401k Plan data: PASSAGE HEALTHCARE 401(K) PLAN plan

PASSAGE HEALTHCARE 401(K) PLAN 401k Plan overview

Plan Name	PASSAGE HEALTHCARE 401(K) PLAN
Plan identification number	001

PASSAGE HEALTHCARE 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

PASSAGE HEALTHCARE, LLC has sponsored the creation of one or more 401k plans.

Company Name: PASSAGE HEALTHCARE, LLC

Employer identification number (EIN): 660833572

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PASSAGE HEALTHCARE 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 FRANCHESCA MARTIN
001 2015-01-01 LARRY COTTLE

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2016-01-01	FRANCHESCA MARTIN
001	2015-01-01	LARRY COTTLE

Plan Statistics for PASSAGE HEALTHCARE 401(K) PLAN

401k plan membership statisitcs for PASSAGE HEALTHCARE 401(K) PLAN

Measure Date Value
2016: PASSAGE HEALTHCARE 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 412
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 384
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 108
Total of all active and inactive participants 2016-01-01 492
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 492
Number of participants with account balances 2016-01-01 270
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 10
2015: PASSAGE HEALTHCARE 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 205
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 436
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 37
Total of all active and inactive participants 2015-01-01 473
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 473
Number of participants with account balances 2015-01-01 210
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0

Measure	Date	Value
2016: PASSAGE HEALTHCARE 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	412
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	384
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	108
Total of all active and inactive participants	2016-01-01	492
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	492
Number of participants with account balances	2016-01-01	270
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	10
2015: PASSAGE HEALTHCARE 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	205
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	436
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	37
Total of all active and inactive participants	2015-01-01	473
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	473
Number of participants with account balances	2015-01-01	210
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0

Financial Data on PASSAGE HEALTHCARE 401(K) PLAN

Measure	Date	Value
2016 : PASSAGE HEALTHCARE 401(K) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$496,187
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$57,632
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$44,549
Value of total corrective distributions	2016-12-31	$11,008
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$400,811
Value of total assets at end of year	2016-12-31	$2,103,423
Value of total assets at beginning of year	2016-12-31	$1,664,868
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$2,075
Total interest from all sources	2016-12-31	$76
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$304,736
Participant contributions at end of year	2016-12-31	$25,577
Participant contributions at beginning of year	2016-12-31	$15,271
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$6,086
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$438,555
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$2,103,423
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$1,664,868
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in pooled separate accounts at end of year	2016-12-31	$1,974,742
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$1,578,526
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-12-31	$76
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$62,893
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$53,370
Net investment gain/loss from pooled separate accounts	2016-12-31	$95,300
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	Yes
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	$89,989
Employer contributions (assets) at end of year	2016-12-31	$40,211
Employer contributions (assets) at beginning of year	2016-12-31	$17,701
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$44,549
Contract administrator fees	2016-12-31	$2,075
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
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	PADDEN, GUERRINI & ASSOCIATES, P.C.
Accountancy firm EIN	2016-12-31	232290841
2015 : PASSAGE HEALTHCARE 401(K) PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$382,303
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$414,603
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$412,326
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$431,731
Value of total assets at end of year	2015-12-31	$1,664,868
Value of total assets at beginning of year	2015-12-31	$1,697,168
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$2,277
Total interest from all sources	2015-12-31	$29
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$170,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$260,883
Participant contributions at end of year	2015-12-31	$15,271
Participant contributions at beginning of year	2015-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$94,503
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-32,300
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$1,664,868
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$1,697,168
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in pooled separate accounts at end of year	2015-12-31	$1,578,526
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$1,626,107
Interest earned on other investments	2015-12-31	$18
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$11
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$53,370
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$59,505
Net investment gain/loss from pooled separate accounts	2015-12-31	$-49,457
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	$76,345
Employer contributions (assets) at end of year	2015-12-31	$17,701
Employer contributions (assets) at beginning of year	2015-12-31	$11,556
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$412,326
Contract administrator fees	2015-12-31	$2,277
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	PADDEN, GUERRINI & ASSOCIATES, P.C.
Accountancy firm EIN	2015-12-31	232290841

Form 5500 Responses for PASSAGE HEALTHCARE 401(K) PLAN

2016: PASSAGE HEALTHCARE 401(K) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	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: PASSAGE HEALTHCARE 401(K) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – 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

Insurance Providers Used on plan

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

GH4702

Policy instance

Insurance contract or identification number	GH4702
Number of Individuals Covered	189
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $9,111
Total amount of fees paid to insurance company	USD $891
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,111
Insurance broker organization code?	7
Amount paid for insurance broker fees	891
Additional information about fees paid to insurance broker	TPA PARTNERSHIP PROGRAM
Insurance broker name	PA RETIREMENT SOLUTIONS, INC.

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Company Name:	PASSAGE HEALTHCARE, LLC
Employer identification number (EIN):	660833572
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities