401k Plan data: STONEGATE NURSING CENTER, LTD 401(K) PLAN plan

STONEGATE NURSING CENTER, LTD 401(K) PLAN 401k Plan overview

Plan Name	STONEGATE NURSING CENTER, LTD 401(K) PLAN
Plan identification number	001

STONEGATE NURSING CENTER, LTD 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

STONEGATE NURSING CENTER, LTD has sponsored the creation of one or more 401k plans.

Company Name: STONEGATE NURSING CENTER, LTD

Employer identification number (EIN): 752783921

NAIC Classification: 812990
NAIC Description: All Other Personal Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan STONEGATE NURSING CENTER, LTD 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 DIANA THOMAS
001 2016-01-01 DIANA THOMAS
001 2015-01-01 DIANA THOMAS
001 2014-01-01 DIANA THOMAS
001 2013-01-01 DIANA THOMAS
001 2012-01-01 DIANA THOMAS
001 2011-01-01 DIANA THOMAS
001 2010-01-01 DIANA M. THOMAS
001 2009-01-01 DIANA M. THOMAS
001 2009-01-01 DIANA M. THOMAS

Plan id#	Filing Submission Date	Name of Administrator
001	2016-01-01	DIANA THOMAS
001	2016-01-01	DIANA THOMAS
001	2015-01-01	DIANA THOMAS
001	2014-01-01	DIANA THOMAS
001	2013-01-01	DIANA THOMAS
001	2012-01-01	DIANA THOMAS
001	2011-01-01	DIANA THOMAS
001	2010-01-01	DIANA M. THOMAS
001	2009-01-01	DIANA M. THOMAS
001	2009-01-01	DIANA M. THOMAS

Plan Statistics for STONEGATE NURSING CENTER, LTD 401(K) PLAN

401k plan membership statisitcs for STONEGATE NURSING CENTER, LTD 401(K) PLAN

Measure Date Value
2016: STONEGATE NURSING CENTER, LTD 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 152
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 0
Number of participants with account balances 2016-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: STONEGATE NURSING CENTER, LTD 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 168
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 152
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 21
Total of all active and inactive participants 2015-01-01 173
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 173
Number of participants with account balances 2015-01-01 76
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: STONEGATE NURSING CENTER, LTD 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 170
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 147
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 17
Total of all active and inactive participants 2014-01-01 164
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 164
Number of participants with account balances 2014-01-01 73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 3
2013: STONEGATE NURSING CENTER, LTD 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 180
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 148
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 17
Total of all active and inactive participants 2013-01-01 165
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 165
Number of participants with account balances 2013-01-01 71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 1
2012: STONEGATE NURSING CENTER, LTD 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 184
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 157
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 17
Total of all active and inactive participants 2012-01-01 174
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 174
Number of participants with account balances 2012-01-01 65
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 2
2011: STONEGATE NURSING CENTER, LTD 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 154
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 168
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 16
Total of all active and inactive participants 2011-01-01 184
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 184
Number of participants with account balances 2011-01-01 61
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: STONEGATE NURSING CENTER, LTD 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 148
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 128
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 12
Total of all active and inactive participants 2010-01-01 140
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 140
Number of participants with account balances 2010-01-01 57
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 9
2009: STONEGATE NURSING CENTER, LTD 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 202
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 178
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 10
Total of all active and inactive participants 2009-01-01 188
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 188
Number of participants with account balances 2009-01-01 45
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2016: STONEGATE NURSING CENTER, LTD 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	152
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	0
Number of participants with account balances	2016-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: STONEGATE NURSING CENTER, LTD 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	168
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	152
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	21
Total of all active and inactive participants	2015-01-01	173
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	173
Number of participants with account balances	2015-01-01	76
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: STONEGATE NURSING CENTER, LTD 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	170
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	147
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	17
Total of all active and inactive participants	2014-01-01	164
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	164
Number of participants with account balances	2014-01-01	73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	3
2013: STONEGATE NURSING CENTER, LTD 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	180
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	148
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	17
Total of all active and inactive participants	2013-01-01	165
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	165
Number of participants with account balances	2013-01-01	71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	1
2012: STONEGATE NURSING CENTER, LTD 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	184
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	157
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	17
Total of all active and inactive participants	2012-01-01	174
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	174
Number of participants with account balances	2012-01-01	65
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	2
2011: STONEGATE NURSING CENTER, LTD 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	154
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	168
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	16
Total of all active and inactive participants	2011-01-01	184
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	184
Number of participants with account balances	2011-01-01	61
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: STONEGATE NURSING CENTER, LTD 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	148
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	128
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	12
Total of all active and inactive participants	2010-01-01	140
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	140
Number of participants with account balances	2010-01-01	57
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	9
2009: STONEGATE NURSING CENTER, LTD 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	202
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	178
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	10
Total of all active and inactive participants	2009-01-01	188
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	188
Number of participants with account balances	2009-01-01	45
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on STONEGATE NURSING CENTER, LTD 401(K) PLAN

Measure	Date	Value
2016 : STONEGATE NURSING CENTER, LTD 401(K) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-05-12	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-05-12	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-05-12	$0
Total income from all sources (including contributions)	2016-05-12	$-11,244
Total loss/gain on sale of assets	2016-05-12	$0
Total of all expenses incurred	2016-05-12	$573,293
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-05-12	$571,342
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-05-12	$0
Value of total assets at end of year	2016-05-12	$0
Value of total assets at beginning of year	2016-05-12	$584,537
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-05-12	$1,951
Total interest from all sources	2016-05-12	$67
Total dividends received (eg from common stock, registered investment company shares)	2016-05-12	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-05-12	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2016-05-12	$0
Was this plan covered by a fidelity bond	2016-05-12	Yes
Value of fidelity bond cover	2016-05-12	$1,000,000
If this is an individual account plan, was there a blackout period	2016-05-12	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-05-12	$0
Were there any nonexempt tranactions with any party-in-interest	2016-05-12	No
Participant contributions at end of year	2016-05-12	$0
Participant contributions at beginning of year	2016-05-12	$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	2016-05-12	No
Value of net income/loss	2016-05-12	$-584,537
Value of net assets at end of year (total assets less liabilities)	2016-05-12	$0
Value of net assets at beginning of year (total assets less liabilities)	2016-05-12	$584,537
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-05-12	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-05-12	No
Were any leases to which the plan was party in default or uncollectible	2016-05-12	No
Value of interest in pooled separate accounts at end of year	2016-05-12	$0
Value of interest in pooled separate accounts at beginning of year	2016-05-12	$574,579
Interest earned on other investments	2016-05-12	$67
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-05-12	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-05-12	$9,958
Net investment gain/loss from pooled separate accounts	2016-05-12	$-11,311
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-05-12	No
Was there a failure to transmit to the plan any participant contributions	2016-05-12	No
Has the plan failed to provide any benefit when due under the plan	2016-05-12	No
Employer contributions (assets) at end of year	2016-05-12	$0
Employer contributions (assets) at beginning of year	2016-05-12	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-05-12	$571,342
Contract administrator fees	2016-05-12	$1,951
Did the plan have assets held for investment	2016-05-12	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	2016-05-12	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-05-12	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-05-12	Yes
Opinion of an independent qualified public accountant for this plan	2016-05-12	Disclaimer
Accountancy firm name	2016-05-12	PHILIP T.CHARON, CPA, PLLC
Accountancy firm EIN	2016-05-12	274510644
2015 : STONEGATE NURSING CENTER, LTD 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	$66,972
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$50,616
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$47,197
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$79,129
Value of total assets at end of year	2015-12-31	$584,537
Value of total assets at beginning of year	2015-12-31	$568,181
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$3,419
Total interest from all sources	2015-12-31	$220
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	$1,000,000
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	$69,031
Participant contributions at end of year	2015-12-31	$0
Participant contributions at beginning of year	2015-12-31	$1,529
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$6,852
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	$16,356
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$584,537
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$568,181
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in pooled separate accounts at end of year	2015-12-31	$574,579
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$555,792
Interest earned on other investments	2015-12-31	$220
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$9,958
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$7,339
Net investment gain/loss from pooled separate accounts	2015-12-31	$-12,377
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	$3,246
Employer contributions (assets) at end of year	2015-12-31	$0
Employer contributions (assets) at beginning of year	2015-12-31	$3,521
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$47,197
Contract administrator fees	2015-12-31	$3,419
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	PHILIP T.CHARON, CPA, PLLC
Accountancy firm EIN	2015-12-31	274510644
2014 : STONEGATE NURSING CENTER, LTD 401(K) PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$95,404
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$24,827
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$21,479
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$73,939
Value of total assets at end of year	2014-12-31	$568,181
Value of total assets at beginning of year	2014-12-31	$497,604
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$3,348
Total interest from all sources	2014-12-31	$124
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$1,000,000
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	$70,418
Participant contributions at end of year	2014-12-31	$1,529
Participant contributions at beginning of year	2014-12-31	$0
Administrative expenses (other) incurred	2014-12-31	$3,348
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	$70,577
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$568,181
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$497,604
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in pooled separate accounts at end of year	2014-12-31	$555,792
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$489,082
Interest earned on other investments	2014-12-31	$124
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$7,339
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$2,668
Net investment gain/loss from pooled separate accounts	2014-12-31	$21,341
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$3,521
Employer contributions (assets) at end of year	2014-12-31	$3,521
Employer contributions (assets) at beginning of year	2014-12-31	$5,854
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$21,479
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	PHILIP T.CHARON, CPA, PLLC
Accountancy firm EIN	2014-12-31	274510644
2013 : STONEGATE NURSING CENTER, LTD 401(K) PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$139,692
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$21,480
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$18,430
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$64,392
Value of total assets at end of year	2013-12-31	$497,604
Value of total assets at beginning of year	2013-12-31	$379,392
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$3,050
Total interest from all sources	2013-12-31	$32
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$58,538
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	$118,212
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$497,604
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$379,392
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
Investment advisory and management fees	2013-12-31	$3,050
Value of interest in pooled separate accounts at end of year	2013-12-31	$489,082
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$373,801
Interest earned on other investments	2013-12-31	$32
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$2,668
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$589
Net investment gain/loss from pooled separate accounts	2013-12-31	$75,268
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$5,854
Employer contributions (assets) at end of year	2013-12-31	$5,854
Employer contributions (assets) at beginning of year	2013-12-31	$5,002
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$18,430
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	PHILIP T.CHARON, CPA, PLLC
Accountancy firm EIN	2013-12-31	274510644
2012 : STONEGATE NURSING CENTER, LTD 401(K) PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$86,727
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$17,954
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$14,808
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$55,026
Value of total assets at end of year	2012-12-31	$379,392
Value of total assets at beginning of year	2012-12-31	$310,619
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$3,146
Total interest from all sources	2012-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
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	$1,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$50,024
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	$68,773
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$379,392
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$310,619
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Investment advisory and management fees	2012-12-31	$3,146
Value of interest in pooled separate accounts at end of year	2012-12-31	$373,801
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$298,709
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$589
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$193
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$31,692
Net investment gain/loss from pooled separate accounts	2012-12-31	$9
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	$5,002
Employer contributions (assets) at end of year	2012-12-31	$5,002
Employer contributions (assets) at beginning of year	2012-12-31	$11,717
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$14,808
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	PHILIP T.CHARON & CO. PLLC
Accountancy firm EIN	2012-12-31	274510644
2011 : STONEGATE NURSING CENTER, LTD 401(K) PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$41,134
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$18,042
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$14,817
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$60,563
Value of total assets at end of year	2011-12-31	$310,619
Value of total assets at beginning of year	2011-12-31	$287,527
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$3,225
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	$1,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$48,846
Other income not declared elsewhere	2011-12-31	$-2,168
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	$23,092
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$310,619
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$287,527
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 pooled separate accounts at end of year	2011-12-31	$298,709
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$275,569
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$193
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$164
Net investment gain/loss from pooled separate accounts	2011-12-31	$-17,261
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	$11,717
Employer contributions (assets) at end of year	2011-12-31	$11,717
Employer contributions (assets) at beginning of year	2011-12-31	$11,794
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$14,817
Contract administrator fees	2011-12-31	$3,225
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	THE HALL GROUP
Accountancy firm EIN	2011-12-31	752519158
2010 : STONEGATE NURSING CENTER, LTD 401(K) PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$85,190
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$23,581
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$20,033
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$61,137
Value of total assets at end of year	2010-12-31	$287,527
Value of total assets at beginning of year	2010-12-31	$225,918
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$3,548
Total interest from all sources	2010-12-31	$24,053
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
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	$1,000,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$49,343
Administrative expenses (other) incurred	2010-12-31	$557
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	$61,609
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$287,527
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$225,918
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 pooled separate accounts at end of year	2010-12-31	$275,569
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$215,429
Interest earned on other investments	2010-12-31	$24,053
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$164
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$451
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	$11,794
Employer contributions (assets) at end of year	2010-12-31	$11,794
Employer contributions (assets) at beginning of year	2010-12-31	$10,038
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$20,033
Contract administrator fees	2010-12-31	$2,991
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	THE HALL GROUP
Accountancy firm EIN	2010-12-31	752519158
2009 : STONEGATE NURSING CENTER, LTD 401(K) PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for STONEGATE NURSING CENTER, LTD 401(K) PLAN

2016: STONEGATE NURSING CENTER, LTD 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	Yes
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
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: STONEGATE NURSING CENTER, LTD 401(K) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: STONEGATE NURSING CENTER, LTD 401(K) 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 - Trust	Yes
2013: STONEGATE NURSING CENTER, LTD 401(K) 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 - Trust	Yes
2012: STONEGATE NURSING CENTER, LTD 401(K) 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 - Trust	Yes
2011: STONEGATE NURSING CENTER, LTD 401(K) 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 - Trust	Yes
2010: STONEGATE NURSING CENTER, LTD 401(K) PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: STONEGATE NURSING CENTER, LTD 401(K) PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )

Policy contract number

91675145

Policy instance

Insurance contract or identification number	91675145
Number of Individuals Covered	0
Insurance policy start date	2016-01-01
Insurance policy end date	2016-05-12
Total amount of commissions paid to insurance broker	USD $388
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $388
Insurance broker organization code?	3
Insurance broker name	HATCHER TIMOTHY O

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )

Policy contract number

91675145

Policy instance

Insurance contract or identification number	91675145
Number of Individuals Covered	76
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,512
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,512
Insurance broker organization code?	3
Insurance broker name	HATCHER TIMOTHY O

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )

Policy contract number

91675145

Policy instance

Insurance contract or identification number	91675145
Number of Individuals Covered	73
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,313
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,313
Insurance broker organization code?	3
Insurance broker name	HATCHER TIMOTHY O

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )

Policy contract number

91675145

Policy instance

Insurance contract or identification number	91675145
Number of Individuals Covered	71
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,055
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,055
Insurance broker organization code?	3
Insurance broker name	HATCHER TIMOTHY O

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )

Policy contract number

91675145

Policy instance

Insurance contract or identification number	91675145
Number of Individuals Covered	65
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $764
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $194
Insurance broker organization code?	3
Insurance broker name	HATCHER TIMOTHY O

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )

Policy contract number

91675145

Policy instance

Insurance contract or identification number	91675145
Number of Individuals Covered	61
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $743
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )

Policy contract number

91675145

Policy instance

Insurance contract or identification number	91675145
Number of Individuals Covered	57
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $108
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $108
Insurance broker organization code?	3
Insurance broker name	HAYES SHAWN E

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Company Name:	STONEGATE NURSING CENTER, LTD
Employer identification number (EIN):	752783921
NAIC Classification:	812990
NAIC Description:	All Other Personal Services