401k Plan data: SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN plan

SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN
Plan identification number	003

SILVER CREEK MANOR 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

KAR LITTLE BOX LLC D/B/A SILVER CREEK MANOR has sponsored the creation of one or more 401k plans.

Company Name: KAR LITTLE BOX LLC D/B/A SILVER CREEK MANOR

Employer identification number (EIN): 461916006

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
003 2021-01-01 KIMBERLY CIOCIOLA 2021-08-24
003 2020-01-01 KIMBERLY CIOCIOLA 2021-05-19
003 2019-01-01
003 2018-01-01
003 2017-01-01 KIMBERLY CIOCIOLA
003 2016-01-01 KIMBERLY CIOCIOLA
003 2015-01-01 KIMBERLY CIOCIOLA
003 2014-01-01 KIMBERLY CIOCIOLA
003 2013-01-01 KIMBERLY CIOCIOLA

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
003	2021-01-01	KIMBERLY CIOCIOLA	2021-08-24
003	2020-01-01	KIMBERLY CIOCIOLA	2021-05-19
003	2019-01-01
003	2018-01-01
003	2017-01-01	KIMBERLY CIOCIOLA
003	2016-01-01	KIMBERLY CIOCIOLA
003	2015-01-01	KIMBERLY CIOCIOLA
003	2014-01-01	KIMBERLY CIOCIOLA
003	2013-01-01	KIMBERLY CIOCIOLA

Plan Statistics for SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN

Measure Date Value
2019: SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 112
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 70
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 22
Total of all active and inactive participants 2019-01-01 92
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 92
Number of participants with account balances 2019-01-01 66
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 3
2018: SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 120
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 79
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 32
Total of all active and inactive participants 2018-01-01 111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 111
Number of participants with account balances 2018-01-01 83
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 3
2017: SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 130
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 85
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 30
Total of all active and inactive participants 2017-01-01 115
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 115
Number of participants with account balances 2017-01-01 87
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 2
2016: SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 133
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 85
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 45
Total of all active and inactive participants 2016-01-01 130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 130
Number of participants with account balances 2016-01-01 111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 6
2015: SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 127
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 100
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 33
Total of all active and inactive participants 2015-01-01 133
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 133
Number of participants with account balances 2015-01-01 115
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 6
2014: SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 128
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 105
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 22
Total of all active and inactive participants 2014-01-01 127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 127
Number of participants with account balances 2014-01-01 109
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 7
2013: SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 131
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 109
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 18
Total of all active and inactive participants 2013-01-01 127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 127
Number of participants with account balances 2013-01-01 110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 4

Measure	Date	Value
2019: SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	112
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	70
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	22
Total of all active and inactive participants	2019-01-01	92
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	92
Number of participants with account balances	2019-01-01	66
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	3
2018: SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	120
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	79
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	32
Total of all active and inactive participants	2018-01-01	111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	111
Number of participants with account balances	2018-01-01	83
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	3
2017: SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	130
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	85
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	30
Total of all active and inactive participants	2017-01-01	115
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	115
Number of participants with account balances	2017-01-01	87
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	2
2016: SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	133
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	85
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	45
Total of all active and inactive participants	2016-01-01	130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	130
Number of participants with account balances	2016-01-01	111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	6
2015: SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	127
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	100
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	33
Total of all active and inactive participants	2015-01-01	133
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	133
Number of participants with account balances	2015-01-01	115
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	6
2014: SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	128
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	105
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	22
Total of all active and inactive participants	2014-01-01	127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	127
Number of participants with account balances	2014-01-01	109
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	7
2013: SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	131
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	109
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	18
Total of all active and inactive participants	2013-01-01	127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	127
Number of participants with account balances	2013-01-01	110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	4

Financial Data on SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2019 : SILVER CREEK MANOR 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 liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$582,999
Total income from all sources (including contributions)	2019-12-31	$582,999
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	$209,895
Total of all expenses incurred	2019-12-31	$209,895
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$182,871
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$182,871
Value of total corrective distributions	2019-12-31	$1,036
Value of total corrective distributions	2019-12-31	$1,036
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$119,315
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$119,315
Value of total assets at end of year	2019-12-31	$2,631,045
Value of total assets at end of year	2019-12-31	$2,631,045
Value of total assets at beginning of year	2019-12-31	$2,257,941
Value of total assets at beginning of year	2019-12-31	$2,257,941
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$25,988
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$25,988
Total interest from all sources	2019-12-31	$3,323
Total interest from all sources	2019-12-31	$3,323
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$71,692
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$71,692
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	$71,692
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$71,692
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	$300,000
Value of fidelity bond cover	2019-12-31	$300,000
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	$92,310
Contributions received from participants	2019-12-31	$92,310
Participant contributions at end of year	2019-12-31	$51,348
Participant contributions at end of year	2019-12-31	$51,348
Participant contributions at beginning of year	2019-12-31	$40,033
Participant contributions at beginning of year	2019-12-31	$40,033
Other income not declared elsewhere	2019-12-31	$0
Other income not declared elsewhere	2019-12-31	$0
Administrative expenses (other) incurred	2019-12-31	$25,988
Administrative expenses (other) incurred	2019-12-31	$25,988
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	$373,104
Value of net income/loss	2019-12-31	$373,104
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$2,631,045
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$2,631,045
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$2,257,941
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$2,257,941
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$1,961,535
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$1,961,535
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$1,709,073
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$1,709,073
Interest on participant loans	2019-12-31	$2,574
Interest earned on other investments	2019-12-31	$749
Interest earned on other investments	2019-12-31	$749
Value of interest in common/collective trusts at end of year	2019-12-31	$560,976
Value of interest in common/collective trusts at end of year	2019-12-31	$560,976
Value of interest in common/collective trusts at beginning of year	2019-12-31	$448,955
Value of interest in common/collective trusts at beginning of year	2019-12-31	$448,955
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$57,186
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$57,186
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$59,880
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$59,880
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$249,218
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$249,218
Net investment gain or loss from common/collective trusts	2019-12-31	$139,451
Net investment gain or loss from common/collective trusts	2019-12-31	$139,451
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	$27,005
Contributions received in cash from employer	2019-12-31	$27,005
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$182,871
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$182,871
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	BLUM, SHAPIRO & CO., P.C.
Accountancy firm name	2019-12-31	BLUM, SHAPIRO & CO., P.C.
Accountancy firm EIN	2019-12-31	061009205
Accountancy firm EIN	2019-12-31	061009205
2018 : SILVER CREEK MANOR 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	$4,853
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$318,112
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$302,115
Value of total corrective distributions	2018-12-31	$1,156
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$125,307
Value of total assets at end of year	2018-12-31	$2,257,941
Value of total assets at beginning of year	2018-12-31	$2,571,200
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$14,841
Total interest from all sources	2018-12-31	$2,041
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$97,004
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$97,004
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$300,000
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	$93,516
Participant contributions at end of year	2018-12-31	$40,033
Participant contributions at beginning of year	2018-12-31	$42,134
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$2,989
Other income not declared elsewhere	2018-12-31	$0
Administrative expenses (other) incurred	2018-12-31	$14,841
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	$-313,259
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$2,257,941
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$2,571,200
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$1,709,073
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$0
Value of interest in pooled separate accounts at end of year	2018-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$2,472,101
Interest on participant loans	2018-12-31	$1,578
Interest earned on other investments	2018-12-31	$463
Value of interest in common/collective trusts at end of year	2018-12-31	$448,955
Value of interest in common/collective trusts at beginning of year	2018-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$59,880
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$56,965
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-190,823
Net investment gain/loss from pooled separate accounts	2018-12-31	$-16,800
Net investment gain or loss from common/collective trusts	2018-12-31	$-11,876
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	$28,802
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$302,115
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	BLUM, SHAPIRO & CO., P.C.
Accountancy firm EIN	2018-12-31	061009205
2017 : SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$496,517
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$139,881
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$115,022
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$122,376
Value of total assets at end of year	2017-12-31	$2,571,200
Value of total assets at beginning of year	2017-12-31	$2,214,564
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$24,859
Total interest from all sources	2017-12-31	$1,425
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$300,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$91,834
Participant contributions at end of year	2017-12-31	$42,134
Participant contributions at beginning of year	2017-12-31	$32,933
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$509
Administrative expenses (other) incurred	2017-12-31	$24,859
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$356,636
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$2,571,200
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$2,214,564
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in pooled separate accounts at end of year	2017-12-31	$2,472,101
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$2,128,372
Interest on participant loans	2017-12-31	$1,047
Interest earned on other investments	2017-12-31	$378
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$56,965
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$53,259
Net investment gain/loss from pooled separate accounts	2017-12-31	$372,716
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$30,033
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$115,022
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	BLUM, SHAPIRO & CO., P.C.
Accountancy firm EIN	2017-12-31	061009205
2016 : SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$5,393
Total income from all sources (including contributions)	2016-12-31	$268,640
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$373,519
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$346,604
Value of total corrective distributions	2016-12-31	$22
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$129,302
Value of total assets at end of year	2016-12-31	$2,214,564
Value of total assets at beginning of year	2016-12-31	$2,324,836
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$26,893
Total interest from all sources	2016-12-31	$1,097
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$300,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$95,805
Participant contributions at end of year	2016-12-31	$32,933
Participant contributions at beginning of year	2016-12-31	$29,174
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2016-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2016-12-31	$5,393
Administrative expenses (other) incurred	2016-12-31	$26,893
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$-104,879
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$2,214,564
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$2,319,443
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in pooled separate accounts at end of year	2016-12-31	$2,128,372
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$2,170,163
Interest on participant loans	2016-12-31	$666
Interest earned on other investments	2016-12-31	$431
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$53,259
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$125,499
Net investment gain/loss from pooled separate accounts	2016-12-31	$138,241
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$33,497
Employer contributions (assets) at end of year	2016-12-31	$0
Employer contributions (assets) at beginning of year	2016-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$346,604
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	BLUM, SHAPIRO & CO., P.C.
Accountancy firm EIN	2016-12-31	061009205
2015 : SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$5,393
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$190,261
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$180,618
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$148,185
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$160,647
Value of total assets at end of year	2015-12-31	$2,324,836
Value of total assets at beginning of year	2015-12-31	$2,309,800
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$32,433
Total interest from all sources	2015-12-31	$1,720
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$300,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$125,475
Participant contributions at end of year	2015-12-31	$29,174
Participant contributions at beginning of year	2015-12-31	$30,611
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-12-31	$5,393
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$0
Administrative expenses (other) incurred	2015-12-31	$32,433
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$9,643
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$2,319,443
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$2,309,800
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in pooled separate accounts at end of year	2015-12-31	$2,170,163
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$2,115,153
Interest on participant loans	2015-12-31	$797
Interest earned on other investments	2015-12-31	$923
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$125,499
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$114,036
Net investment gain/loss from pooled separate accounts	2015-12-31	$27,894
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$35,172
Employer contributions (assets) at end of year	2015-12-31	$0
Employer contributions (assets) at beginning of year	2015-12-31	$50,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$148,185
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	BLUM, SHAPIRO & CO., P.C.
Accountancy firm EIN	2015-12-31	061009205
2014 : SILVER CREEK MANOR 401(K) PROFIT SHARING 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	$390,204
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$76,940
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$45,831
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$244,476
Value of total assets at end of year	2014-12-31	$2,309,800
Value of total assets at beginning of year	2014-12-31	$1,996,536
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$31,109
Total interest from all sources	2014-12-31	$1,906
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$300,000
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	$125,334
Participant contributions at end of year	2014-12-31	$30,611
Participant contributions at beginning of year	2014-12-31	$26,811
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$33,196
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	$313,264
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$2,309,800
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$1,996,536
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	$2,115,153
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$1,895,338
Interest on participant loans	2014-12-31	$818
Interest earned on other investments	2014-12-31	$1,088
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$114,036
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$74,387
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$117,315
Net investment gain/loss from pooled separate accounts	2014-12-31	$26,507
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	$85,946
Employer contributions (assets) at end of year	2014-12-31	$50,000
Employer contributions (assets) at beginning of year	2014-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$45,831
Contract administrator fees	2014-12-31	$31,109
Liabilities. Value of benefit claims payable at end of year	2014-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2014-12-31	$0
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	BLUM, SHAPIRO & CO., P.C.
Accountancy firm EIN	2014-12-31	061009205
2013 : SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$116,981
Total income from all sources (including contributions)	2013-12-31	$486,743
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$422,826
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$395,574
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$173,199
Value of total assets at end of year	2013-12-31	$1,996,536
Value of total assets at beginning of year	2013-12-31	$2,049,600
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$27,252
Total interest from all sources	2013-12-31	$7,530
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$300,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$91,999
Participant contributions at end of year	2013-12-31	$26,811
Participant contributions at beginning of year	2013-12-31	$20,560
Administrative expenses (other) incurred	2013-12-31	$27,252
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$63,917
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$1,996,536
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$1,932,619
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in pooled separate accounts at end of year	2013-12-31	$1,895,338
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$1,766,439
Interest on participant loans	2013-12-31	$780
Interest earned on other investments	2013-12-31	$6,750
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$74,387
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$262,601
Net investment gain/loss from pooled separate accounts	2013-12-31	$306,014
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$81,200
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$395,574
Liabilities. Value of benefit claims payable at end of year	2013-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2013-12-31	$116,981
Did the plan have assets held for investment	2013-12-31	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	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	BLUM, SHAPIRO & CO., P.C.
Accountancy firm EIN	2013-12-31	061009205

Form 5500 Responses for SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN

2019: SILVER CREEK MANOR 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 – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: SILVER CREEK MANOR 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 – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: SILVER CREEK MANOR 401(K) PROFIT SHARING 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: SILVER CREEK MANOR 401(K) PROFIT SHARING 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: SILVER CREEK MANOR 401(K) PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: SILVER CREEK MANOR 401(K) PROFIT SHARING 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

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

504057-01

Policy instance

Insurance contract or identification number	504057-01
Number of Individuals Covered	66
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

504057-01

Policy instance

Insurance contract or identification number	504057-01
Number of Individuals Covered	83
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

804813-000

Policy instance

Insurance contract or identification number	804813-000
Number of Individuals Covered	0
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,423
Total amount of fees paid to insurance company	USD $325
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	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 $3,423
Insurance broker organization code?	3
Amount paid for insurance broker fees	325
Additional information about fees paid to insurance broker	TPA ADMINISTRATOR ALLOWANCE

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

804813-000

Policy instance

Insurance contract or identification number	804813-000
Number of Individuals Covered	87
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $9,357
Total amount of fees paid to insurance company	USD $1,175
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	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 $9,357
Insurance broker organization code?	3
Amount paid for insurance broker fees	1175
Additional information about fees paid to insurance broker	TPA ADMINISTRATOR ALLOWANCE
Insurance broker name	THE ANGELL PENSION GROUP, INC.

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

804813-000

Policy instance

Insurance contract or identification number	804813-000
Number of Individuals Covered	115
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $8,484
Total amount of fees paid to insurance company	USD $1,138
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 $8,484
Insurance broker organization code?	3
Amount paid for insurance broker fees	848
Additional information about fees paid to insurance broker	TPA ADMINISTRATOR ALLOWANCE
Insurance broker name	EMPLOYERS GROUP

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

804813-000

Policy instance

Insurance contract or identification number	804813-000
Number of Individuals Covered	109
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $21,504
Total amount of fees paid to insurance company	USD $779
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 $21,504
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	THE ANGELL PENSION GROUP, INC.

ZURICH AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90537 )

Policy contract number

K4310A

Policy instance

Insurance contract or identification number	K4310A
Number of Individuals Covered	0
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

GH4705

Policy instance

Insurance contract or identification number	GH4705
Number of Individuals Covered	0
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
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

ZURICH AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 90537 )

Policy contract number

K4310A

Policy instance

Insurance contract or identification number	K4310A
Number of Individuals Covered	1
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

GH4705

Policy instance

Insurance contract or identification number	GH4705
Number of Individuals Covered	110
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $10,337
Total amount of fees paid to insurance company	USD $1,023
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 $10,337
Insurance broker organization code?	3
Amount paid for insurance broker fees	1023
Additional information about fees paid to insurance broker	TPA ADMINISTRATOR ALLOWANCE
Insurance broker name	THE ANGELL PENSION GROUP, INC.

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Company Name:	KAR LITTLE BOX LLC D/B/A SILVER CREEK MANOR
Employer identification number (EIN):	461916006
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities