401k Plan data: MON AMI, A PRIVATE CAREGIVER SERVICE, INC. 401(K) PLAN plan

MON AMI, A PRIVATE CAREGIVER SERVICE, INC. 401(K) PLAN 401k Plan overview

Plan Name	MON AMI, A PRIVATE CAREGIVER SERVICE, INC. 401(K) PLAN
Plan identification number	001

MON AMI, A PRIVATE CAREGIVER SERVICE, INC. 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.
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

MON AMI, A PRIVATE CAREGIVER SERVICE, INC. has sponsored the creation of one or more 401k plans.

Company Name: MON AMI, A PRIVATE CAREGIVER SERVICE, INC.

Employer identification number (EIN): 061753049

NAIC Classification: 721310
NAIC Description: Rooming and Boarding Houses

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MON AMI, A PRIVATE CAREGIVER SERVICE, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2013-01-01 DEBRA WILLIAMS
001 2012-01-01 DEBRA WILLIAMS
001 2011-01-01 DEBRA WILLIAMS

Plan id#	Filing Submission Date	Name of Administrator
001	2013-01-01	DEBRA WILLIAMS
001	2012-01-01	DEBRA WILLIAMS
001	2011-01-01	DEBRA WILLIAMS

Plan Statistics for MON AMI, A PRIVATE CAREGIVER SERVICE, INC. 401(K) PLAN

401k plan membership statisitcs for MON AMI, A PRIVATE CAREGIVER SERVICE, INC. 401(K) PLAN

Measure Date Value
2013: MON AMI, A PRIVATE CAREGIVER SERVICE, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 14
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 0
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 0
Total of all active and inactive participants 2013-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 0
Number of participants with account balances 2013-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: MON AMI, A PRIVATE CAREGIVER SERVICE, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 25
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 0
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 14
Total of all active and inactive participants 2012-01-01 14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 14
Number of participants with account balances 2012-01-01 14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: MON AMI, A PRIVATE CAREGIVER SERVICE, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 36
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 25
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 0
Total of all active and inactive participants 2011-01-01 25
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 25
Number of participants with account balances 2011-01-01 25

Measure	Date	Value
2013: MON AMI, A PRIVATE CAREGIVER SERVICE, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	14
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	0
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	0
Total of all active and inactive participants	2013-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	0
Number of participants with account balances	2013-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: MON AMI, A PRIVATE CAREGIVER SERVICE, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	25
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	0
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	14
Total of all active and inactive participants	2012-01-01	14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	14
Number of participants with account balances	2012-01-01	14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: MON AMI, A PRIVATE CAREGIVER SERVICE, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	36
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	25
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	0
Total of all active and inactive participants	2011-01-01	25
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	25
Number of participants with account balances	2011-01-01	25

Financial Data on MON AMI, A PRIVATE CAREGIVER SERVICE, INC. 401(K) PLAN

Measure	Date	Value
2013 : MON AMI, A PRIVATE CAREGIVER SERVICE, INC. 401(K) PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$88
Expenses. Total of all expenses incurred	2013-12-31	$3,593
Benefits paid (including direct rollovers)	2013-12-31	$3,463
Total plan assets at end of year	2013-12-31	$0
Total plan assets at beginning of year	2013-12-31	$3,505
Expenses. Other expenses not covered elsewhere	2013-12-31	$130
Other income received	2013-12-31	$88
Net income (gross income less expenses)	2013-12-31	$-3,505
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$3,505
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : MON AMI, A PRIVATE CAREGIVER SERVICE, INC. 401(K) PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$1,750
Expenses. Total of all expenses incurred	2012-12-31	$16,676
Benefits paid (including direct rollovers)	2012-12-31	$14,915
Total plan assets at end of year	2012-12-31	$3,505
Total plan assets at beginning of year	2012-12-31	$18,431
Value of fidelity bond covering the plan	2012-12-31	$10,000
Total contributions received or receivable from participants	2012-12-31	$620
Expenses. Other expenses not covered elsewhere	2012-12-31	$1,761
Other income received	2012-12-31	$1,130
Net income (gross income less expenses)	2012-12-31	$-14,926
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$3,505
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$18,431
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : MON AMI, A PRIVATE CAREGIVER SERVICE, INC. 401(K) PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$10,636
Expenses. Total of all expenses incurred	2011-12-31	$3,829
Benefits paid (including direct rollovers)	2011-12-31	$2,046
Total plan assets at end of year	2011-12-31	$18,431
Total plan assets at beginning of year	2011-12-31	$11,624
Value of fidelity bond covering the plan	2011-12-31	$10,000
Total contributions received or receivable from participants	2011-12-31	$2,985
Expenses. Other expenses not covered elsewhere	2011-12-31	$1,783
Other income received	2011-12-31	$-285
Net income (gross income less expenses)	2011-12-31	$6,807
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$18,431
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$11,624
Total contributions received or receivable from employer(s)	2011-12-31	$7,936
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : MON AMI, A PRIVATE CAREGIVER SERVICE, INC. 401(K) PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$11,624
Expenses. Total of all expenses incurred	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$11,624
Total plan assets at beginning of year	2010-12-31	$0
Value of fidelity bond covering the plan	2010-12-31	$10,000
Net income (gross income less expenses)	2010-12-31	$11,624
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$11,624
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$0
Total contributions received or receivable from employer(s)	2010-12-31	$11,624
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0

Form 5500 Responses for MON AMI, A PRIVATE CAREGIVER SERVICE, INC. 401(K) PLAN

2013: MON AMI, A PRIVATE CAREGIVER SERVICE, INC. 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	Yes
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: MON AMI, A PRIVATE CAREGIVER SERVICE, INC. 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 is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: MON AMI, A PRIVATE CAREGIVER SERVICE, INC. 401(K) 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 – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	MON AMI, A PRIVATE CAREGIVER SERVICE, INC.
Employer identification number (EIN):	061753049
NAIC Classification:	721310
NAIC Description:	Rooming and Boarding Houses