401k Plan data: CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN plan

CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 401k Plan overview

Plan Name	CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN
Plan identification number	001

CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

CEDAR HAVEN ACQUISITION LLC CEDAR HAVEN HEALTHCARE CENTER has sponsored the creation of one or more 401k plans.

Company Name: CEDAR HAVEN ACQUISITION LLC CEDAR HAVEN HEALTHCARE CENTER

Employer identification number (EIN): 471518400

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

Additional information about CEDAR HAVEN ACQUISITION LLC CEDAR HAVEN HEALTHCARE CENTER

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 5579627

More information about CEDAR HAVEN ACQUISITION LLC CEDAR HAVEN HEALTHCARE CENTER

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 JEFF HADLEY 2023-10-12
001 2021-01-01 JEFF HADLEY 2022-10-05
001 2020-01-01 JEFF HADLEY 2021-10-08
001 2019-01-01 JEFF HADLEY 2020-10-08 JEFF HADLEY 2020-10-08
001 2018-01-01 JEFF HADLEY 2019-10-15
001 2018-01-01 JEFF HADLEY 2019-10-15
001 2018-01-01 JEFF HADLEY 2020-01-06
001 2017-01-01
001 2016-01-01
001 2015-01-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	JEFF HADLEY	2023-10-12
001	2021-01-01	JEFF HADLEY	2022-10-05
001	2020-01-01	JEFF HADLEY	2021-10-08
001	2019-01-01	JEFF HADLEY	2020-10-08	JEFF HADLEY	2020-10-08
001	2018-01-01	JEFF HADLEY	2019-10-15
001	2018-01-01	JEFF HADLEY	2019-10-15
001	2018-01-01	JEFF HADLEY	2020-01-06
001	2017-01-01
001	2016-01-01
001	2015-01-01

Plan Statistics for CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN

401k plan membership statisitcs for CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN

Measure Date Value
2022: CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 390
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 228
Number of retired or separated participants receiving benefits 2022-01-01 8
Number of other retired or separated participants entitled to future benefits 2022-01-01 85
Total of all active and inactive participants 2022-01-01 321
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 321
Number of participants with account balances 2022-01-01 160
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 410
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 275
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 84
Total of all active and inactive participants 2021-01-01 359
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 359
Number of participants with account balances 2021-01-01 190
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 6
2020: CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 442
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 309
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 98
Total of all active and inactive participants 2020-01-01 407
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 407
Number of participants with account balances 2020-01-01 201
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 10
2019: CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 399
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 351
Number of retired or separated participants receiving benefits 2019-01-01 3
Number of other retired or separated participants entitled to future benefits 2019-01-01 87
Total of all active and inactive participants 2019-01-01 441
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 441
Number of participants with account balances 2019-01-01 203
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 3
2018: CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 387
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 300
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 81
Total of all active and inactive participants 2018-01-01 381
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 381
Number of participants with account balances 2018-01-01 216
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 370
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 353
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 34
Total of all active and inactive participants 2017-01-01 387
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 387
Number of participants with account balances 2017-01-01 232
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 6
2016: CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 345
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 338
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 22
Total of all active and inactive participants 2016-01-01 360
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 360
Number of participants with account balances 2016-01-01 233
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 8
2015: CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 333
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 330
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 13
Total of all active and inactive participants 2015-01-01 343
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 343
Number of participants with account balances 2015-01-01 242
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 8

Measure	Date	Value
2022: CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	390
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	228
Number of retired or separated participants receiving benefits	2022-01-01	8
Number of other retired or separated participants entitled to future benefits	2022-01-01	85
Total of all active and inactive participants	2022-01-01	321
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	321
Number of participants with account balances	2022-01-01	160
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	410
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	275
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	84
Total of all active and inactive participants	2021-01-01	359
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	359
Number of participants with account balances	2021-01-01	190
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	6
2020: CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	442
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	309
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	98
Total of all active and inactive participants	2020-01-01	407
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	407
Number of participants with account balances	2020-01-01	201
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	10
2019: CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	399
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	351
Number of retired or separated participants receiving benefits	2019-01-01	3
Number of other retired or separated participants entitled to future benefits	2019-01-01	87
Total of all active and inactive participants	2019-01-01	441
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	441
Number of participants with account balances	2019-01-01	203
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	3
2018: CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	387
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	300
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	81
Total of all active and inactive participants	2018-01-01	381
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	381
Number of participants with account balances	2018-01-01	216
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	370
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	353
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	34
Total of all active and inactive participants	2017-01-01	387
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	387
Number of participants with account balances	2017-01-01	232
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	6
2016: CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	345
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	338
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	22
Total of all active and inactive participants	2016-01-01	360
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	360
Number of participants with account balances	2016-01-01	233
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	8
2015: CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	333
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	330
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	13
Total of all active and inactive participants	2015-01-01	343
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	343
Number of participants with account balances	2015-01-01	242
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	8

Financial Data on CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN

Measure	Date	Value
2022 : CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-62,452
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$498,326
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$491,375
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$245,513
Value of total assets at end of year	2022-12-31	$2,177,421
Value of total assets at beginning of year	2022-12-31	$2,738,199
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$6,951
Total interest from all sources	2022-12-31	$3,185
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$205,388
Participant contributions at end of year	2022-12-31	$51,946
Participant contributions at beginning of year	2022-12-31	$47,754
Participant contributions at end of year	2022-12-31	$8,093
Participant contributions at beginning of year	2022-12-31	$7,482
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$12,335
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2022-12-31	$4,487
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-560,778
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$2,177,421
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$2,738,199
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in pooled separate accounts at end of year	2022-12-31	$2,112,135
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$2,681,764
Interest on participant loans	2022-12-31	$3,185
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$4,141
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$48
Net investment gain/loss from pooled separate accounts	2022-12-31	$-311,150
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$27,790
Employer contributions (assets) at end of year	2022-12-31	$1,106
Employer contributions (assets) at beginning of year	2022-12-31	$1,151
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$486,888
Contract administrator fees	2022-12-31	$6,951
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	BERRY, DUNN, MCNEIL & PARKER, LLC
Accountancy firm EIN	2022-12-31	010523282
2021 : CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$5,304
Total income from all sources (including contributions)	2021-12-31	$580,190
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$203,932
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$186,229
Expenses. Certain deemed distributions of participant loans	2021-12-31	$0
Value of total corrective distributions	2021-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$312,451
Value of total assets at end of year	2021-12-31	$2,738,199
Value of total assets at beginning of year	2021-12-31	$2,367,245
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$17,703
Total interest from all sources	2021-12-31	$2,846
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$270,150
Participant contributions at end of year	2021-12-31	$47,754
Participant contributions at beginning of year	2021-12-31	$55,029
Participant contributions at end of year	2021-12-31	$7,482
Participant contributions at beginning of year	2021-12-31	$10,829
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$5,223
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2021-12-31	$5,304
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$376,258
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$2,738,199
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$2,361,941
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in pooled separate accounts at end of year	2021-12-31	$2,681,764
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$2,299,615
Interest on participant loans	2021-12-31	$2,846
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$48
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$185
Net investment gain/loss from pooled separate accounts	2021-12-31	$264,893
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$37,078
Employer contributions (assets) at end of year	2021-12-31	$1,151
Employer contributions (assets) at beginning of year	2021-12-31	$1,587
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$186,229
Contract administrator fees	2021-12-31	$17,703
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	BERRY, DUNN, MCNEIL & PARKER, LLC
Accountancy firm EIN	2021-12-31	010523282
2020 : CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$5,304
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$9,609
Total income from all sources (including contributions)	2020-12-31	$621,792
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$189,016
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$152,247
Expenses. Certain deemed distributions of participant loans	2020-12-31	$1,380
Value of total corrective distributions	2020-12-31	$9,376
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$394,994
Value of total assets at end of year	2020-12-31	$2,367,245
Value of total assets at beginning of year	2020-12-31	$1,938,774
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$26,013
Total interest from all sources	2020-12-31	$3,551
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$317,693
Participant contributions at end of year	2020-12-31	$55,029
Participant contributions at beginning of year	2020-12-31	$61,781
Participant contributions at end of year	2020-12-31	$10,829
Participant contributions at beginning of year	2020-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$27,936
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2020-12-31	$5,304
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-12-31	$9,609
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$432,776
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$2,361,941
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$1,929,165
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in pooled separate accounts at end of year	2020-12-31	$2,299,615
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$1,876,993
Interest on participant loans	2020-12-31	$3,551
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$185
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$0
Net investment gain/loss from pooled separate accounts	2020-12-31	$223,247
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$49,365
Employer contributions (assets) at end of year	2020-12-31	$1,587
Employer contributions (assets) at beginning of year	2020-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$152,247
Contract administrator fees	2020-12-31	$26,013
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Unqualified
Accountancy firm name	2020-12-31	BERRY, DUNN, MCNEIL & PARKER, LLC
Accountancy firm EIN	2020-12-31	010523282
2019 : CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2019 401k financial data
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	$9,609
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	$681,362
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$305,270
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$281,396
Expenses. Certain deemed distributions of participant loans	2019-12-31	$9,295
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$374,946
Value of total assets at end of year	2019-12-31	$1,938,774
Value of total assets at beginning of year	2019-12-31	$1,553,073
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$14,579
Total interest from all sources	2019-12-31	$2,741
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
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
Contributions received from participants	2019-12-31	$259,586
Participant contributions at end of year	2019-12-31	$61,781
Participant contributions at beginning of year	2019-12-31	$27,558
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$69,811
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$9,609
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$376,092
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$1,929,165
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$1,553,073
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 leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in pooled separate accounts at end of year	2019-12-31	$1,876,993
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$1,525,515
Interest on participant loans	2019-12-31	$2,741
Net investment gain/loss from pooled separate accounts	2019-12-31	$303,675
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
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	$45,549
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$281,396
Contract administrator fees	2019-12-31	$14,579
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
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
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	BERRY, DUNN, MCNEIL & PARKER, LLC
Accountancy firm EIN	2019-12-31	010523282
2018 : CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$267,608
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$224,784
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$219,516
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$365,004
Value of total assets at end of year	2018-12-31	$1,553,073
Value of total assets at beginning of year	2018-12-31	$1,510,249
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$5,268
Total interest from all sources	2018-12-31	$1,168
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Administrative expenses professional fees incurred	2018-12-31	$5,268
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$5,555,000
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	$243,372
Participant contributions at end of year	2018-12-31	$27,558
Participant contributions at beginning of year	2018-12-31	$16,813
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$73,753
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	$42,824
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$1,553,073
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$1,510,249
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 pooled separate accounts at end of year	2018-12-31	$1,525,515
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$1,493,075
Interest on participant loans	2018-12-31	$1,168
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$361
Net investment gain/loss from pooled separate accounts	2018-12-31	$-98,564
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	$47,879
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$219,516
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2018-12-31	No
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	BERRY, DUNN, MCNEIL & PARKER, LLC
Accountancy firm EIN	2018-12-31	010523282
2017 : CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$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	$597,160
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$136,228
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$132,474
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$441,485
Value of total assets at end of year	2017-12-31	$1,510,249
Value of total assets at beginning of year	2017-12-31	$1,049,317
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$3,754
Total interest from all sources	2017-12-31	$497
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Administrative expenses professional fees incurred	2017-12-31	$3,754
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$5,555,000
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	$356,688
Participant contributions at end of year	2017-12-31	$16,813
Participant contributions at beginning of year	2017-12-31	$3,815
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$16,807
Total non interest bearing cash at end of year	2017-12-31	$0
Total non interest bearing cash at beginning of year	2017-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$460,932
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$1,510,249
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$1,049,317
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	$1,493,075
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$992,528
Interest on participant loans	2017-12-31	$428
Interest earned on other investments	2017-12-31	$69
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$361
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$52,974
Net investment gain/loss from pooled separate accounts	2017-12-31	$155,178
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	$67,990
Employer contributions (assets) at end of year	2017-12-31	$0
Employer contributions (assets) at beginning of year	2017-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$132,474
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2017-12-31	No
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	BERRY, DUNN, MCNEIL & PARKER, LLC
Accountancy firm EIN	2017-12-31	010523282
2016 : CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$601,215
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$32,598
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$30,541
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$538,040
Value of total assets at end of year	2016-12-31	$1,049,317
Value of total assets at beginning of year	2016-12-31	$480,700
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$2,057
Total interest from all sources	2016-12-31	$622
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Administrative expenses professional fees incurred	2016-12-31	$2,057
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$5,555,000
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	$406,444
Participant contributions at end of year	2016-12-31	$3,815
Participant contributions at beginning of year	2016-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$53,253
Total non interest bearing cash at end of year	2016-12-31	$0
Total non interest bearing cash at beginning of year	2016-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$568,617
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$1,049,317
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$480,700
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	$992,528
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$453,909
Interest on participant loans	2016-12-31	$90
Interest earned on other investments	2016-12-31	$532
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$52,974
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$24,273
Net investment gain/loss from pooled separate accounts	2016-12-31	$62,553
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	$78,343
Employer contributions (assets) at end of year	2016-12-31	$0
Employer contributions (assets) at beginning of year	2016-12-31	$2,518
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$30,541
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2016-12-31	No
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	BERRY, DUNN, MCNEIL & PARKER, LLC
Accountancy firm EIN	2016-12-31	010523282
2015 : CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$485,925
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$5,225
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$4,895
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$492,105
Value of total assets at end of year	2015-12-31	$480,700
Value of total assets at beginning of year	2015-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$330
Total interest from all sources	2015-12-31	$138
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	$5,555,000
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	$372,009
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$50,000
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	$480,700
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$480,700
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$0
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
Interest earned on other investments	2015-12-31	$138
Value of interest in common/collective trusts at end of year	2015-12-31	$453,909
Value of interest in common/collective trusts at beginning of year	2015-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$24,273
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$0
Net investment gain/loss from pooled separate accounts	2015-12-31	$-6,318
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	$70,096
Employer contributions (assets) at end of year	2015-12-31	$2,518
Employer contributions (assets) at beginning of year	2015-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$4,895
Contract administrator fees	2015-12-31	$330
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2015-12-31	No
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	BERRY, DUNN, MCNEIL & PARKER, LLC
Accountancy firm EIN	2015-12-31	010523282

Form 5500 Responses for CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN

2022: CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: CEDAR HAVEN HEALTHCARE CENTER 401(K) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	First time form 5500 has been submitted	Yes
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

Insurance Providers Used on plan

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

935793

Policy instance

Insurance contract or identification number	935793
Number of Individuals Covered	159
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $10,448
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	9798
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	4

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

935793

Policy instance

Insurance contract or identification number	935793
Number of Individuals Covered	192
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $9,638
Total amount of fees paid to insurance company	USD $1,204
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
Commission paid to Insurance Broker	USD $9,638
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	4

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

935793

Policy instance

Insurance contract or identification number	935793
Number of Individuals Covered	201
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $7,614
Total amount of fees paid to insurance company	USD $950
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
Commission paid to Insurance Broker	USD $7,614
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	4

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

935793

Policy instance

Insurance contract or identification number	935793
Number of Individuals Covered	203
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $5,165
Total amount of fees paid to insurance company	USD $837
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
Commission paid to Insurance Broker	USD $5,165
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	4

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

935793

Policy instance

Insurance contract or identification number	935793
Number of Individuals Covered	215
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $6,195
Total amount of fees paid to insurance company	USD $582
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
Commission paid to Insurance Broker	USD $6,195
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	4

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

935793

Policy instance

Insurance contract or identification number	935793
Number of Individuals Covered	232
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $6,098
Total amount of fees paid to insurance company	USD $762
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
Commission paid to Insurance Broker	USD $6,098
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	4
Insurance broker name	CONTINENTAL BENEFITS GROUP, INC.

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

935793

Policy instance

Insurance contract or identification number	935793
Number of Individuals Covered	242
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $361
Total amount of fees paid to insurance company	USD $400
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	400
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker organization code?	5
Insurance broker name	WELLS FARGO ADVISORS INS AGENCY, LL

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Company Name:	CEDAR HAVEN ACQUISITION LLC CEDAR HAVEN HEALTHCARE CENTER
Employer identification number (EIN):	471518400
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	5579627