401k Plan data: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN plan

BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 401k Plan overview

Plan Name	BETHANY NURSING HOME INC SIMPLE 401(K) PLAN
Plan identification number	001

BETHANY NURSING HOME INC SIMPLE 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.
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

BETHANY NURSING HOME INC has sponsored the creation of one or more 401k plans.

Company Name: BETHANY NURSING HOME INC

Employer identification number (EIN): 341321422

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BETHANY NURSING HOME INC SIMPLE 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01 SUSAN KELLY SUSAN KELLY 2018-10-11
001 2016-01-01 SUSAN KELLY
001 2015-01-01 SUSAN KELLY
001 2014-01-01 MARY F. MEYER
001 2013-01-01 MARY F. MEYER 2014-07-08
001 2012-01-01 MARY F. MEYER 2013-07-26
001 2011-01-01 MARY F. MEYER 2012-10-11
001 2010-01-01 MARY MEYER 2011-10-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01
001	2022-01-01
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2017-01-01	SUSAN KELLY		SUSAN KELLY	2018-10-11
001	2016-01-01	SUSAN KELLY
001	2015-01-01	SUSAN KELLY
001	2014-01-01	MARY F. MEYER
001	2013-01-01	MARY F. MEYER	2014-07-08
001	2012-01-01	MARY F. MEYER	2013-07-26
001	2011-01-01	MARY F. MEYER	2012-10-11
001	2010-01-01	MARY MEYER	2011-10-13

Plan Statistics for BETHANY NURSING HOME INC SIMPLE 401(K) PLAN

401k plan membership statisitcs for BETHANY NURSING HOME INC SIMPLE 401(K) PLAN

Measure Date Value
2022: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 156
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 114
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 27
Total of all active and inactive participants 2022-01-01 141
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 141
Number of participants with account balances 2022-01-01 96
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 8
2021: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 137
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 108
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 28
Total of all active and inactive participants 2021-01-01 136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 136
Number of participants with account balances 2021-01-01 100
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 5
2020: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 122
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 102
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 32
Total of all active and inactive participants 2020-01-01 134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 134
Number of participants with account balances 2020-01-01 107
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 1
2019: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 110
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 93
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 29
Total of all active and inactive participants 2019-01-01 122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 122
Number of participants with account balances 2019-01-01 104
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 166
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 88
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 22
Total of all active and inactive participants 2018-01-01 110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 110
Number of participants with account balances 2018-01-01 98
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 162
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 91
Number of retired or separated participants receiving benefits 2017-01-01 18
Number of other retired or separated participants entitled to future benefits 2017-01-01 47
Total of all active and inactive participants 2017-01-01 156
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 156
Number of participants with account balances 2017-01-01 156
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 150
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 95
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 55
Total of all active and inactive participants 2016-01-01 150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 2
Total participants 2016-01-01 152
Number of participants with account balances 2016-01-01 152
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 139
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 91
Number of retired or separated participants receiving benefits 2015-01-01 12
Number of other retired or separated participants entitled to future benefits 2015-01-01 35
Total of all active and inactive participants 2015-01-01 138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 2
Total participants 2015-01-01 140
Number of participants with account balances 2015-01-01 140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 130
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 85
Number of retired or separated participants receiving benefits 2014-01-01 10
Number of other retired or separated participants entitled to future benefits 2014-01-01 30
Total of all active and inactive participants 2014-01-01 125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 1
Total participants 2014-01-01 126
Number of participants with account balances 2014-01-01 126
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0

Measure	Date	Value
2022: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	156
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	114
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	27
Total of all active and inactive participants	2022-01-01	141
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	141
Number of participants with account balances	2022-01-01	96
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	8
2021: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	137
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	108
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	28
Total of all active and inactive participants	2021-01-01	136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	136
Number of participants with account balances	2021-01-01	100
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	5
2020: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	122
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	102
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	32
Total of all active and inactive participants	2020-01-01	134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	134
Number of participants with account balances	2020-01-01	107
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	1
2019: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	110
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	93
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	29
Total of all active and inactive participants	2019-01-01	122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	122
Number of participants with account balances	2019-01-01	104
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	166
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	88
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	22
Total of all active and inactive participants	2018-01-01	110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	110
Number of participants with account balances	2018-01-01	98
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	162
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	91
Number of retired or separated participants receiving benefits	2017-01-01	18
Number of other retired or separated participants entitled to future benefits	2017-01-01	47
Total of all active and inactive participants	2017-01-01	156
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	156
Number of participants with account balances	2017-01-01	156
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	150
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	95
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	55
Total of all active and inactive participants	2016-01-01	150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	2
Total participants	2016-01-01	152
Number of participants with account balances	2016-01-01	152
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	139
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	91
Number of retired or separated participants receiving benefits	2015-01-01	12
Number of other retired or separated participants entitled to future benefits	2015-01-01	35
Total of all active and inactive participants	2015-01-01	138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	2
Total participants	2015-01-01	140
Number of participants with account balances	2015-01-01	140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	130
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	85
Number of retired or separated participants receiving benefits	2014-01-01	10
Number of other retired or separated participants entitled to future benefits	2014-01-01	30
Total of all active and inactive participants	2014-01-01	125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	1
Total participants	2014-01-01	126
Number of participants with account balances	2014-01-01	126
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0

Financial Data on BETHANY NURSING HOME INC SIMPLE 401(K) PLAN

Measure	Date	Value
2022 : BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-31,701
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$102,967
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$99,062
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$252,195
Value of total assets at end of year	2022-12-31	$1,518,126
Value of total assets at beginning of year	2022-12-31	$1,652,794
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$3,905
Total interest from all sources	2022-12-31	$684
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$68,697
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$68,697
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$144,187
Participant contributions at end of year	2022-12-31	$22,875
Participant contributions at beginning of year	2022-12-31	$13,275
Participant contributions at end of year	2022-12-31	$0
Participant contributions at beginning of year	2022-12-31	$13,624
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2022-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2022-12-31	$0
Total non interest bearing cash at end of year	2022-12-31	$0
Total non interest bearing cash at beginning of year	2022-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-134,668
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$1,518,126
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$1,652,794
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$1,489,933
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$1,611,668
Interest on participant loans	2022-12-31	$684
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-12-31	$5,318
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-12-31	$5,266
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-12-31	$5,266
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-353,277
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$108,008
Employer contributions (assets) at end of year	2022-12-31	$0
Employer contributions (assets) at beginning of year	2022-12-31	$8,961
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$99,062
Contract administrator fees	2022-12-31	$3,905
Did the plan have assets held for investment	2022-12-31	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	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	BARNES WENDLING, CPAS, INC.
Accountancy firm EIN	2022-12-31	341463411
2021 : BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$398,670
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$78,722
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$76,297
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$222,207
Value of total assets at end of year	2021-12-31	$1,652,794
Value of total assets at beginning of year	2021-12-31	$1,332,846
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$2,425
Total interest from all sources	2021-12-31	$576
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$75,031
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$75,031
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$128,090
Participant contributions at end of year	2021-12-31	$13,275
Participant contributions at beginning of year	2021-12-31	$16,385
Participant contributions at end of year	2021-12-31	$13,624
Participant contributions at beginning of year	2021-12-31	$15,034
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2021-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2021-12-31	$0
Total non interest bearing cash at end of year	2021-12-31	$0
Total non interest bearing cash at beginning of year	2021-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$319,948
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$1,652,794
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$1,332,846
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$1,611,668
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$1,289,392
Interest on participant loans	2021-12-31	$576
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2021-12-31	$5,266
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2021-12-31	$3,568
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2021-12-31	$3,568
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$100,856
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$94,117
Employer contributions (assets) at end of year	2021-12-31	$8,961
Employer contributions (assets) at beginning of year	2021-12-31	$8,467
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$76,297
Contract administrator fees	2021-12-31	$2,425
Did the plan have assets held for investment	2021-12-31	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	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	BARNES WENDLING, CPAS, INC.
Accountancy firm EIN	2021-12-31	341463411
2020 : BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$397,469
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$244,111
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$239,904
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$220,944
Value of total assets at end of year	2020-12-31	$1,332,846
Value of total assets at beginning of year	2020-12-31	$1,179,488
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$4,207
Total interest from all sources	2020-12-31	$707
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$41,259
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$41,259
Administrative expenses professional fees incurred	2020-12-31	$4,207
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$130,938
Participant contributions at end of year	2020-12-31	$16,385
Participant contributions at beginning of year	2020-12-31	$11,697
Participant contributions at end of year	2020-12-31	$15,034
Participant contributions at beginning of year	2020-12-31	$10,509
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2020-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-12-31	$0
Total non interest bearing cash at end of year	2020-12-31	$0
Total non interest bearing cash at beginning of year	2020-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$153,358
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$1,332,846
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$1,179,488
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$1,289,392
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$1,148,484
Income. Interest from loans (other than to participants)	2020-12-31	$707
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-12-31	$3,568
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-12-31	$2,487
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-12-31	$2,487
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$134,559
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$90,006
Employer contributions (assets) at end of year	2020-12-31	$8,467
Employer contributions (assets) at beginning of year	2020-12-31	$6,311
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$239,904
Did the plan have assets held for investment	2020-12-31	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	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Unqualified
Accountancy firm name	2020-12-31	BARNES WENDLING, CPAS, INC.
Accountancy firm EIN	2020-12-31	341463411
2019 : BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$309,776
Total income from all sources (including contributions)	2019-12-31	$309,776
Total loss/gain on sale of assets	2019-12-31	$0
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$7,132
Total of all expenses incurred	2019-12-31	$7,132
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$5,782
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$5,782
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$145,036
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$145,036
Value of total assets at end of year	2019-12-31	$1,179,488
Value of total assets at end of year	2019-12-31	$1,179,488
Value of total assets at beginning of year	2019-12-31	$876,844
Value of total assets at beginning of year	2019-12-31	$876,844
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$1,350
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$1,350
Total interest from all sources	2019-12-31	$559
Total interest from all sources	2019-12-31	$559
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$41,073
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$41,073
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$41,073
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$41,073
Administrative expenses professional fees incurred	2019-12-31	$1,350
Administrative expenses professional fees incurred	2019-12-31	$1,350
Was this plan covered by a fidelity bond	2019-12-31	Yes
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$80,436
Contributions received from participants	2019-12-31	$80,436
Participant contributions at end of year	2019-12-31	$11,697
Participant contributions at end of year	2019-12-31	$11,697
Participant contributions at beginning of year	2019-12-31	$11,064
Participant contributions at beginning of year	2019-12-31	$11,064
Participant contributions at end of year	2019-12-31	$10,509
Participant contributions at end of year	2019-12-31	$10,509
Participant contributions at beginning of year	2019-12-31	$1,361
Participant contributions at beginning of year	2019-12-31	$1,361
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$8,215
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$8,215
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$0
Total non interest bearing cash at end of year	2019-12-31	$0
Total non interest bearing cash at end of year	2019-12-31	$0
Total non interest bearing cash at beginning of year	2019-12-31	$0
Total non interest bearing cash at beginning of year	2019-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$302,644
Value of net income/loss	2019-12-31	$302,644
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$1,179,488
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$1,179,488
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$876,844
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$876,844
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$1,148,484
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$1,148,484
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$853,961
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$853,961
Value of interest in pooled separate accounts at end of year	2019-12-31	$0
Value of interest in pooled separate accounts at end of year	2019-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$0
Interest on participant loans	2019-12-31	$559
Interest on participant loans	2019-12-31	$559
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$2,487
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$2,487
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$123,108
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$123,108
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2019-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$56,385
Contributions received in cash from employer	2019-12-31	$56,385
Employer contributions (assets) at end of year	2019-12-31	$6,311
Employer contributions (assets) at end of year	2019-12-31	$6,311
Employer contributions (assets) at beginning of year	2019-12-31	$10,458
Employer contributions (assets) at beginning of year	2019-12-31	$10,458
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$5,782
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$5,782
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan have assets held for investment	2019-12-31	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	2019-12-31	No
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	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	BARNES WENDLING, CPAS, INC.
Accountancy firm name	2019-12-31	BARNES WENDLING, CPAS, INC.
Accountancy firm EIN	2019-12-31	341463411
Accountancy firm EIN	2019-12-31	341463411
2018 : BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$719
Total income from all sources (including contributions)	2018-12-31	$41,393
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$205,422
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$198,035
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$91,514
Value of total assets at end of year	2018-12-31	$876,844
Value of total assets at beginning of year	2018-12-31	$1,041,592
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$7,387
Total interest from all sources	2018-12-31	$666
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$33,008
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$33,008
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$500,000
If this is an individual account plan, was there a blackout period	2018-12-31	Yes
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$36,772
Participant contributions at end of year	2018-12-31	$11,064
Participant contributions at beginning of year	2018-12-31	$13,937
Participant contributions at end of year	2018-12-31	$1,361
Participant contributions at beginning of year	2018-12-31	$5,464
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2018-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2018-12-31	$719
Total non interest bearing cash at end of year	2018-12-31	$0
Total non interest bearing cash at beginning of year	2018-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$-164,029
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$876,844
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$1,040,873
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$853,961
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$0
Value of interest in pooled separate accounts at end of year	2018-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$983,122
Interest on participant loans	2018-12-31	$666
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-84,637
Net investment gain/loss from pooled separate accounts	2018-12-31	$842
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$54,742
Employer contributions (assets) at end of year	2018-12-31	$10,458
Employer contributions (assets) at beginning of year	2018-12-31	$39,069
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$198,035
Contract administrator fees	2018-12-31	$7,387
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	2018-12-31	Yes
Did the plan have assets held for investment	2018-12-31	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	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	BARNES WENDLING, CPAS, INC.
Accountancy firm EIN	2018-12-31	341463411
2017 : BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$719
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$222,160
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$42,822
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$42,772
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$142,541
Value of total assets at end of year	2017-12-31	$1,041,592
Value of total assets at beginning of year	2017-12-31	$861,535
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$50
Total interest from all sources	2017-12-31	$249
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Administrative expenses professional fees incurred	2017-12-31	$50
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$75,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$45,045
Participant contributions at end of year	2017-12-31	$13,937
Participant contributions at beginning of year	2017-12-31	$6,436
Participant contributions at end of year	2017-12-31	$5,464
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2017-12-31	$719
Total non interest bearing cash at end of year	2017-12-31	$0
Total non interest bearing cash at beginning of year	2017-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$179,338
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$1,040,873
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$861,535
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in pooled separate accounts at end of year	2017-12-31	$983,122
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$855,099
Interest on participant loans	2017-12-31	$249
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-12-31	$0
Net investment gain/loss from pooled separate accounts	2017-12-31	$79,370
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$97,496
Employer contributions (assets) at end of year	2017-12-31	$39,069
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$42,772
Did the plan have assets held for investment	2017-12-31	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	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	D.A. BAGNOLA & COMPANY, INC.
Accountancy firm EIN	2017-12-31	411411715
2016 : BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$119,792
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$19,920
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$19,895
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$87,389
Value of total assets at end of year	2016-12-31	$861,535
Value of total assets at beginning of year	2016-12-31	$761,663
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$25
Total interest from all sources	2016-12-31	$555
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Administrative expenses professional fees incurred	2016-12-31	$25
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$75,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$30,170
Participant contributions at end of year	2016-12-31	$6,436
Participant contributions at beginning of year	2016-12-31	$16,221
Total non interest bearing cash at end of year	2016-12-31	$0
Total non interest bearing cash at beginning of year	2016-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$99,872
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$861,535
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$761,663
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in pooled separate accounts at end of year	2016-12-31	$855,099
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$739,986
Interest on participant loans	2016-12-31	$461
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2016-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-12-31	$5,456
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-12-31	$5,456
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-12-31	$94
Net investment gain/loss from pooled separate accounts	2016-12-31	$31,848
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$57,219
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$19,895
Did the plan have assets held for investment	2016-12-31	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	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	D.A. BAGNOLA & COMPANY INC.
Accountancy firm EIN	2016-12-31	341411715
2015 : BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 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	$21,552
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$25,404
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$25,379
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$38,661
Value of total assets at end of year	2015-12-31	$761,663
Value of total assets at beginning of year	2015-12-31	$765,515
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$25
Total interest from all sources	2015-12-31	$1,583
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Administrative expenses professional fees incurred	2015-12-31	$25
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$25,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$19,223
Participant contributions at end of year	2015-12-31	$16,221
Participant contributions at beginning of year	2015-12-31	$34,133
Participant contributions at beginning of year	2015-12-31	$3,855
Total non interest bearing cash at end of year	2015-12-31	$0
Total non interest bearing cash at beginning of year	2015-12-31	$0
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	$-3,852
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$761,663
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$765,515
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 pooled separate accounts at end of year	2015-12-31	$739,986
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$677,416
Interest on participant loans	2015-12-31	$1,315
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$5,456
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$13,175
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$13,175
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$268
Net investment gain/loss from pooled separate accounts	2015-12-31	$-18,692
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	$19,438
Employer contributions (assets) at beginning of year	2015-12-31	$36,936
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$25,379
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	D.A. BAGNOLA & COMPANY INC
Accountancy firm EIN	2015-12-31	341411715
2014 : BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total transfer of assets to this plan	2014-12-31	$0
Total transfer of assets from this plan	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	$111,100
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$51,105
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$51,105
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$75,139
Value of total assets at end of year	2014-12-31	$765,515
Value of total assets at beginning of year	2014-12-31	$705,520
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$0
Total interest from all sources	2014-12-31	$2,486
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$25,000
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	$20,552
Participant contributions at end of year	2014-12-31	$34,133
Participant contributions at beginning of year	2014-12-31	$49,555
Participant contributions at end of year	2014-12-31	$3,855
Participant contributions at beginning of year	2014-12-31	$2,949
Total non interest bearing cash at end of year	2014-12-31	$0
Total non interest bearing cash at beginning of year	2014-12-31	$0
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	$59,995
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$765,515
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$705,520
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 pooled separate accounts at end of year	2014-12-31	$677,416
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$604,845
Interest on participant loans	2014-12-31	$2,069
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$13,175
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$14,639
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$14,639
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$417
Net investment gain/loss from pooled separate accounts	2014-12-31	$33,475
Net investment gain or loss from common/collective trusts	2014-12-31	$0
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	$54,587
Employer contributions (assets) at end of year	2014-12-31	$36,936
Employer contributions (assets) at beginning of year	2014-12-31	$33,532
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$51,105
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	D.A. BAGNOLA & COMPANY INC
Accountancy firm EIN	2014-12-31	341411715

Form 5500 Responses for BETHANY NURSING HOME INC SIMPLE 401(K) PLAN

2022: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 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	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
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: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 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: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 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 – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 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 – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	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 – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: BETHANY NURSING HOME INC SIMPLE 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )

Policy contract number

RP010226

Policy instance

Insurance contract or identification number	RP010226
Number of Individuals Covered	0
Insurance policy start date	2018-01-01
Insurance policy end date	2018-03-31
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?	0
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?	Yes

THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )

Policy contract number

RP010226

Policy instance

Insurance contract or identification number	RP010226
Number of Individuals Covered	156
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $5,877
Are there contracts with allocated funds for individual policies?	0
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
Amount paid for insurance broker fees	5877
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3
Insurance broker name	OPPENHEIMER & CO INC

THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )

Policy contract number

GP1732

Policy instance

Insurance contract or identification number	GP1732
Number of Individuals Covered	140
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,380
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
Commission paid to Insurance Broker	USD $1,982
Insurance broker organization code?	3
Insurance broker name	JOE T. CLARK

THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )

Policy contract number

GP1732

Policy instance

Insurance contract or identification number	GP1732
Number of Individuals Covered	126
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $353
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
Commission paid to Insurance Broker	USD $353
Insurance broker organization code?	3
Insurance broker name	JOE T. CLARK

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Company Name:	BETHANY NURSING HOME INC
Employer identification number (EIN):	341321422
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities