401k Plan data: CALVERT COUNTY NURSING CENTER, INC. 401(K) PROFIT SHARING PLAN plan

CALVERT COUNTY NURSING CENTER, INC. 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	CALVERT COUNTY NURSING CENTER, INC. 401(K) PROFIT SHARING PLAN
Plan identification number	001

CALVERT COUNTY NURSING CENTER, INC. 401(K) PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
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.

401k Sponsoring company profile

CALVERT COUNTY NURSING CENTER, INC. has sponsored the creation of one or more 401k plans.

Company Name: CALVERT COUNTY NURSING CENTER, INC.

Employer identification number (EIN): 520890928

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CALVERT COUNTY NURSING CENTER, INC. 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2015-01-01 TAMI RADISCH
001 2014-01-01 TAMI RADISCH TAMI RADISCH 2015-10-12
001 2013-01-01 CHARLES PHILLIPS
001 2012-01-01 CHARLES PHILLIPS
001 2011-01-01 RICHARD HANAUER

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2015-01-01	TAMI RADISCH
001	2014-01-01	TAMI RADISCH	TAMI RADISCH	2015-10-12
001	2013-01-01	CHARLES PHILLIPS
001	2012-01-01	CHARLES PHILLIPS
001	2011-01-01	RICHARD HANAUER

Plan Statistics for CALVERT COUNTY NURSING CENTER, INC. 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for CALVERT COUNTY NURSING CENTER, INC. 401(K) PROFIT SHARING PLAN

Measure Date Value
2015: CALVERT COUNTY NURSING CENTER, INC. 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 188
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 0
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 0
Total of all active and inactive participants 2015-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 0
Number of participants with account balances 2015-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: CALVERT COUNTY NURSING CENTER, INC. 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 188
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 216
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 1
Total of all active and inactive participants 2014-01-01 217
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 217
Number of participants with account balances 2014-01-01 29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: CALVERT COUNTY NURSING CENTER, INC. 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 152
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 180
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 6
Total of all active and inactive participants 2013-01-01 186
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 186
Number of participants with account balances 2013-01-01 36
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: CALVERT COUNTY NURSING CENTER, INC. 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 172
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 141
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 11
Total of all active and inactive participants 2012-01-01 152
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 152
Number of participants with account balances 2012-01-01 45
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 3
2011: CALVERT COUNTY NURSING CENTER, INC. 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 172
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 162
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 5
Total of all active and inactive participants 2011-01-01 167
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 167
Number of participants with account balances 2011-01-01 45
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 2

Measure	Date	Value
2015: CALVERT COUNTY NURSING CENTER, INC. 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	188
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	0
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	0
Total of all active and inactive participants	2015-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	0
Number of participants with account balances	2015-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: CALVERT COUNTY NURSING CENTER, INC. 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	188
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	216
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	1
Total of all active and inactive participants	2014-01-01	217
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	217
Number of participants with account balances	2014-01-01	29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: CALVERT COUNTY NURSING CENTER, INC. 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	152
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	180
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	6
Total of all active and inactive participants	2013-01-01	186
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	186
Number of participants with account balances	2013-01-01	36
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: CALVERT COUNTY NURSING CENTER, INC. 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	172
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	141
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	11
Total of all active and inactive participants	2012-01-01	152
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	152
Number of participants with account balances	2012-01-01	45
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	3
2011: CALVERT COUNTY NURSING CENTER, INC. 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	172
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	162
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	5
Total of all active and inactive participants	2011-01-01	167
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	167
Number of participants with account balances	2011-01-01	45
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	2

Financial Data on CALVERT COUNTY NURSING CENTER, INC. 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2015 : CALVERT COUNTY NURSING CENTER, INC. 401(K) PROFIT SHARING PLAN 2015 401k financial data
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-07-10	$663
Total income from all sources (including contributions)	2015-07-10	$28,367
Total of all expenses incurred	2015-07-10	$365,558
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-07-10	$361,463
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-07-10	$25,077
Value of total assets at end of year	2015-07-10	$0
Value of total assets at beginning of year	2015-07-10	$337,854
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-07-10	$4,095
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-07-10	No
Was this plan covered by a fidelity bond	2015-07-10	Yes
Value of fidelity bond cover	2015-07-10	$50,000
If this is an individual account plan, was there a blackout period	2015-07-10	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-07-10	$0
Were there any nonexempt tranactions with any party-in-interest	2015-07-10	No
Contributions received from participants	2015-07-10	$25,077
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-07-10	$663
Other income not declared elsewhere	2015-07-10	$3,290
Total non interest bearing cash at end of year	2015-07-10	$0
Total non interest bearing cash at beginning of year	2015-07-10	$177
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-07-10	No
Value of net income/loss	2015-07-10	$-337,191
Value of net assets at end of year (total assets less liabilities)	2015-07-10	$0
Value of net assets at beginning of year (total assets less liabilities)	2015-07-10	$337,191
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-07-10	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-07-10	No
Were any leases to which the plan was party in default or uncollectible	2015-07-10	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-07-10	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-07-10	$337,677
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-07-10	No
Was there a failure to transmit to the plan any participant contributions	2015-07-10	No
Has the plan failed to provide any benefit when due under the plan	2015-07-10	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-07-10	$361,463
Contract administrator fees	2015-07-10	$4,095
Did the plan have assets held for investment	2015-07-10	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	2015-07-10	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-07-10	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-07-10	Yes
Opinion of an independent qualified public accountant for this plan	2015-07-10	Disclaimer
Accountancy firm name	2015-07-10	GROSS, MENDELSOHN
Accountancy firm EIN	2015-07-10	520982413
2014 : CALVERT COUNTY NURSING CENTER, INC. 401(K) PROFIT SHARING PLAN 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$663
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$685
Total income from all sources (including contributions)	2014-12-31	$59,616
Total of all expenses incurred	2014-12-31	$96,644
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$93,404
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$38,609
Value of total assets at end of year	2014-12-31	$337,854
Value of total assets at beginning of year	2014-12-31	$374,904
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$3,240
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Administrative expenses professional fees incurred	2014-12-31	$700
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$50,000
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	$38,609
Participant contributions at end of year	2014-12-31	$0
Participant contributions at beginning of year	2014-12-31	$2,799
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-12-31	$663
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$685
Total non interest bearing cash at end of year	2014-12-31	$177
Total non interest bearing cash at beginning of year	2014-12-31	$177
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	$-37,028
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$337,191
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$374,219
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 registered invesment companies (eg mutual funds) at end of year	2014-12-31	$337,677
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$371,928
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$21,007
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$93,404
Contract administrator fees	2014-12-31	$2,540
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	GROSS, MENDELSOHN
Accountancy firm EIN	2014-12-31	520982413
2013 : CALVERT COUNTY NURSING CENTER, INC. 401(K) PROFIT SHARING PLAN 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$685
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$775
Total income from all sources (including contributions)	2013-12-31	$97,016
Total of all expenses incurred	2013-12-31	$60,380
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$52,248
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$58,824
Value of total assets at end of year	2013-12-31	$374,904
Value of total assets at beginning of year	2013-12-31	$338,358
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$8,132
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Administrative expenses professional fees incurred	2013-12-31	$6,156
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$50,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$58,824
Participant contributions at end of year	2013-12-31	$2,799
Participant contributions at beginning of year	2013-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-12-31	$685
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-12-31	$775
Total non interest bearing cash at end of year	2013-12-31	$177
Total non interest bearing cash at beginning of year	2013-12-31	$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	2013-12-31	No
Value of net income/loss	2013-12-31	$36,636
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$374,219
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$337,583
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 registered invesment companies (eg mutual funds) at end of year	2013-12-31	$371,928
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$338,358
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$38,192
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	Yes
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$52,248
Contract administrator fees	2013-12-31	$1,976
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	GROSS, MENDELSOHN
Accountancy firm EIN	2013-12-31	520982413
2012 : CALVERT COUNTY NURSING CENTER, INC. 401(K) PROFIT SHARING PLAN 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$775
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$1,015
Total income from all sources (including contributions)	2012-12-31	$102,913
Total of all expenses incurred	2012-12-31	$82,848
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$82,198
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$72,621
Value of total assets at end of year	2012-12-31	$338,358
Value of total assets at beginning of year	2012-12-31	$318,533
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$650
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$50,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$67,621
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-12-31	$775
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$1,015
Other income not declared elsewhere	2012-12-31	$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	2012-12-31	No
Value of net income/loss	2012-12-31	$20,065
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$337,583
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$317,518
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$338,358
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$318,533
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$30,292
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$5,000
Employer contributions (assets) at end of year	2012-12-31	$0
Employer contributions (assets) at beginning of year	2012-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$82,198
Contract administrator fees	2012-12-31	$650
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	GROSS, MENDELSOHN
Accountancy firm EIN	2012-12-31	520982413
2011 : CALVERT COUNTY NURSING CENTER, INC. 401(K) PROFIT SHARING PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$1,015
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$77,960
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$160,039
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$159,814
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$89,379
Value of total assets at end of year	2011-12-31	$318,533
Value of total assets at beginning of year	2011-12-31	$399,597
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$225
Total interest from all sources	2011-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$10,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$84,379
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$1,015
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$-82,079
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$317,518
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$399,597
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$318,533
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$399,597
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-11,419
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$5,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$159,814
Contract administrator fees	2011-12-31	$225
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	GROSS, MENDELSOHN
Accountancy firm EIN	2011-12-31	520982413
2010 : CALVERT COUNTY NURSING CENTER, INC. 401(K) PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources (including contributions)	2010-12-31	$125,011
Total of all expenses incurred	2010-12-31	$42,282
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$42,107
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$104,952
Value of total assets at end of year	2010-12-31	$399,597
Value of total assets at beginning of year	2010-12-31	$316,868
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$175
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$20,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$97,729
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$2,223
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$82,729
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$399,597
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$316,868
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$399,597
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$316,868
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$20,059
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$5,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$42,107
Contract administrator fees	2010-12-31	$175
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	GROSS, MENDELSOHN
Accountancy firm EIN	2010-12-31	520982413

Form 5500 Responses for CALVERT COUNTY NURSING CENTER, INC. 401(K) PROFIT SHARING PLAN

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

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

109134

Policy instance

Insurance contract or identification number	109134
Number of Individuals Covered	0
Insurance policy start date	2015-01-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $603
Total amount of fees paid to insurance company	USD $2,924
Commission paid to Insurance Broker	USD $603
Insurance broker organization code?	3
Amount paid for insurance broker fees	2924
Additional information about fees paid to insurance broker	FEES
Insurance broker name	MGA PENSION CONSULTANTS, INC.

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

109134

Policy instance

Insurance contract or identification number	109134
Number of Individuals Covered	142
Insurance policy start date	2014-02-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $779
Total amount of fees paid to insurance company	USD $245
Commission paid to Insurance Broker	USD $779
Additional information about fees paid to insurance broker	COMMISSION
Insurance broker organization code?	3
Amount paid for insurance broker fees	245
Insurance broker name	MGA PENSION CONSULTANTS, INC

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

109134

Policy instance

Insurance contract or identification number	109134
Number of Individuals Covered	146
Insurance policy start date	2013-02-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,808
Total amount of fees paid to insurance company	USD $5,470
Commission paid to Insurance Broker	USD $2,808
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3
Amount paid for insurance broker fees	5470
Insurance broker name	MGA PENSION CONSULTANTS, INC

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

820442

Policy instance

Insurance contract or identification number	820442
Number of Individuals Covered	0
Insurance policy start date	2013-01-01
Insurance policy end date	2013-01-31
Total amount of commissions paid to insurance broker	USD $167
Total amount of fees paid to insurance company	USD $41
Commission paid to Insurance Broker	USD $167
Additional information about fees paid to insurance broker	COMMISSION
Insurance broker organization code?	3
Amount paid for insurance broker fees	41
Insurance broker name	MGA PENSION CONSULTANTS, INC

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

820442

Policy instance

Insurance contract or identification number	820442
Number of Individuals Covered	42
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $694
Total amount of fees paid to insurance company	USD $524
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	351
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $694
Insurance broker name	MGA PENSION CONSULTANTS, INC

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

820442

Policy instance

Insurance contract or identification number	820442
Number of Individuals Covered	45
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $890
Total amount of fees paid to insurance company	USD $630

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

820442

Policy instance

Insurance contract or identification number	820442
Number of Individuals Covered	48
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $6,233
Total amount of fees paid to insurance company	USD $2,675

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Company Name:	CALVERT COUNTY NURSING CENTER, INC.
Employer identification number (EIN):	520890928
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities