441750

Policy instance

Insurance contract or identification number	441750
Number of Individuals Covered	309
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $126
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	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 $126
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441465

Policy instance

Insurance contract or identification number	441465
Number of Individuals Covered	309
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $101
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $101
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441750

Policy instance

Insurance contract or identification number	441750
Number of Individuals Covered	214
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $114
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	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 $87
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	HOLLIFIELD, PATRICK T.

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441465

Policy instance

Insurance contract or identification number	441465
Number of Individuals Covered	214
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $102
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $73
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	HOLLIFIELD, PATRICK T.

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441750

Policy instance

Insurance contract or identification number	441750
Number of Individuals Covered	219
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $157
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	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 $157
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	HOLLIFIELD, PATRICK T.

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441465

Policy instance

Insurance contract or identification number	441465
Number of Individuals Covered	219
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $109
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $109
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	HOLLIFIELD, PATRICK T.

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441750

Policy instance

Insurance contract or identification number	441750
Number of Individuals Covered	230
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $190
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	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 $190
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	HOLLIFIELD, PATRICK T.

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441465

Policy instance

Insurance contract or identification number	441465
Number of Individuals Covered	230
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $133
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $133
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	HOLLIFIELD, PATRICK T.

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441750

Policy instance

Insurance contract or identification number	441750
Number of Individuals Covered	312
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441465

Policy instance

Insurance contract or identification number	441465
Number of Individuals Covered	312
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $952
Total amount of fees paid to insurance company	USD $400
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $952
Amount paid for insurance broker fees	400
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE AND PRORATED INCENTIVE, NOT DEDUCTED FROM PLAN
Insurance broker organization code?	3
Insurance broker name	HOLLIFIELD, PATRICK T.

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441750

Policy instance

Insurance contract or identification number	441750
Number of Individuals Covered	241
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441465

Policy instance

Insurance contract or identification number	441465
Number of Individuals Covered	241
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $727
Total amount of fees paid to insurance company	USD $41
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $727
Amount paid for insurance broker fees	41
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	3
Insurance broker name	HOLLIFIELD, PATRICK T.

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441465

Policy instance

Insurance contract or identification number	441465
Number of Individuals Covered	203
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $776
Total amount of fees paid to insurance company	USD $172
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

441465

Policy instance

Insurance contract or identification number	441465
Number of Individuals Covered	226
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $717
Total amount of fees paid to insurance company	USD $167
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	HENRY COUNTY NURSING HOME
Employer identification number (EIN):	630962057
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities