401k Plan data: EMPLOYEE SAFETY PROGRAM BENEFIT PLAN plan

EMPLOYEE SAFETY PROGRAM BENEFIT PLAN 401k Plan overview

Plan Name	EMPLOYEE SAFETY PROGRAM BENEFIT PLAN
Plan identification number	501

EMPLOYEE SAFETY PROGRAM BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Temporary disability (accident and sickness) Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

DIVERSICARE LEASING CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: DIVERSICARE LEASING CORPORATION

Employer identification number (EIN): 760770964

NAIC Classification: 811190

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE SAFETY PROGRAM BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2014-01-01 VICKY DICLEMENTE
501 2013-01-01 VICKY DICLEMENTE
501 2012-01-01 VICKY DICLEMENTE
501 2011-01-01 VICKY DICLEMENTE
501 2009-01-01 2010-07-12
501 2009-01-01 VICKY DICLEMENTE
501 2009-01-01 VICKY DICLEMENTE

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2014-01-01	VICKY DICLEMENTE
501	2013-01-01	VICKY DICLEMENTE
501	2012-01-01	VICKY DICLEMENTE
501	2011-01-01	VICKY DICLEMENTE
501	2009-01-01		2010-07-12
501	2009-01-01	VICKY DICLEMENTE
501	2009-01-01	VICKY DICLEMENTE

Plan Statistics for EMPLOYEE SAFETY PROGRAM BENEFIT PLAN

401k plan membership statisitcs for EMPLOYEE SAFETY PROGRAM BENEFIT PLAN

Measure Date Value
2014: EMPLOYEE SAFETY PROGRAM BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 82
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 85
Total of all active and inactive participants 2014-01-01 85
Total participants 2014-01-01 85
2013: EMPLOYEE SAFETY PROGRAM BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 96
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 82
Total of all active and inactive participants 2013-01-01 82
Total participants 2013-01-01 82
2012: EMPLOYEE SAFETY PROGRAM BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 85
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 96
Total of all active and inactive participants 2012-01-01 96
Total participants 2012-01-01 96
2011: EMPLOYEE SAFETY PROGRAM BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 87
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 85
Total of all active and inactive participants 2011-01-01 85
Total participants 2011-01-01 85
2009: EMPLOYEE SAFETY PROGRAM BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 96
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 89
Total of all active and inactive participants 2009-01-01 89
Total participants 2009-01-01 89

Measure	Date	Value
2014: EMPLOYEE SAFETY PROGRAM BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	82
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	85
Total of all active and inactive participants	2014-01-01	85
Total participants	2014-01-01	85
2013: EMPLOYEE SAFETY PROGRAM BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	96
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	82
Total of all active and inactive participants	2013-01-01	82
Total participants	2013-01-01	82
2012: EMPLOYEE SAFETY PROGRAM BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	85
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	96
Total of all active and inactive participants	2012-01-01	96
Total participants	2012-01-01	96
2011: EMPLOYEE SAFETY PROGRAM BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	87
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	85
Total of all active and inactive participants	2011-01-01	85
Total participants	2011-01-01	85
2009: EMPLOYEE SAFETY PROGRAM BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	96
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	89
Total of all active and inactive participants	2009-01-01	89
Total participants	2009-01-01	89

Form 5500 Responses for EMPLOYEE SAFETY PROGRAM BENEFIT PLAN

2014: EMPLOYEE SAFETY PROGRAM BENEFIT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: EMPLOYEE SAFETY PROGRAM BENEFIT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
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 – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: EMPLOYEE SAFETY PROGRAM BENEFIT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
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 – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: EMPLOYEE SAFETY PROGRAM BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
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 – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: EMPLOYEE SAFETY PROGRAM BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

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Company Name:	DIVERSICARE LEASING CORPORATION
Employer identification number (EIN):	760770964
NAIC Classification:	811190