401k Plan data: BETHEL HOME & SERVICES, INC. 403(B) RETIREMENT PLAN plan

BETHEL HOME & SERVICES, INC. 403(B) RETIREMENT PLAN 401k Plan overview

Plan Name	BETHEL HOME & SERVICES, INC. 403(B) RETIREMENT PLAN
Plan identification number	010

BETHEL HOME & SERVICES, INC. 403(B) RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
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.
Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

BETHEL HOME & SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name: BETHEL HOME & SERVICES, INC.

Employer identification number (EIN): 390896624

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BETHEL HOME & SERVICES, INC. 403(B) RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
010 2012-01-01 ANN SKAALAND
010 2011-01-01 ANN SKAALAND ANN SKAALAND 2012-10-15
010 2010-01-01 ANN SKAALAND ANN SKAALAND 2011-10-17
010 2009-01-01 ANN SKAALAND ANN SKAALAND 2010-10-14

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
010	2012-01-01	ANN SKAALAND
010	2011-01-01	ANN SKAALAND	ANN SKAALAND	2012-10-15
010	2010-01-01	ANN SKAALAND	ANN SKAALAND	2011-10-17
010	2009-01-01	ANN SKAALAND	ANN SKAALAND	2010-10-14

Plan Statistics for BETHEL HOME & SERVICES, INC. 403(B) RETIREMENT PLAN

401k plan membership statisitcs for BETHEL HOME & SERVICES, INC. 403(B) RETIREMENT PLAN

Measure Date Value
2012: BETHEL HOME & SERVICES, INC. 403(B) RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 138
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 132
Number of retired or separated participants receiving benefits 2012-01-01 4
Number of other retired or separated participants entitled to future benefits 2012-01-01 22
Total of all active and inactive participants 2012-01-01 158
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 158
Number of participants with account balances 2012-01-01 134
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 5
2011: BETHEL HOME & SERVICES, INC. 403(B) RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 145
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 111
Number of retired or separated participants receiving benefits 2011-01-01 4
Number of other retired or separated participants entitled to future benefits 2011-01-01 23
Total of all active and inactive participants 2011-01-01 138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 138
Number of participants with account balances 2011-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 6
2010: BETHEL HOME & SERVICES, INC. 403(B) RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 164
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 122
Number of retired or separated participants receiving benefits 2010-01-01 2
Number of other retired or separated participants entitled to future benefits 2010-01-01 21
Total of all active and inactive participants 2010-01-01 145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 145
Number of participants with account balances 2010-01-01 143
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 11
2009: BETHEL HOME & SERVICES, INC. 403(B) RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 139
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 129
Number of retired or separated participants receiving benefits 2009-01-01 3
Number of other retired or separated participants entitled to future benefits 2009-01-01 31
Total of all active and inactive participants 2009-01-01 163
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 163
Number of participants with account balances 2009-01-01 138
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 17

Measure	Date	Value
2012: BETHEL HOME & SERVICES, INC. 403(B) RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	138
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	132
Number of retired or separated participants receiving benefits	2012-01-01	4
Number of other retired or separated participants entitled to future benefits	2012-01-01	22
Total of all active and inactive participants	2012-01-01	158
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	158
Number of participants with account balances	2012-01-01	134
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	5
2011: BETHEL HOME & SERVICES, INC. 403(B) RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	145
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	111
Number of retired or separated participants receiving benefits	2011-01-01	4
Number of other retired or separated participants entitled to future benefits	2011-01-01	23
Total of all active and inactive participants	2011-01-01	138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	138
Number of participants with account balances	2011-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	6
2010: BETHEL HOME & SERVICES, INC. 403(B) RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	164
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	122
Number of retired or separated participants receiving benefits	2010-01-01	2
Number of other retired or separated participants entitled to future benefits	2010-01-01	21
Total of all active and inactive participants	2010-01-01	145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	145
Number of participants with account balances	2010-01-01	143
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	11
2009: BETHEL HOME & SERVICES, INC. 403(B) RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	139
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	129
Number of retired or separated participants receiving benefits	2009-01-01	3
Number of other retired or separated participants entitled to future benefits	2009-01-01	31
Total of all active and inactive participants	2009-01-01	163
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	163
Number of participants with account balances	2009-01-01	138
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	17

Financial Data on BETHEL HOME & SERVICES, INC. 403(B) RETIREMENT PLAN

Measure	Date	Value
2012 : BETHEL HOME & SERVICES, INC. 403(B) RETIREMENT PLAN 2012 401k financial data
Total income from all sources (including contributions)	2012-12-31	$517,310
Total of all expenses incurred	2012-12-31	$218,063
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$204,129
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$177,490
Value of total assets at end of year	2012-12-31	$2,791,368
Value of total assets at beginning of year	2012-12-31	$2,492,121
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$13,934
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$34,364
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$34,364
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$500,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$119,515
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$3,025
Administrative expenses (other) incurred	2012-12-31	$598
Total non interest bearing cash at end of year	2012-12-31	$76,293
Total non interest bearing cash at beginning of year	2012-12-31	$96,244
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$299,247
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$2,791,368
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$2,492,121
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Investment advisory and management fees	2012-12-31	$13,336
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$2,715,075
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$2,395,877
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$305,456
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$54,950
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$204,129
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	2012-12-31	No
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	JOHNSON BLOCK & COMPANY
Accountancy firm EIN	2012-12-31	391628949
2011 : BETHEL HOME & SERVICES, INC. 403(B) RETIREMENT PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$143,193
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$162,344
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$148,286
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$186,405
Value of total assets at end of year	2011-12-31	$2,492,121
Value of total assets at beginning of year	2011-12-31	$2,511,272
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$14,058
Total interest from all sources	2011-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$28,417
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$28,417
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$500,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$123,832
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$6,531
Administrative expenses (other) incurred	2011-12-31	$720
Total non interest bearing cash at end of year	2011-12-31	$96,244
Total non interest bearing cash at beginning of year	2011-12-31	$97,243
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$-19,151
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$2,492,121
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$2,511,272
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Investment advisory and management fees	2011-12-31	$13,338
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$2,395,877
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$2,414,029
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-71,629
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$56,042
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$148,286
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	VIG & ASSOCIATES
Accountancy firm EIN	2011-12-31	392004536
2010 : BETHEL HOME & SERVICES, INC. 403(B) RETIREMENT PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$493,126
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$347,836
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$332,762
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$177,741
Value of total assets at end of year	2010-12-31	$2,511,272
Value of total assets at beginning of year	2010-12-31	$2,365,982
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$15,074
Total interest from all sources	2010-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$26,027
Total dividends received from registered investment company shares (eg mutual funds)	2010-12-31	$26,027
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$500,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$118,267
Administrative expenses (other) incurred	2010-12-31	$1,087
Total non interest bearing cash at end of year	2010-12-31	$97,243
Total non interest bearing cash at beginning of year	2010-12-31	$124,989
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$145,290
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$2,511,272
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$2,365,982
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Investment advisory and management fees	2010-12-31	$13,987
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$2,414,029
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$2,240,993
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$289,358
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$59,474
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$332,762
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	VIG & ASSOCIATES
Accountancy firm EIN	2010-12-31	392004536
2009 : BETHEL HOME & SERVICES, INC. 403(B) RETIREMENT 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 BETHEL HOME & SERVICES, INC. 403(B) RETIREMENT PLAN

2012: BETHEL HOME & SERVICES, INC. 403(B) RETIREMENT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: BETHEL HOME & SERVICES, INC. 403(B) RETIREMENT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: BETHEL HOME & SERVICES, INC. 403(B) RETIREMENT 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 – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: BETHEL HOME & SERVICES, INC. 403(B) RETIREMENT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	First time form 5500 has been submitted	Yes
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 – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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BETHEL HOME, INC. BARGAINING UNIT PENSION PLAN [EIN = 391209707]

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Company Name:	BETHEL HOME & SERVICES, INC.
Employer identification number (EIN):	390896624
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities