401k Plan data: CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN plan

CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 401k Plan overview

Plan Name	CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN
Plan identification number	001

CAMEO CARE CENTER, INC. 401(K) RETIREMENT 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

CAMEO CARE CENTER, INC. has sponsored the creation of one or more 401k plans.

Company Name: CAMEO CARE CENTER, INC.

Employer identification number (EIN): 391142730

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 MILAN KRESOVIC
001 2015-01-01 MILAN KRESOVIC
001 2014-01-01 MILAN KRESOVIC
001 2014-01-01 MILAN KRESOVIC
001 2013-01-01 BORISLAV KRESOVIC
001 2012-01-01 MILAN KRESOVIC
001 2011-01-01 BORISLAV KRESOVIC
001 2010-01-01 BORISLAV KRESOVIC 2011-10-11
001 2009-01-01 BORISLAV KRESOVIC
001 2008-01-01 BORISLAV KRESOVIC

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2016-01-01	MILAN KRESOVIC
001	2015-01-01	MILAN KRESOVIC
001	2014-01-01	MILAN KRESOVIC
001	2014-01-01	MILAN KRESOVIC
001	2013-01-01	BORISLAV KRESOVIC
001	2012-01-01	MILAN KRESOVIC
001	2011-01-01	BORISLAV KRESOVIC
001	2010-01-01	BORISLAV KRESOVIC	2011-10-11
001	2009-01-01	BORISLAV KRESOVIC
001	2008-01-01	BORISLAV KRESOVIC

Plan Statistics for CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN

401k plan membership statisitcs for CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN

Measure Date Value
2016: CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 112
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 111
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 0
Total of all active and inactive participants 2016-01-01 111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 111
Number of participants with account balances 2016-01-01 27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 118
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 111
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 1
Total of all active and inactive participants 2015-01-01 112
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 112
Number of participants with account balances 2015-01-01 24
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 116
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 111
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 6
Total of all active and inactive participants 2014-01-01 117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 117
Number of participants with account balances 2014-01-01 24
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 118
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 116
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 4
Total of all active and inactive participants 2013-01-01 120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 120
Number of participants with account balances 2013-01-01 21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 1
2012: CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 119
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 80
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 4
Total of all active and inactive participants 2012-01-01 84
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 84
Number of participants with account balances 2012-01-01 19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 112
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 87
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 4
Total of all active and inactive participants 2011-01-01 91
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 91
Number of participants with account balances 2011-01-01 20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 108
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 87
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 1
Total of all active and inactive participants 2009-01-01 88
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 88
Number of participants with account balances 2009-01-01 12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0
2008: CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 2008 401k membership
Total participants, beginning-of-year 2008-01-01 80
Total number of active participants reported on line 7a of the Form 5500 2008-01-01 86
Number of retired or separated participants receiving benefits 2008-01-01 0
Number of other retired or separated participants entitled to future benefits 2008-01-01 0
Total of all active and inactive participants 2008-01-01 86
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2008-01-01 0
Total participants 2008-01-01 86
Number of participants with account balances 2008-01-01 13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2008-01-01 0

Measure	Date	Value
2016: CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	112
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	111
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	0
Total of all active and inactive participants	2016-01-01	111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	111
Number of participants with account balances	2016-01-01	27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	118
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	111
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	1
Total of all active and inactive participants	2015-01-01	112
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	112
Number of participants with account balances	2015-01-01	24
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	116
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	111
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	6
Total of all active and inactive participants	2014-01-01	117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	117
Number of participants with account balances	2014-01-01	24
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	118
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	116
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	4
Total of all active and inactive participants	2013-01-01	120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	120
Number of participants with account balances	2013-01-01	21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	1
2012: CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	119
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	80
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	4
Total of all active and inactive participants	2012-01-01	84
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	84
Number of participants with account balances	2012-01-01	19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	112
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	87
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	4
Total of all active and inactive participants	2011-01-01	91
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	91
Number of participants with account balances	2011-01-01	20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	108
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	87
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	1
Total of all active and inactive participants	2009-01-01	88
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	88
Number of participants with account balances	2009-01-01	12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0
2008: CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 2008 401k membership
Total participants, beginning-of-year	2008-01-01	80
Total number of active participants reported on line 7a of the Form 5500	2008-01-01	86
Number of retired or separated participants receiving benefits	2008-01-01	0
Number of other retired or separated participants entitled to future benefits	2008-01-01	0
Total of all active and inactive participants	2008-01-01	86
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2008-01-01	0
Total participants	2008-01-01	86
Number of participants with account balances	2008-01-01	13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2008-01-01	0

