401k Plan data: PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING PLAN plan

PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING PLAN
Plan identification number	001

PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING 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.
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

PARK VILLAGE HEALTH CARE CENTER INC has sponsored the creation of one or more 401k plans.

Company Name: PARK VILLAGE HEALTH CARE CENTER INC

Employer identification number (EIN): 341723568

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 JEFF TUCKER 2023-06-27
001 2021-01-01 ROBERT O'DONNELL 2022-07-11
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01 ROBERT O'DONNELL 2018-06-22
001 2016-01-01 ROBERT O'DONNELL 2017-06-06
001 2015-01-01 ROBERT O'DONNELL 2016-07-18
001 2014-01-01 ROBERT O'DONNELL 2015-06-15
001 2013-01-01 ROBERT O'DONNELL 2014-07-28
001 2012-01-01 ROBERT O'DONNELL 2013-10-04
001 2011-01-01 ROBERT O'DONNELL 2012-07-10
001 2010-01-01 ROBERT O'DONNELL
001 2009-01-01 ROBERT O'DONNELL

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-01-01	JEFF TUCKER	2023-06-27
001	2021-01-01	ROBERT O'DONNELL	2022-07-11
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2017-01-01	ROBERT O'DONNELL	2018-06-22
001	2016-01-01	ROBERT O'DONNELL	2017-06-06
001	2015-01-01	ROBERT O'DONNELL	2016-07-18
001	2014-01-01	ROBERT O'DONNELL	2015-06-15
001	2013-01-01	ROBERT O'DONNELL	2014-07-28
001	2012-01-01	ROBERT O'DONNELL	2013-10-04
001	2011-01-01	ROBERT O'DONNELL	2012-07-10
001	2010-01-01	ROBERT O'DONNELL
001	2009-01-01	ROBERT O'DONNELL

Plan Statistics for PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING PLAN

Measure Date Value
2020: PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 109
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 77
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 11
Total of all active and inactive participants 2020-01-01 88
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 88
Number of participants with account balances 2020-01-01 61
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 3
2019: PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 126
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 86
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 11
Total of all active and inactive participants 2019-01-01 97
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 97
Number of participants with account balances 2019-01-01 60
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 2
2018: PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 122
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 89
Number of retired or separated participants receiving benefits 2018-01-01 3
Number of other retired or separated participants entitled to future benefits 2018-01-01 25
Total of all active and inactive participants 2018-01-01 117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 117
Number of participants with account balances 2018-01-01 84
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 3
2010: PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 113
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 94
Number of retired or separated participants receiving benefits 2010-01-01 1
Number of other retired or separated participants entitled to future benefits 2010-01-01 11
Total of all active and inactive participants 2010-01-01 106
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 1
Total participants 2010-01-01 107
Number of participants with account balances 2010-01-01 69
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 5
2009: PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 104
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 93
Number of retired or separated participants receiving benefits 2009-01-01 1
Number of other retired or separated participants entitled to future benefits 2009-01-01 9
Total of all active and inactive participants 2009-01-01 103
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 2
Total participants 2009-01-01 105
Number of participants with account balances 2009-01-01 67
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 2

Measure	Date	Value
2020: PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	109
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	77
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	11
Total of all active and inactive participants	2020-01-01	88
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	88
Number of participants with account balances	2020-01-01	61
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	3
2019: PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	126
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	86
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	11
Total of all active and inactive participants	2019-01-01	97
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	97
Number of participants with account balances	2019-01-01	60
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	2
2018: PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	122
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	89
Number of retired or separated participants receiving benefits	2018-01-01	3
Number of other retired or separated participants entitled to future benefits	2018-01-01	25
Total of all active and inactive participants	2018-01-01	117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	117
Number of participants with account balances	2018-01-01	84
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	3
2010: PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	113
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	94
Number of retired or separated participants receiving benefits	2010-01-01	1
Number of other retired or separated participants entitled to future benefits	2010-01-01	11
Total of all active and inactive participants	2010-01-01	106
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	1
Total participants	2010-01-01	107
Number of participants with account balances	2010-01-01	69
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	5
2009: PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	104
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	93
Number of retired or separated participants receiving benefits	2009-01-01	1
Number of other retired or separated participants entitled to future benefits	2009-01-01	9
Total of all active and inactive participants	2009-01-01	103
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	2
Total participants	2009-01-01	105
Number of participants with account balances	2009-01-01	67
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	2

Financial Data on PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2020 : PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total transfer of assets to this plan	2020-12-31	$5,107
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$3,407
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$2,197
Total income from all sources (including contributions)	2020-12-31	$617,950
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$303,793
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$277,891
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$189,207
Value of total assets at end of year	2020-12-31	$3,146,330
Value of total assets at beginning of year	2020-12-31	$2,825,856
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$25,902
Total interest from all sources	2020-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$60,789
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	$60,789
Administrative expenses professional fees incurred	2020-12-31	$25,283
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$400,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$144,642
Participant contributions at end of year	2020-12-31	$0
Participant contributions at beginning of year	2020-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$1,585
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2020-12-31	$3,407
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-12-31	$2,197
Other income not declared elsewhere	2020-12-31	$0
Administrative expenses (other) incurred	2020-12-31	$619
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	$314,157
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$3,142,923
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$2,823,659
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	$2,858,818
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$2,728,576
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-12-31	$287,512
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-12-31	$96,230
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-12-31	$96,230
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$367,954
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	No
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	$42,980
Employer contributions (assets) at end of year	2020-12-31	$0
Employer contributions (assets) at beginning of year	2020-12-31	$1,050
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$277,891
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	Disclaimer
Accountancy firm name	2020-12-31	APPLE GROWTH PARTNERS
Accountancy firm EIN	2020-12-31	814504770
2019 : PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING 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 transfer of assets to this plan	2019-12-31	$0
Total transfer of assets to this plan	2019-12-31	$0
Total transfer of assets from this plan	2019-12-31	$875,790
Total transfer of assets from this plan	2019-12-31	$875,790
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$2,197
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$2,197
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	$880,431
Total income from all sources (including contributions)	2019-12-31	$880,431
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	$438,109
Total of all expenses incurred	2019-12-31	$438,109
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$387,576
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$387,576
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$172,214
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$172,214
Value of total assets at end of year	2019-12-31	$2,825,856
Value of total assets at end of year	2019-12-31	$2,825,856
Value of total assets at beginning of year	2019-12-31	$3,257,127
Value of total assets at beginning of year	2019-12-31	$3,257,127
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$50,533
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$50,533
Total interest from all sources	2019-12-31	$2,298
Total interest from all sources	2019-12-31	$2,298
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$76,252
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$76,252
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	$76,252
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$76,252
Administrative expenses professional fees incurred	2019-12-31	$12,300
Administrative expenses professional fees incurred	2019-12-31	$12,300
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	$400,000
Value of fidelity bond cover	2019-12-31	$400,000
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
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
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	$135,356
Contributions received from participants	2019-12-31	$135,356
Participant contributions at end of year	2019-12-31	$0
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$2,197
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$2,197
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
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	$442,322
Value of net income/loss	2019-12-31	$442,322
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$2,823,659
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$2,823,659
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$3,257,127
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$3,257,127
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
Investment advisory and management fees	2019-12-31	$38,233
Investment advisory and management fees	2019-12-31	$38,233
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$2,728,576
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$2,728,576
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$3,145,767
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$3,145,767
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$96,230
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$96,230
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$102,669
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$102,669
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$102,669
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$102,669
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$2,298
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$2,298
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$629,667
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$629,667
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	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
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	$36,858
Contributions received in cash from employer	2019-12-31	$36,858
Employer contributions (assets) at end of year	2019-12-31	$1,050
Employer contributions (assets) at end of year	2019-12-31	$1,050
Employer contributions (assets) at beginning of year	2019-12-31	$8,691
Employer contributions (assets) at beginning of year	2019-12-31	$8,691
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$387,576
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$387,576
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	APPLE GROWTH PARTNERS
Accountancy firm name	2019-12-31	APPLE GROWTH PARTNERS
Accountancy firm EIN	2019-12-31	341082617
Accountancy firm EIN	2019-12-31	341082617
2018 : PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING 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	$0
Total income from all sources (including contributions)	2018-12-31	$19,924
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$256,541
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$233,719
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$203,001
Value of total assets at end of year	2018-12-31	$3,257,127
Value of total assets at beginning of year	2018-12-31	$3,493,744
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$22,822
Total interest from all sources	2018-12-31	$1,847
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$74,576
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$74,576
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$400,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$146,332
Participant contributions at end of year	2018-12-31	$0
Participant contributions at beginning of year	2018-12-31	$5,904
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$4,562
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	$-236,617
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$3,257,127
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$3,493,744
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
Investment advisory and management fees	2018-12-31	$18,467
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$3,145,767
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$3,385,274
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-12-31	$102,669
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-12-31	$100,718
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-12-31	$100,718
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-31	$1,847
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-259,500
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	No
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	$52,107
Employer contributions (assets) at end of year	2018-12-31	$8,691
Employer contributions (assets) at beginning of year	2018-12-31	$1,848
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$233,719
Contract administrator fees	2018-12-31	$4,355
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	No
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	APPLE GROWTH PARTNERS
Accountancy firm EIN	2018-12-31	341082617
2010 : PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$283,939
Expenses. Total of all expenses incurred	2010-12-31	$56,520
Benefits paid (including direct rollovers)	2010-12-31	$53,169
Total plan assets at end of year	2010-12-31	$1,395,707
Total plan assets at beginning of year	2010-12-31	$1,168,288
Value of fidelity bond covering the plan	2010-12-31	$100,000
Total contributions received or receivable from participants	2010-12-31	$85,926
Other income received	2010-12-31	$165,073
Net income (gross income less expenses)	2010-12-31	$227,419
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$1,395,707
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$1,168,288
Total contributions received or receivable from employer(s)	2010-12-31	$32,940
Value of corrective distributions	2010-12-31	$826
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$2,525
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING PLAN

2020: PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING 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: PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING 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 – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING 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 – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2010: PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: PARK VILLAGE HEALTH CARE CENTER 401(K) PROFIT SHARING 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

MINNESOTA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66168 )

Policy contract number

062148

Policy instance

Insurance contract or identification number	062148
Number of Individuals Covered	69
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,430
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?	Yes
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
Commission paid to Insurance Broker	USD $2,430
Insurance broker organization code?	3
Insurance broker name	LAWRENCE A. MADAMA, JR

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Company Name:	PARK VILLAGE HEALTH CARE CENTER INC
Employer identification number (EIN):	341723568
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities