401k Plan data: AMERICOAST HOLDINGS, LLC 401(K) PLAN plan

AMERICOAST HOLDINGS, LLC 401(K) PLAN 401k Plan overview

Plan Name	AMERICOAST HOLDINGS, LLC 401(K) PLAN
Plan identification number	001

AMERICOAST HOLDINGS, LLC 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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

401k Sponsoring company profile

COMMUNITY CARE HOLDINGS, LLC has sponsored the creation of one or more 401k plans.

Company Name: COMMUNITY CARE HOLDINGS, LLC

Employer identification number (EIN): 270433222

NAIC Classification: 446190

Additional information about COMMUNITY CARE HOLDINGS, LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 4700018

More information about COMMUNITY CARE HOLDINGS, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AMERICOAST HOLDINGS, LLC 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2017-01-01 JENNIFER KUCZEWSKI 2018-03-27 JENNIFER KUCZEWSKI 2018-03-27
001 2016-01-01 JENNIFER KUCZEWSKI 2017-05-22 JENNIFER KUCZEWSKI 2017-05-22
001 2015-01-01 JENNIFER KUCZEWSKI 2016-06-10 JENNIFER KUCZEWSKI 2016-06-10
001 2014-01-01 JENNIFER KUCZEWSKI 2015-10-08 JENNIFER KUCZEWSKI 2015-10-08
001 2013-01-01 JENNIFER KUCZEWSKI 2014-10-09 JENNIFER KUCZEWSKI 2014-10-09
001 2012-01-01 ELIZABETH WATTS-GORMLEY 2013-09-23 ELIZABETH WATTS-GORMLEY 2013-09-23
001 2011-01-01 ELIZABETH WATTS-GORMLEY ELIZABETH WATTS-GORMLEY 2012-09-27
001 2009-01-01 ELIZABETH WATTS GORMLEY ELIZABETH WATTS GORMLEY 2010-07-22

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2017-01-01	JENNIFER KUCZEWSKI	2018-03-27	JENNIFER KUCZEWSKI	2018-03-27
001	2016-01-01	JENNIFER KUCZEWSKI	2017-05-22	JENNIFER KUCZEWSKI	2017-05-22
001	2015-01-01	JENNIFER KUCZEWSKI	2016-06-10	JENNIFER KUCZEWSKI	2016-06-10
001	2014-01-01	JENNIFER KUCZEWSKI	2015-10-08	JENNIFER KUCZEWSKI	2015-10-08
001	2013-01-01	JENNIFER KUCZEWSKI	2014-10-09	JENNIFER KUCZEWSKI	2014-10-09
001	2012-01-01	ELIZABETH WATTS-GORMLEY	2013-09-23	ELIZABETH WATTS-GORMLEY	2013-09-23
001	2011-01-01	ELIZABETH WATTS-GORMLEY		ELIZABETH WATTS-GORMLEY	2012-09-27
001	2009-01-01	ELIZABETH WATTS GORMLEY		ELIZABETH WATTS GORMLEY	2010-07-22

Plan Statistics for AMERICOAST HOLDINGS, LLC 401(K) PLAN

401k plan membership statisitcs for AMERICOAST HOLDINGS, LLC 401(K) PLAN

Measure Date Value
2011: AMERICOAST HOLDINGS, LLC 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 47
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 47
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 2
Total of all active and inactive participants 2011-01-01 49
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 49
Number of participants with account balances 2011-01-01 22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: AMERICOAST HOLDINGS, LLC 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 44
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 38
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 2
Total of all active and inactive participants 2009-01-01 40
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 40
Number of participants with account balances 2009-01-01 15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2011: AMERICOAST HOLDINGS, LLC 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	47
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	47
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	2
Total of all active and inactive participants	2011-01-01	49
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	49
Number of participants with account balances	2011-01-01	22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: AMERICOAST HOLDINGS, LLC 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	44
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	38
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	2
Total of all active and inactive participants	2009-01-01	40
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	40
Number of participants with account balances	2009-01-01	15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on AMERICOAST HOLDINGS, LLC 401(K) PLAN

Measure	Date	Value
2011 : AMERICOAST HOLDINGS, LLC 401(K) PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$87,728
Expenses. Total of all expenses incurred	2011-12-31	$13,337
Benefits paid (including direct rollovers)	2011-12-31	$13,325
Total plan assets at end of year	2011-12-31	$551,977
Total plan assets at beginning of year	2011-12-31	$477,586
Value of fidelity bond covering the plan	2011-12-31	$50,000
Total contributions received or receivable from participants	2011-12-31	$98,379
Expenses. Other expenses not covered elsewhere	2011-12-31	$0
Contributions received from other sources (not participants or employers)	2011-12-31	$9,868
Other income received	2011-12-31	$-20,519
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$74,391
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$551,977
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$477,586
Assets. Value of participant loans	2011-12-31	$6,633
Total contributions received or receivable from employer(s)	2011-12-31	$0
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$12
2010 : AMERICOAST HOLDINGS, LLC 401(K) PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$104,449
Expenses. Total of all expenses incurred	2010-12-31	$36,225
Benefits paid (including direct rollovers)	2010-12-31	$30,471
Total plan assets at end of year	2010-12-31	$477,586
Total plan assets at beginning of year	2010-12-31	$409,362
Value of fidelity bond covering the plan	2010-12-31	$50,000
Total contributions received or receivable from participants	2010-12-31	$68,656
Other income received	2010-12-31	$35,793
Net income (gross income less expenses)	2010-12-31	$68,224
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$477,586
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$409,362
Assets. Value of participant loans	2010-12-31	$3,800
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$5,754
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0

Form 5500 Responses for AMERICOAST HOLDINGS, LLC 401(K) PLAN

2011: AMERICOAST HOLDINGS, LLC 401(K) PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – 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
2009: AMERICOAST HOLDINGS, LLC 401(K) PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan 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

JOHN HANCOCK LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 86375 )

Policy contract number

81622

Policy instance

Insurance contract or identification number	81622
Number of Individuals Covered	0
Insurance policy start date	2011-01-01
Insurance policy end date	2011-04-18
Total amount of commissions paid to insurance broker	USD $622
Total amount of fees paid to insurance company	USD $146
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

JOHN HANCOCK LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 86375 )

Policy contract number

81622

Policy instance

Insurance contract or identification number	81622
Number of Individuals Covered	22
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,177
Total amount of fees paid to insurance company	USD $488
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,177
Insurance broker organization code?	3
Amount paid for insurance broker fees	488
Additional information about fees paid to insurance broker	TPA FEELS & COMPENSATION
Insurance broker name	ACTUARIAL CONSULTING SERVICES, INC.

Potentially related plans

AMERICOAST HOLDINGS, LLC 401(K) PLAN [EIN = 201365992]

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Company Name:	COMMUNITY CARE HOLDINGS, LLC
Employer identification number (EIN):	270433222
NAIC Classification:	446190

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	4700018