401k Plan data: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST plan

PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 401k Plan overview

Plan Name	PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST
Plan identification number	001

PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Leveraged ESOP - An ESOP that acquires employer securities with borrowed money or other debt-financing techniques. A completed Schedule E must be attached to a Form 5500 filed for an ESOP.
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

PATTI LEWIS CARE HOME, INC. has sponsored the creation of one or more 401k plans.

Company Name: PATTI LEWIS CARE HOME, INC.

Employer identification number (EIN): 202712531

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

Additional information about PATTI LEWIS CARE HOME, INC.

Jurisdiction of Incorporation: Michigan Secretary of State

Incorporation Date: 0000-00-00

Company Identification Number: 46683D

Legal Registered Office Address: 205 FRANCIS ROAD HOWELL

United States of America (USA)
48843

More information about PATTI LEWIS CARE HOME, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01 JOHN LEWIS
001 2017-01-01
001 2016-01-01 JOHN LEWIS JOHN LEWIS 2017-06-16
001 2016-01-01 JOHN LEWIS
001 2016-01-01
001 2015-01-01
001 2015-01-01 JOHN LEWIS
001 2014-01-01 JOHN LEWIS
001 2013-01-01 JOHN LEWIS
001 2012-01-01 JOHN A LEWIS
001 2011-01-01 JOHN LEWIS

Plan Statistics for PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST

401k plan membership statisitcs for PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST

Measure Date Value
2021: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2021 401k membership
Total participants, beginning-of-year 2021-01-01 22
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 0
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 0
Number of participants with account balances 2021-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2020 401k membership
Total participants, beginning-of-year 2020-01-01 23
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 14
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 6
Total of all active and inactive participants 2020-01-01 20
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 20
Number of participants with account balances 2020-01-01 20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2019 401k membership
Total participants, beginning-of-year 2019-01-01 26
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 17
Number of retired or separated participants receiving benefits 2019-01-01 1
Number of other retired or separated participants entitled to future benefits 2019-01-01 1
Total of all active and inactive participants 2019-01-01 19
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 19
Number of participants with account balances 2019-01-01 19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2018 401k membership
Total participants, beginning-of-year 2018-01-01 30
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 13
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 9
Total of all active and inactive participants 2018-01-01 22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 22
Number of participants with account balances 2018-01-01 22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2017 401k membership
Total participants, beginning-of-year 2017-01-01 27
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 15
Number of retired or separated participants receiving benefits 2017-01-01 2
Number of other retired or separated participants entitled to future benefits 2017-01-01 9
Total of all active and inactive participants 2017-01-01 26
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 26
Number of participants with account balances 2017-01-01 26
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2016 401k membership
Total participants, beginning-of-year 2016-01-01 29
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 18
Number of retired or separated participants receiving benefits 2016-01-01 1
Number of other retired or separated participants entitled to future benefits 2016-01-01 6
Total of all active and inactive participants 2016-01-01 25
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 25
Number of participants with account balances 2016-01-01 25
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2015 401k membership
Total participants, beginning-of-year 2015-01-01 24
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 20
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 3
Total of all active and inactive participants 2015-01-01 23
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 23
Number of participants with account balances 2015-01-01 23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2014 401k membership
Total participants, beginning-of-year 2014-01-01 22
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 16
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 8
Total of all active and inactive participants 2014-01-01 24
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 24
Number of participants with account balances 2014-01-01 24
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2013 401k membership
Total participants, beginning-of-year 2013-01-01 20
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 17
Number of retired or separated participants receiving benefits 2013-01-01 5
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 22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 22
Number of participants with account balances 2013-01-01 17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2012 401k membership
Total participants, beginning-of-year 2012-01-01 20
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 14
Number of retired or separated participants receiving benefits 2012-01-01 6
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 20
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 20
Number of participants with account balances 2012-01-01 20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2011 401k membership
Total participants, beginning-of-year 2011-01-01 12
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 13
Number of retired or separated participants receiving benefits 2011-01-01 7
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 20
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 20
Number of participants with account balances 2011-01-01 17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0

Measure	Date	Value
2021: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2021 401k membership
Total participants, beginning-of-year	2021-01-01	22
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	0
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	0
Number of participants with account balances	2021-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2020 401k membership
Total participants, beginning-of-year	2020-01-01	23
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	14
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	6
Total of all active and inactive participants	2020-01-01	20
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	20
Number of participants with account balances	2020-01-01	20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2019 401k membership
Total participants, beginning-of-year	2019-01-01	26
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	17
Number of retired or separated participants receiving benefits	2019-01-01	1
Number of other retired or separated participants entitled to future benefits	2019-01-01	1
Total of all active and inactive participants	2019-01-01	19
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	19
Number of participants with account balances	2019-01-01	19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2018 401k membership
Total participants, beginning-of-year	2018-01-01	30
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	13
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	9
Total of all active and inactive participants	2018-01-01	22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	22
Number of participants with account balances	2018-01-01	22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2017 401k membership
Total participants, beginning-of-year	2017-01-01	27
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	15
Number of retired or separated participants receiving benefits	2017-01-01	2
Number of other retired or separated participants entitled to future benefits	2017-01-01	9
Total of all active and inactive participants	2017-01-01	26
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	26
Number of participants with account balances	2017-01-01	26
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2016 401k membership
Total participants, beginning-of-year	2016-01-01	29
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	18
Number of retired or separated participants receiving benefits	2016-01-01	1
Number of other retired or separated participants entitled to future benefits	2016-01-01	6
Total of all active and inactive participants	2016-01-01	25
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	25
Number of participants with account balances	2016-01-01	25
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2015 401k membership
Total participants, beginning-of-year	2015-01-01	24
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	20
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	3
Total of all active and inactive participants	2015-01-01	23
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	23
Number of participants with account balances	2015-01-01	23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2014 401k membership
Total participants, beginning-of-year	2014-01-01	22
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	16
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	8
Total of all active and inactive participants	2014-01-01	24
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	24
Number of participants with account balances	2014-01-01	24
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2013 401k membership
Total participants, beginning-of-year	2013-01-01	20
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	17
Number of retired or separated participants receiving benefits	2013-01-01	5
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	22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	22
Number of participants with account balances	2013-01-01	17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2012 401k membership
Total participants, beginning-of-year	2012-01-01	20
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	14
Number of retired or separated participants receiving benefits	2012-01-01	6
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	20
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	20
Number of participants with account balances	2012-01-01	20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2011 401k membership
Total participants, beginning-of-year	2011-01-01	12
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	13
Number of retired or separated participants receiving benefits	2011-01-01	7
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	20
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	20
Number of participants with account balances	2011-01-01	17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0

Financial Data on PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST

Measure	Date	Value
2021 : PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2021 401k financial data
Total income from all sources	2021-06-01	$20,995
Expenses. Total of all expenses incurred	2021-06-01	$1,078,911
Benefits paid (including direct rollovers)	2021-06-01	$1,076,847
Total plan assets at end of year	2021-06-01	$0
Total plan assets at beginning of year	2021-06-01	$1,057,916
Value of fidelity bond covering the plan	2021-06-01	$106,000
Total contributions received or receivable from participants	2021-06-01	$2,043
Expenses. Other expenses not covered elsewhere	2021-06-01	$0
Contributions received from other sources (not participants or employers)	2021-06-01	$0
Other income received	2021-06-01	$16,484
Noncash contributions received	2021-06-01	$0
Net income (gross income less expenses)	2021-06-01	$-1,057,916
Net plan assets at end of year (total assets less liabilities)	2021-06-01	$0
Net plan assets at beginning of year (total assets less liabilities)	2021-06-01	$1,057,916
Assets. Value of participant loans	2021-06-01	$0
Assets. Value of employer securities	2021-06-01	$0
Total contributions received or receivable from employer(s)	2021-06-01	$2,468
Value of certain deemed distributions of participant loans	2021-06-01	$372
Value of corrective distributions	2021-06-01	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2021-06-01	$1,692
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-06-01	$0
2020 : PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2020 401k financial data
Total plan liabilities at beginning of year	2020-12-31	$0
Total income from all sources	2020-12-31	$235,268
Expenses. Total of all expenses incurred	2020-12-31	$1,779
Benefits paid (including direct rollovers)	2020-12-31	$741
Total plan assets at end of year	2020-12-31	$1,057,916
Total plan assets at beginning of year	2020-12-31	$824,427
Value of fidelity bond covering the plan	2020-12-31	$82,500
Total contributions received or receivable from participants	2020-12-31	$24,671
Contributions received from other sources (not participants or employers)	2020-12-31	$0
Other income received	2020-12-31	$193,168
Noncash contributions received	2020-12-31	$0
Net income (gross income less expenses)	2020-12-31	$233,489
Net plan assets at end of year (total assets less liabilities)	2020-12-31	$1,057,916
Net plan assets at beginning of year (total assets less liabilities)	2020-12-31	$824,427
Assets. Value of participant loans	2020-12-31	$500
Assets. Value of employer securities	2020-12-31	$761,594
Total contributions received or receivable from employer(s)	2020-12-31	$17,429
Value of certain deemed distributions of participant loans	2020-12-31	$1,038
Value of corrective distributions	2020-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2020-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
2019 : PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2019 401k financial data
Total plan liabilities at end of year	2019-12-31	$0
Total plan liabilities at beginning of year	2019-12-31	$0
Total income from all sources	2019-12-31	$85,671
Expenses. Total of all expenses incurred	2019-12-31	$20,299
Benefits paid (including direct rollovers)	2019-12-31	$18,979
Total plan assets at end of year	2019-12-31	$824,427
Total plan assets at beginning of year	2019-12-31	$759,055
Value of fidelity bond covering the plan	2019-12-31	$82,500
Total contributions received or receivable from participants	2019-12-31	$26,770
Expenses. Other expenses not covered elsewhere	2019-12-31	$0
Contributions received from other sources (not participants or employers)	2019-12-31	$0
Other income received	2019-12-31	$43,467
Noncash contributions received	2019-12-31	$0
Net income (gross income less expenses)	2019-12-31	$65,372
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$824,427
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$759,055
Assets. Value of participant loans	2019-12-31	$1,146
Assets. Value of employer securities	2019-12-31	$600,976
Total contributions received or receivable from employer(s)	2019-12-31	$15,434
Value of certain deemed distributions of participant loans	2019-12-31	$0
Value of corrective distributions	2019-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2019-12-31	$1,320
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
2018 : PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2018 401k financial data
Total income from all sources	2018-12-31	$53,010
Expenses. Total of all expenses incurred	2018-12-31	$20,151
Benefits paid (including direct rollovers)	2018-12-31	$18,574
Total plan assets at end of year	2018-12-31	$759,055
Total plan assets at beginning of year	2018-12-31	$726,196
Value of fidelity bond covering the plan	2018-12-31	$80,000
Total contributions received or receivable from participants	2018-12-31	$35,475
Expenses. Other expenses not covered elsewhere	2018-12-31	$0
Contributions received from other sources (not participants or employers)	2018-12-31	$0
Other income received	2018-12-31	$3,603
Noncash contributions received	2018-12-31	$0
Net income (gross income less expenses)	2018-12-31	$32,859
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$759,055
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$726,196
Assets. Value of participant loans	2018-12-31	$1,668
Assets. Value of employer securities	2018-12-31	$597,380
Total contributions received or receivable from employer(s)	2018-12-31	$13,932
Value of certain deemed distributions of participant loans	2018-12-31	$0
Value of corrective distributions	2018-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$1,577
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
2017 : PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2017 401k financial data
Total income from all sources	2017-12-31	$120,916
Expenses. Total of all expenses incurred	2017-12-31	$65,910
Benefits paid (including direct rollovers)	2017-12-31	$65,105
Total plan assets at end of year	2017-12-31	$741,945
Total plan assets at beginning of year	2017-12-31	$686,939
Value of fidelity bond covering the plan	2017-12-31	$80,000
Total contributions received or receivable from participants	2017-12-31	$28,206
Expenses. Other expenses not covered elsewhere	2017-12-31	$0
Contributions received from other sources (not participants or employers)	2017-12-31	$0
Other income received	2017-12-31	$75,657
Noncash contributions received	2017-12-31	$0
Net income (gross income less expenses)	2017-12-31	$55,006
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$741,945
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$686,939
Assets. Value of participant loans	2017-12-31	$2,254
Assets. Value of employer securities	2017-12-31	$586,159
Total contributions received or receivable from employer(s)	2017-12-31	$17,053
Value of certain deemed distributions of participant loans	2017-12-31	$0
Value of corrective distributions	2017-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$805
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
2016 : PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2016 401k financial data
Total income from all sources	2016-12-31	$69,521
Expenses. Total of all expenses incurred	2016-12-31	$6,765
Benefits paid (including direct rollovers)	2016-12-31	$6,015
Total plan assets at end of year	2016-12-31	$842,312
Total plan assets at beginning of year	2016-12-31	$779,556
Value of fidelity bond covering the plan	2016-12-31	$80,000
Total contributions received or receivable from participants	2016-12-31	$27,258
Expenses. Other expenses not covered elsewhere	2016-12-31	$750
Other income received	2016-12-31	$11,852
Net income (gross income less expenses)	2016-12-31	$62,756
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$842,312
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$779,556
Assets. Value of employer securities	2016-12-31	$757,390
Total contributions received or receivable from employer(s)	2016-12-31	$30,411
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2015 401k financial data
Total income from all sources	2015-12-31	$-9,718
Expenses. Total of all expenses incurred	2015-12-31	$2,579
Benefits paid (including direct rollovers)	2015-12-31	$2,529
Total plan assets at end of year	2015-12-31	$779,556
Total plan assets at beginning of year	2015-12-31	$791,853
Value of fidelity bond covering the plan	2015-12-31	$80,000
Other income received	2015-12-31	$-24,496
Net income (gross income less expenses)	2015-12-31	$-12,297
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$779,556
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$791,853
Assets. Value of employer securities	2015-12-31	$734,638
Total contributions received or receivable from employer(s)	2015-12-31	$14,778
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$50
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2014 401k financial data
Total income from all sources	2014-12-31	$37,388
Expenses. Total of all expenses incurred	2014-12-31	$409
Benefits paid (including direct rollovers)	2014-12-31	$409
Total plan assets at end of year	2014-12-31	$791,853
Total plan assets at beginning of year	2014-12-31	$754,874
Value of fidelity bond covering the plan	2014-12-31	$80,000
Other income received	2014-12-31	$27,200
Net income (gross income less expenses)	2014-12-31	$36,979
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$791,853
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$754,874
Assets. Value of employer securities	2014-12-31	$758,593
Total contributions received or receivable from employer(s)	2014-12-31	$10,188
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 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 plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$-11,239
Expenses. Total of all expenses incurred	2013-12-31	$6,692
Benefits paid (including direct rollovers)	2013-12-31	$6,581
Total plan assets at end of year	2013-12-31	$754,874
Total plan assets at beginning of year	2013-12-31	$772,805
Value of fidelity bond covering the plan	2013-12-31	$80,000
Total contributions received or receivable from participants	2013-12-31	$0
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	$-11,239
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$-17,931
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$754,874
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$772,805
Assets. Value of employer securities	2013-12-31	$732,195
Total contributions received or receivable from employer(s)	2013-12-31	$0
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	$111
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2012 401k financial data
Total income from all sources	2012-12-31	$61,763
Expenses. Total of all expenses incurred	2012-12-31	$1,132
Benefits paid (including direct rollovers)	2012-12-31	$1,030
Total plan assets at end of year	2012-12-31	$772,805
Total plan assets at beginning of year	2012-12-31	$712,174
Value of fidelity bond covering the plan	2012-12-31	$80,000
Other income received	2012-12-31	$52,414
Net income (gross income less expenses)	2012-12-31	$60,631
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$772,805
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$712,174
Assets. Value of employer securities	2012-12-31	$746,863
Total contributions received or receivable from employer(s)	2012-12-31	$9,349
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$102
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2011 401k financial data
Total income from all sources	2011-12-31	$11,712
Expenses. Total of all expenses incurred	2011-12-31	$55,316
Benefits paid (including direct rollovers)	2011-12-31	$55,203
Total plan assets at end of year	2011-12-31	$712,174
Total plan assets at beginning of year	2011-12-31	$755,778
Value of fidelity bond covering the plan	2011-12-31	$1,000,000
Other income received	2011-12-31	$7,076
Net income (gross income less expenses)	2011-12-31	$-43,604
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$712,174
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$755,778
Assets. Value of employer securities	2011-12-31	$695,668
Total contributions received or receivable from employer(s)	2011-12-31	$4,636
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$113
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0

Form 5500 Responses for PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST

2021: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	Yes
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 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	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
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: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 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: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 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: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 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: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 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 – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: PATTI LEWIS CARE HOME, INC. PROFIT SHARING PLAN AND TRUST 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	First time form 5500 has been submitted	Yes
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 – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

300169-000

Policy instance

Insurance contract or identification number	300169-000
Number of Individuals Covered	378
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $14,781
Total amount of fees paid to insurance company	USD $10,973
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,781
Additional information about fees paid to insurance broker	INSURANCE AGENT
Insurance broker organization code?	3
Amount paid for insurance broker fees	10973
Insurance broker name	DESTEL-BERGEN CORPORATION

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

300169-000

Policy instance

Insurance contract or identification number	300169-000
Number of Individuals Covered	336
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $13,707
Total amount of fees paid to insurance company	USD $13,635
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
Commission paid to Insurance Broker	USD $13,707
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	INSURANCE AGENT
Insurance broker organization code?	3
Insurance broker name	DESTEL-BERGEN CORPORATION

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

300169-000

Policy instance

Insurance contract or identification number	300169-000
Number of Individuals Covered	415
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $12,879
Total amount of fees paid to insurance company	USD $13,087
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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Company Name:	PATTI LEWIS CARE HOME, INC.
Employer identification number (EIN):	202712531
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities

Jurisdiction of Incorporation:	Michigan Secretary of State
Incorporation Date:	0000-00-00
Company Identification Number:	46683D
Legal Registered Office Address:	205 FRANCIS ROAD HOWELL United States of America (USA) 48843