Financial Data on CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN

Measure	Date	Value
2016 : CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 2016 401k financial data
Total income from all sources	2016-12-31	$417,280
Expenses. Total of all expenses incurred	2016-12-31	$60,565
Benefits paid (including direct rollovers)	2016-12-31	$60,565
Total plan assets at end of year	2016-12-31	$2,056,150
Total plan assets at beginning of year	2016-12-31	$1,699,435
Value of fidelity bond covering the plan	2016-12-31	$100,000
Total contributions received or receivable from participants	2016-12-31	$131,362
Contributions received from other sources (not participants or employers)	2016-12-31	$85,804
Other income received	2016-12-31	$146,019
Net income (gross income less expenses)	2016-12-31	$356,715
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$2,056,150
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$1,699,435
Assets. Value of participant loans	2016-12-31	$32,071
Total contributions received or receivable from employer(s)	2016-12-31	$54,095
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$183,128
Expenses. Total of all expenses incurred	2015-12-31	$30,101
Benefits paid (including direct rollovers)	2015-12-31	$28,861
Total plan assets at end of year	2015-12-31	$1,699,435
Total plan assets at beginning of year	2015-12-31	$1,546,408
Value of fidelity bond covering the plan	2015-12-31	$100,000
Total contributions received or receivable from participants	2015-12-31	$121,329
Contributions received from other sources (not participants or employers)	2015-12-31	$24,100
Other income received	2015-12-31	$-14,083
Net income (gross income less expenses)	2015-12-31	$153,027
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$1,699,435
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$1,546,408
Assets. Value of participant loans	2015-12-31	$37,171
Total contributions received or receivable from employer(s)	2015-12-31	$51,782
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$1,240
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	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	$271,644
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$21,930
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$19,974
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$217,379
Value of total assets at end of year	2014-12-31	$1,546,407
Value of total assets at beginning of year	2014-12-31	$1,296,693
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$1,956
Total interest from all sources	2014-12-31	$3,703
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Total income from all sources	2014-12-31	$271,645
Expenses. Total of all expenses incurred	2014-12-31	$21,930
Benefits paid (including direct rollovers)	2014-12-31	$19,974
Total plan assets at end of year	2014-12-31	$1,546,408
Total plan assets at beginning of year	2014-12-31	$1,296,693
Value of fidelity bond covering the plan	2014-12-31	$100,000
Total contributions received or receivable from participants	2014-12-31	$104,416
Assets. Value of loans (other than to participants)	2014-12-31	$21,959
Expenses. Other expenses not covered elsewhere	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$69,857
Other income received	2014-12-31	$54,266
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$249,715
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$1,546,408
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$1,296,693
Assets. Value of participant loans	2014-12-31	$21,959
Total contributions received or receivable from employer(s)	2014-12-31	$43,106
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$1,956
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	$100,000
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	$104,416
Participant contributions at end of year	2014-12-31	$21,959
Participant contributions at beginning of year	2014-12-31	$17,589
Participant contributions at end of year	2014-12-31	$21,949
Participant contributions at beginning of year	2014-12-31	$6,188
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$69,857
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	$249,714
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$1,546,407
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$1,296,693
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	$1,382,991
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$1,168,163
Interest on participant loans	2014-12-31	$570
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$106,666
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$93,870
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$93,870
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$3,133
Net investment gain/loss from pooled separate accounts	2014-12-31	$50,562
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	$43,106
Employer contributions (assets) at end of year	2014-12-31	$12,842
Employer contributions (assets) at beginning of year	2014-12-31	$10,883
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$19,974
Contract administrator fees	2014-12-31	$1,956
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
2013 : CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 2013 401k financial data
Total plan liabilities at end of year	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$385,821
Expenses. Total of all expenses incurred	2013-12-31	$21,523
Benefits paid (including direct rollovers)	2013-12-31	$15,325
Total plan assets at end of year	2013-12-31	$1,296,693
Total plan assets at beginning of year	2013-12-31	$932,395
Value of fidelity bond covering the plan	2013-12-31	$94,000
Total contributions received or receivable from participants	2013-12-31	$95,562
Expenses. Other expenses not covered elsewhere	2013-12-31	$6,198
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$249,509
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$364,298
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$1,296,693
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$932,395
Total contributions received or receivable from employer(s)	2013-12-31	$40,750
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$233,763
Expenses. Total of all expenses incurred	2012-12-31	$24,162
Benefits paid (including direct rollovers)	2012-12-31	$18,031
Total plan assets at end of year	2012-12-31	$932,395
Total plan assets at beginning of year	2012-12-31	$722,794
Value of fidelity bond covering the plan	2012-12-31	$94,000
Total contributions received or receivable from participants	2012-12-31	$87,777
Expenses. Other expenses not covered elsewhere	2012-12-31	$6,131
Contributions received from other sources (not participants or employers)	2012-12-31	$25,088
Other income received	2012-12-31	$83,062
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$209,601
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$932,395
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$722,794
Total contributions received or receivable from employer(s)	2012-12-31	$37,836
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$115,357
Expenses. Total of all expenses incurred	2011-12-31	$69,317
Benefits paid (including direct rollovers)	2011-12-31	$68,617
Total plan assets at end of year	2011-12-31	$722,794
Total plan assets at beginning of year	2011-12-31	$676,754
Value of fidelity bond covering the plan	2011-12-31	$50,000
Total contributions received or receivable from participants	2011-12-31	$76,739
Expenses. Other expenses not covered elsewhere	2011-12-31	$0
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$4,540
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$46,040
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$722,794
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$676,754
Total contributions received or receivable from employer(s)	2011-12-31	$34,078
Value of certain deemed distributions of participant loans	2011-12-31	$700
Value of corrective distributions	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2009 : CAMEO CARE CENTER, INC. 401(K) 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
2008 : CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 2008 401k financial data
Total plan liabilities at beginning of year	2008-12-31	$124
Total income from all sources	2008-12-31	$-78,483
Expenses. Total of all expenses incurred	2008-12-31	$9,996
Benefits paid (including direct rollovers)	2008-12-31	$6,230
Total plan assets at end of year	2008-12-31	$365,471
Total plan assets at beginning of year	2008-12-31	$454,074
Value of fidelity bond covering the plan	2008-12-31	$1,000,000
Total contributions received or receivable from participants	2008-12-31	$46,850
Expenses. Other expenses not covered elsewhere	2008-12-31	$3,766
Contributions received from other sources (not participants or employers)	2008-12-31	$7,117
Other income received	2008-12-31	$-158,304
Net income (gross income less expenses)	2008-12-31	$-88,479
Net plan assets at end of year (total assets less liabilities)	2008-12-31	$365,471
Net plan assets at beginning of year (total assets less liabilities)	2008-12-31	$453,950
Total contributions received or receivable from employer(s)	2008-12-31	$25,854

Form 5500 Responses for CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN

2016: CAMEO CARE CENTER, INC. 401(K) RETIREMENT 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 funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: CAMEO CARE CENTER, INC. 401(K) RETIREMENT 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 funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	Yes
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 funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: CAMEO CARE CENTER, INC. 401(K) 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 – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: CAMEO CARE CENTER, INC. 401(K) RETIREMENT 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
2008: CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN 2008 form 5500 responses
2008-01-01	Type of plan entity	Single employer plan
2008-01-01	Submission has been amended	Yes
2008-01-01	This submission is the final filing	No
2008-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-01-01	Plan is a collectively bargained plan	No
2008-01-01	Plan funding arrangement – Insurance	Yes
2008-01-01	Plan funding arrangement – Trust	Yes
2008-01-01	Plan benefit arrangement – Insurance	Yes
2008-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

E77 3951

Policy instance

Insurance contract or identification number	E77 3951
Number of Individuals Covered	24
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $8,865
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	1
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 $3,546
Insurance broker organization code?	3
Insurance broker name	WILLIAMS FINANCIAL LLC

UNION CENTRAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 80837 )

Policy contract number

E77 3951

Policy instance

Insurance contract or identification number	E77 3951
Number of Individuals Covered	25
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $8,365
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	1
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 $3,346
Insurance broker organization code?	3
Insurance broker name	WILLIAMS FINANCIAL LLC

UNION CENTRAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 80837 )

Policy contract number

E77 3951

Policy instance

Insurance contract or identification number	E77 3951
Number of Individuals Covered	21
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $5,668
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	1
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 $2,267
Insurance broker organization code?	3
Insurance broker name	WILLIAMS FINANCIAL LLC

UNION CENTRAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 80837 )

Policy contract number

E77 3951

Policy instance

Insurance contract or identification number	E77 3951
Number of Individuals Covered	19
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $6,297
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	1
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 $2,519
Insurance broker organization code?	3
Insurance broker name	WILLIAMS FINANCIAL LLC

UNION CENTRAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 80837 )

Policy contract number

E77 3951

Policy instance

Insurance contract or identification number	E77 3951
Number of Individuals Covered	20
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $4,539
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	1
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

UNION CENTRAL LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 80837 )

Policy contract number

ESP 7395

Policy instance

Insurance contract or identification number	ESP 7395
Number of Individuals Covered	86
Insurance policy start date	2008-01-01
Insurance policy end date	2008-12-31
Total amount of commissions paid to insurance broker	USD $2,560
Total amount of fees paid to insurance company	USD $640
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,048
Insurance broker organization code?	3
Amount paid for insurance broker fees	640
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker name	SHAUN R. WILLIAMS

Potentially related plans

CAMEO CARE CENTER, INC. 401(K) RETIREMENT PLAN [EIN = 341992703]

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Company Name:	CAMEO CARE CENTER, INC.
Employer identification number (EIN):	391142730
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities