401k Plan data: FOREST FARM HEALTHCARE CENTRE 401(K) PLAN plan

FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 401k Plan overview

Plan Name	FOREST FARM HEALTHCARE CENTRE 401(K) PLAN
Plan identification number	001

FOREST FARM HEALTHCARE CENTRE 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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

401k Sponsoring company profile

FOREST FARM HEALTHCARE CENTRE, INC. has sponsored the creation of one or more 401k plans.

Company Name: FOREST FARM HEALTHCARE CENTRE, INC.

Employer identification number (EIN): 050358785

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FOREST FARM HEALTHCARE CENTRE 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2017-01-01 JENNIFER MELLO
001 2016-01-01 JENNIFER MELLO
001 2015-01-01 JENNIFER MELLO
001 2014-01-01 JENNIFER MELLO
001 2013-01-01 JENNIFER MELLO
001 2012-01-01 JENNIFER MELLO JENNIFER MELLO 2013-05-14
001 2011-01-01 JENNIFER MELLO
001 2010-01-01 JENNIFER MELLO
001 2009-01-01 JENNIFER MELLO

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2017-01-01	JENNIFER MELLO
001	2016-01-01	JENNIFER MELLO
001	2015-01-01	JENNIFER MELLO
001	2014-01-01	JENNIFER MELLO
001	2013-01-01	JENNIFER MELLO
001	2012-01-01	JENNIFER MELLO	JENNIFER MELLO	2013-05-14
001	2011-01-01	JENNIFER MELLO
001	2010-01-01	JENNIFER MELLO
001	2009-01-01	JENNIFER MELLO

Plan Statistics for FOREST FARM HEALTHCARE CENTRE 401(K) PLAN

401k plan membership statisitcs for FOREST FARM HEALTHCARE CENTRE 401(K) PLAN

Measure Date Value
2017: FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 64
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 0
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 0
Total of all active and inactive participants 2017-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 0
Number of participants with account balances 2017-01-01 0
2016: FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 79
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 63
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 1
Total of all active and inactive participants 2016-01-01 64
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 64
Number of participants with account balances 2016-01-01 3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 78
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 67
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 79
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 79
Number of participants with account balances 2015-01-01 29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 80
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 64
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 14
Total of all active and inactive participants 2014-01-01 78
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 78
Number of participants with account balances 2014-01-01 29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 2
2013: FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 85
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 69
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 10
Total of all active and inactive participants 2013-01-01 79
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 1
Total participants 2013-01-01 80
Number of participants with account balances 2013-01-01 29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 89
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 69
Number of retired or separated participants receiving benefits 2012-01-01 1
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 82
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 3
Total participants 2012-01-01 85
Number of participants with account balances 2012-01-01 39
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 2
2011: FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 91
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 76
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 9
Total of all active and inactive participants 2011-01-01 85
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 4
Total participants 2011-01-01 89
Number of participants with account balances 2011-01-01 42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 1
2010: FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 98
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 81
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 9
Total of all active and inactive participants 2010-01-01 90
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 1
Total participants 2010-01-01 91
Number of participants with account balances 2010-01-01 46
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 95
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 87
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 10
Total of all active and inactive participants 2009-01-01 97
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 1
Total participants 2009-01-01 98
Number of participants with account balances 2009-01-01 50
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2017: FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	64
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	0
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	0
Total of all active and inactive participants	2017-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	0
Number of participants with account balances	2017-01-01	0
2016: FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	79
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	63
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	1
Total of all active and inactive participants	2016-01-01	64
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	64
Number of participants with account balances	2016-01-01	3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	78
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	67
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	79
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	79
Number of participants with account balances	2015-01-01	29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	80
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	64
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	14
Total of all active and inactive participants	2014-01-01	78
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	78
Number of participants with account balances	2014-01-01	29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	2
2013: FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	85
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	69
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	10
Total of all active and inactive participants	2013-01-01	79
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	1
Total participants	2013-01-01	80
Number of participants with account balances	2013-01-01	29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	89
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	69
Number of retired or separated participants receiving benefits	2012-01-01	1
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	82
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	3
Total participants	2012-01-01	85
Number of participants with account balances	2012-01-01	39
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	2
2011: FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	91
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	76
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	9
Total of all active and inactive participants	2011-01-01	85
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	4
Total participants	2011-01-01	89
Number of participants with account balances	2011-01-01	42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	1
2010: FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	98
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	81
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	9
Total of all active and inactive participants	2010-01-01	90
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	1
Total participants	2010-01-01	91
Number of participants with account balances	2010-01-01	46
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	95
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	87
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	10
Total of all active and inactive participants	2009-01-01	97
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	1
Total participants	2009-01-01	98
Number of participants with account balances	2009-01-01	50
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on FOREST FARM HEALTHCARE CENTRE 401(K) PLAN

Measure	Date	Value
2017 : FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2017 401k financial data
Transfers to/from the plan	2017-05-05	$0
Total plan liabilities at end of year	2017-05-05	$0
Total plan liabilities at beginning of year	2017-05-05	$0
Total income from all sources	2017-05-05	$14,588
Expenses. Total of all expenses incurred	2017-05-05	$186,183
Benefits paid (including direct rollovers)	2017-05-05	$153,104
Total plan assets at end of year	2017-05-05	$0
Total plan assets at beginning of year	2017-05-05	$171,595
Value of fidelity bond covering the plan	2017-05-05	$260,000
Total contributions received or receivable from participants	2017-05-05	$0
Expenses. Other expenses not covered elsewhere	2017-05-05	$0
Contributions received from other sources (not participants or employers)	2017-05-05	$0
Other income received	2017-05-05	$14,588
Noncash contributions received	2017-05-05	$0
Net income (gross income less expenses)	2017-05-05	$-171,595
Net plan assets at end of year (total assets less liabilities)	2017-05-05	$0
Net plan assets at beginning of year (total assets less liabilities)	2017-05-05	$171,595
Assets. Value of participant loans	2017-05-05	$0
Total contributions received or receivable from employer(s)	2017-05-05	$0
Value of certain deemed distributions of participant loans	2017-05-05	$32,929
Value of corrective distributions	2017-05-05	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2017-05-05	$150
2016 : FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2016 401k financial data
Transfers to/from the plan	2016-12-31	$0
Total plan liabilities at end of year	2016-12-31	$0
Total plan liabilities at beginning of year	2016-12-31	$0
Total income from all sources	2016-12-31	$135,456
Expenses. Total of all expenses incurred	2016-12-31	$1,208,037
Benefits paid (including direct rollovers)	2016-12-31	$1,206,234
Total plan assets at end of year	2016-12-31	$171,595
Total plan assets at beginning of year	2016-12-31	$1,244,176
Value of fidelity bond covering the plan	2016-12-31	$260,000
Total contributions received or receivable from participants	2016-12-31	$52,363
Expenses. Other expenses not covered elsewhere	2016-12-31	$0
Contributions received from other sources (not participants or employers)	2016-12-31	$0
Other income received	2016-12-31	$63,114
Noncash contributions received	2016-12-31	$0
Net income (gross income less expenses)	2016-12-31	$-1,072,581
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$171,595
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$1,244,176
Assets. Value of participant loans	2016-12-31	$79,161
Total contributions received or receivable from employer(s)	2016-12-31	$19,979
Value of certain deemed distributions of participant loans	2016-12-31	$0
Value of corrective distributions	2016-12-31	$190
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$1,613
2015 : FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2015 401k financial data
Transfers to/from the plan	2015-12-31	$0
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$101,157
Expenses. Total of all expenses incurred	2015-12-31	$55,564
Benefits paid (including direct rollovers)	2015-12-31	$55,102
Total plan assets at end of year	2015-12-31	$1,244,176
Total plan assets at beginning of year	2015-12-31	$1,198,583
Value of fidelity bond covering the plan	2015-12-31	$260,000
Total contributions received or receivable from participants	2015-12-31	$56,721
Expenses. Other expenses not covered elsewhere	2015-12-31	$0
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$23,524
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$45,593
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$1,244,176
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$1,198,583
Assets. Value of participant loans	2015-12-31	$70,972
Total contributions received or receivable from employer(s)	2015-12-31	$20,912
Value of certain deemed distributions of participant loans	2015-12-31	$-27
Value of corrective distributions	2015-12-31	$139
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$350
2014 : FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total plan liabilities at end of year	2014-12-31	$0
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$152,480
Expenses. Total of all expenses incurred	2014-12-31	$107,694
Benefits paid (including direct rollovers)	2014-12-31	$103,303
Total plan assets at end of year	2014-12-31	$1,198,583
Total plan assets at beginning of year	2014-12-31	$1,153,797
Value of fidelity bond covering the plan	2014-12-31	$260,000
Total contributions received or receivable from participants	2014-12-31	$46,661
Expenses. Other expenses not covered elsewhere	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$87,711
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$44,786
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$1,198,583
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$1,153,797
Assets. Value of participant loans	2014-12-31	$27,750
Total contributions received or receivable from employer(s)	2014-12-31	$18,108
Value of certain deemed distributions of participant loans	2014-12-31	$2,305
Value of corrective distributions	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$2,086
2013 : FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total plan liabilities at end of year	2013-12-31	$0
Total income from all sources	2013-12-31	$279,768
Expenses. Total of all expenses incurred	2013-12-31	$514,543
Benefits paid (including direct rollovers)	2013-12-31	$512,643
Total plan assets at end of year	2013-12-31	$1,153,797
Total plan assets at beginning of year	2013-12-31	$1,388,572
Value of fidelity bond covering the plan	2013-12-31	$260,000
Total contributions received or receivable from participants	2013-12-31	$55,443
Expenses. Other expenses not covered elsewhere	2013-12-31	$0
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$209,997
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$-234,775
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$1,153,797
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$1,388,572
Assets. Value of participant loans	2013-12-31	$40,692
Total contributions received or receivable from employer(s)	2013-12-31	$14,328
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$1,900
2012 : FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$221,907
Expenses. Total of all expenses incurred	2012-12-31	$103,961
Benefits paid (including direct rollovers)	2012-12-31	$102,506
Total plan assets at end of year	2012-12-31	$1,388,572
Total plan assets at beginning of year	2012-12-31	$1,270,626
Value of fidelity bond covering the plan	2012-12-31	$260,000
Total contributions received or receivable from participants	2012-12-31	$89,971
Other income received	2012-12-31	$100,697
Net income (gross income less expenses)	2012-12-31	$117,946
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$1,388,572
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$1,270,626
Assets. Value of participant loans	2012-12-31	$26,363
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102	2012-12-31	$7,616
Total contributions received or receivable from employer(s)	2012-12-31	$31,239
Value of corrective distributions	2012-12-31	$880
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$575
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$151,647
Expenses. Total of all expenses incurred	2011-12-31	$90,634
Benefits paid (including direct rollovers)	2011-12-31	$86,244
Total plan assets at end of year	2011-12-31	$1,270,626
Total plan assets at beginning of year	2011-12-31	$1,209,613
Value of fidelity bond covering the plan	2011-12-31	$260,000
Total contributions received or receivable from participants	2011-12-31	$116,946
Other income received	2011-12-31	$-3,312
Net income (gross income less expenses)	2011-12-31	$61,013
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,270,626
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$1,209,613
Assets. Value of participant loans	2011-12-31	$31,588
Total contributions received or receivable from employer(s)	2011-12-31	$38,013
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$125
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$4,265
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$240,077
Expenses. Total of all expenses incurred	2010-12-31	$57,044
Benefits paid (including direct rollovers)	2010-12-31	$55,321
Total plan assets at end of year	2010-12-31	$1,209,613
Total plan assets at beginning of year	2010-12-31	$1,026,580
Value of fidelity bond covering the plan	2010-12-31	$260,000
Total contributions received or receivable from participants	2010-12-31	$112,558
Other income received	2010-12-31	$91,378
Net income (gross income less expenses)	2010-12-31	$183,033
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$1,209,613
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$1,026,580
Assets. Value of participant loans	2010-12-31	$15,972
Total contributions received or receivable from employer(s)	2010-12-31	$36,141
Value of corrective distributions	2010-12-31	$98
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$1,625
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for FOREST FARM HEALTHCARE CENTRE 401(K) PLAN

2017: FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	Yes
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: FOREST FARM HEALTHCARE CENTRE 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 – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: FOREST FARM HEALTHCARE CENTRE 401(K) 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 – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: FOREST FARM HEALTHCARE CENTRE 401(K) 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 funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Mulitple 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 funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Mulitple employer plan
2010-01-01	Submission has been amended	No
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 funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: FOREST FARM HEALTHCARE CENTRE 401(K) PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	FOREST FARM HEALTHCARE CENTRE, INC.
Employer identification number (EIN):	050358785
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities