401k Plan data: BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP plan

BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 401k Plan overview

Plan Name	BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP
Plan identification number	001

BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 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.

401k Sponsoring company profile

BRIODY HEALTH CARE FACILITY, LLC has sponsored the creation of one or more 401k plans.

Company Name: BRIODY HEALTH CARE FACILITY, LLC

Employer identification number (EIN): 160847887

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

Additional information about BRIODY HEALTH CARE FACILITY, LLC

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 2004-12-31

Company Identification Number: 3143911

Legal Registered Office Address: 909 LINCOLN AVENUE
NIAGARA
LOCKPORT
United States of America (USA)
14094

More information about BRIODY HEALTH CARE FACILITY, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2015-01-01 ANN BRIODY PETOCK
001 2014-01-01 ANN BRIODY PETOCK
001 2013-01-01 ANN BRIODY PETOCK
001 2012-01-01 ANN BRIODY PETOCK
001 2011-01-01 ANN BRIODY PETOCK
001 2010-01-01 ANN BRIODY PETOCK
001 2009-01-01 ANN BRIODY PETOCK

Plan id#	Filing Submission Date	Name of Administrator
001	2015-01-01	ANN BRIODY PETOCK
001	2014-01-01	ANN BRIODY PETOCK
001	2013-01-01	ANN BRIODY PETOCK
001	2012-01-01	ANN BRIODY PETOCK
001	2011-01-01	ANN BRIODY PETOCK
001	2010-01-01	ANN BRIODY PETOCK
001	2009-01-01	ANN BRIODY PETOCK

Plan Statistics for BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP

401k plan membership statisitcs for BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP

Measure Date Value
2015: BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 2015 401k membership
Total participants, beginning-of-year 2015-01-01 143
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 114
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 15
Total of all active and inactive participants 2015-01-01 129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 129
Number of participants with account balances 2015-01-01 76
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 4
2014: BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 2014 401k membership
Total participants, beginning-of-year 2014-01-01 128
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 117
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 11
Total of all active and inactive participants 2014-01-01 128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 128
Number of participants with account balances 2014-01-01 83
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 4
2013: BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 2013 401k membership
Total participants, beginning-of-year 2013-01-01 142
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 119
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 2013-01-01 128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 128
Number of participants with account balances 2013-01-01 89
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 5
2012: BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 2012 401k membership
Total participants, beginning-of-year 2012-01-01 132
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 137
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 5
Total of all active and inactive participants 2012-01-01 142
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 142
Number of participants with account balances 2012-01-01 88
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 5
2011: BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 2011 401k membership
Total participants, beginning-of-year 2011-01-01 107
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 127
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 5
Total of all active and inactive participants 2011-01-01 132
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 132
Number of participants with account balances 2011-01-01 82
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 6
2010: BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 2010 401k membership
Total participants, beginning-of-year 2010-01-01 151
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 102
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 2010-01-01 107
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 107
Number of participants with account balances 2010-01-01 83
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 19
2009: BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 2009 401k membership
Total participants, beginning-of-year 2009-01-01 145
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 132
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 6
Total of all active and inactive participants 2009-01-01 138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 138
Number of participants with account balances 2009-01-01 78
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 4

Measure	Date	Value
2015: BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 2015 401k membership
Total participants, beginning-of-year	2015-01-01	143
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	114
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	15
Total of all active and inactive participants	2015-01-01	129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	129
Number of participants with account balances	2015-01-01	76
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	4
2014: BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 2014 401k membership
Total participants, beginning-of-year	2014-01-01	128
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	117
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	11
Total of all active and inactive participants	2014-01-01	128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	128
Number of participants with account balances	2014-01-01	83
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	4
2013: BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 2013 401k membership
Total participants, beginning-of-year	2013-01-01	142
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	119
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	128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	128
Number of participants with account balances	2013-01-01	89
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	5
2012: BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 2012 401k membership
Total participants, beginning-of-year	2012-01-01	132
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	137
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	5
Total of all active and inactive participants	2012-01-01	142
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	142
Number of participants with account balances	2012-01-01	88
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	5
2011: BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 2011 401k membership
Total participants, beginning-of-year	2011-01-01	107
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	127
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	5
Total of all active and inactive participants	2011-01-01	132
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	132
Number of participants with account balances	2011-01-01	82
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	6
2010: BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 2010 401k membership
Total participants, beginning-of-year	2010-01-01	151
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	102
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	107
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	107
Number of participants with account balances	2010-01-01	83
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	19
2009: BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 2009 401k membership
Total participants, beginning-of-year	2009-01-01	145
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	132
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	6
Total of all active and inactive participants	2009-01-01	138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	138
Number of participants with account balances	2009-01-01	78
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	4

Financial Data on BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP

Measure	Date	Value
2015 : BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 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	$212,727
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$449,525
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$447,052
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$176,037
Value of total assets at end of year	2015-12-31	$2,675,928
Value of total assets at beginning of year	2015-12-31	$2,912,726
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$2,473
Total interest from all sources	2015-12-31	$1,974
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$172,555
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	$172,555
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$300,000
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	$155,514
Participant contributions at end of year	2015-12-31	$53,144
Participant contributions at beginning of year	2015-12-31	$43,967
Administrative expenses (other) incurred	2015-12-31	$2,473
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	$-236,798
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$2,675,928
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$2,912,726
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 registered invesment companies (eg mutual funds) at end of year	2015-12-31	$2,097,022
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$2,410,937
Value of interest in pooled separate accounts at end of year	2015-12-31	$525,762
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$457,822
Interest on participant loans	2015-12-31	$1,974
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-144,015
Net investment gain/loss from pooled separate accounts	2015-12-31	$6,176
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	No
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	$20,523
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$447,052
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	WITTLIN CAIN & DRY
Accountancy firm EIN	2015-12-31	161594374
2014 : BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 2014 401k financial data
Total unrealized appreciation/depreciation of assets	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
Total income from all sources (including contributions)	2014-12-31	$348,975
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$364,708
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$362,450
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$166,937
Value of total assets at end of year	2014-12-31	$2,912,726
Value of total assets at beginning of year	2014-12-31	$2,928,459
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$2,258
Total interest from all sources	2014-12-31	$2,216
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$175,533
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	$175,533
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$300,000
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
Contributions received from participants	2014-12-31	$146,022
Participant contributions at end of year	2014-12-31	$43,967
Participant contributions at beginning of year	2014-12-31	$66,356
Administrative expenses (other) incurred	2014-12-31	$2,258
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
Value of net income/loss	2014-12-31	$-15,733
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$2,912,726
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$2,928,459
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
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$2,410,937
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$2,383,012
Value of interest in pooled separate accounts at end of year	2014-12-31	$457,822
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$479,091
Interest on participant loans	2014-12-31	$2,216
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$-1,677
Net investment gain/loss from pooled separate accounts	2014-12-31	$5,966
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	No
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	$20,915
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$362,450
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
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	Disclaimer
Accountancy firm name	2014-12-31	WITTLIN CAIN & DRY
Accountancy firm EIN	2014-12-31	161594374
2013 : BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 2013 401k financial data
Total unrealized appreciation/depreciation of assets	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
Total income from all sources (including contributions)	2013-12-31	$607,744
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$166,173
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$163,484
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$173,625
Value of total assets at end of year	2013-12-31	$2,928,459
Value of total assets at beginning of year	2013-12-31	$2,486,888
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$2,689
Total interest from all sources	2013-12-31	$3,257
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$133,846
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	$133,846
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$300,000
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
Contributions received from participants	2013-12-31	$150,816
Participant contributions at end of year	2013-12-31	$66,356
Participant contributions at beginning of year	2013-12-31	$85,772
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
Value of net income/loss	2013-12-31	$441,571
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$2,928,459
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$2,486,888
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
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Investment advisory and management fees	2013-12-31	$2,689
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$2,383,012
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$1,993,472
Value of interest in pooled separate accounts at end of year	2013-12-31	$479,091
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$407,644
Interest on participant loans	2013-12-31	$3,257
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$291,483
Net investment gain/loss from pooled separate accounts	2013-12-31	$5,533
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	No
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	$22,809
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$163,484
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
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	WITTLIN CAIN & DRY
Accountancy firm EIN	2013-12-31	161594374
2012 : BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 2012 401k financial data
Total unrealized appreciation/depreciation of assets	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
Total income from all sources (including contributions)	2012-12-31	$438,197
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$267,738
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$263,044
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$186,847
Value of total assets at end of year	2012-12-31	$2,486,888
Value of total assets at beginning of year	2012-12-31	$2,316,429
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$4,694
Total interest from all sources	2012-12-31	$3,833
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$54,962
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	$54,962
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$300,000
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
Contributions received from participants	2012-12-31	$160,264
Participant contributions at end of year	2012-12-31	$85,772
Participant contributions at beginning of year	2012-12-31	$94,294
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$4,762
Administrative expenses (other) incurred	2012-12-31	$4,694
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
Value of net income/loss	2012-12-31	$170,459
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$2,486,888
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$2,316,429
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
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$1,993,472
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$1,823,608
Value of interest in pooled separate accounts at end of year	2012-12-31	$407,644
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$398,195
Interest on participant loans	2012-12-31	$3,833
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$332
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$332
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$184,853
Net investment gain/loss from pooled separate accounts	2012-12-31	$7,702
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	No
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	$21,821
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$263,044
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
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	WITTLIN CAIN & DRY
Accountancy firm EIN	2012-12-31	161594374
2011 : BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 2011 401k financial data
Total unrealized appreciation/depreciation of assets	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
Total income from all sources (including contributions)	2011-12-31	$140,660
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$72,615
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$65,184
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$162,578
Value of total assets at end of year	2011-12-31	$2,316,429
Value of total assets at beginning of year	2011-12-31	$2,248,384
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$7,431
Total interest from all sources	2011-12-31	$4,046
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$39,688
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	$39,688
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$250,000
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
Contributions received from participants	2011-12-31	$145,105
Participant contributions at end of year	2011-12-31	$94,294
Participant contributions at beginning of year	2011-12-31	$81,978
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$10,051
Administrative expenses (other) incurred	2011-12-31	$7,431
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
Value of net income/loss	2011-12-31	$68,045
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$2,316,429
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$2,248,384
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
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$1,823,608
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$1,792,121
Value of interest in pooled separate accounts at end of year	2011-12-31	$398,195
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$373,521
Interest on participant loans	2011-12-31	$4,046
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$332
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$764
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$764
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-73,749
Net investment gain/loss from pooled separate accounts	2011-12-31	$8,097
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	No
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	$7,422
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$65,184
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
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	WITTLIN CAIN & DRY
Accountancy firm EIN	2011-12-31	161594374
2010 : BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 2010 401k financial data
Total unrealized appreciation/depreciation of assets	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
Total income from all sources (including contributions)	2010-12-31	$438,223
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$41,684
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$34,445
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$205,068
Value of total assets at end of year	2010-12-31	$2,248,384
Value of total assets at beginning of year	2010-12-31	$1,851,845
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$7,239
Total interest from all sources	2010-12-31	$4,496
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$250,000
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
Contributions received from participants	2010-12-31	$147,722
Participant contributions at end of year	2010-12-31	$81,978
Participant contributions at beginning of year	2010-12-31	$54,738
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$6,124
Administrative expenses (other) incurred	2010-12-31	$7,239
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
Value of net income/loss	2010-12-31	$396,539
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$2,248,384
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$1,851,845
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
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$1,792,121
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$1,484,682
Value of interest in pooled separate accounts at end of year	2010-12-31	$373,521
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$311,188
Interest on participant loans	2010-12-31	$4,496
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$764
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$1,237
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$1,237
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$221,539
Net investment gain or loss from common/collective trusts	2010-12-31	$7,120
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	No
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	$51,222
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$34,445
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2010-12-31	No
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
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	WITTLIN CAIN & DRY
Accountancy firm EIN	2010-12-31	161594374

Form 5500 Responses for BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP

2015: BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 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 - Trust	Yes
2014: BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 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 – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 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 – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 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 – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 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 – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 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 - Trust	Yes
2009: BRIODY HEALTH CARE FACILITY, LLC 401(K) PSP 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 – 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

Insurance Providers Used on plan

NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )

Policy contract number

GA32001

Policy instance

Insurance contract or identification number	GA32001
Number of Individuals Covered	76
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
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?	No
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

NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )

Policy contract number

GA32001

Policy instance

Insurance contract or identification number	GA32001
Number of Individuals Covered	83
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
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?	No
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

NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )

Policy contract number

GA32001

Policy instance

Insurance contract or identification number	GA32001
Number of Individuals Covered	66
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
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?	No
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

NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )

Policy contract number

GA32001

Policy instance

Insurance contract or identification number	GA32001
Number of Individuals Covered	77
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
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?	No
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

NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )

Policy contract number

GA32001

Policy instance

Insurance contract or identification number	GA32001
Number of Individuals Covered	62
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
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?	No
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

NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )

Policy contract number

GA32001

Policy instance

Insurance contract or identification number	GA32001
Number of Individuals Covered	55
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
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?	No
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

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See full terms and conditions

Company Name:	BRIODY HEALTH CARE FACILITY, LLC
Employer identification number (EIN):	160847887
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	2004-12-31
Company Identification Number:	3143911
Legal Registered Office Address:	909 LINCOLN AVENUE NIAGARA LOCKPORT United States of America (USA) 14094