401k Plan data: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU plan

NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 401k Plan overview

Plan Name	NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU
Plan identification number	001

NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.

401k Sponsoring company profile

NORTH SHORE ELDER SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name: NORTH SHORE ELDER SERVICES, INC.

Employer identification number (EIN): 042595072

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2019-01-01
001 2018-01-01
001 2017-01-01 PAUL LANZIKOS
001 2016-01-01 PAUL LANZIKOS
001 2015-01-01
001 2014-01-01
001 2013-01-01
001 2012-01-01 PAUL LANZIKOS
001 2011-01-01 PAUL LANZIKOS
001 2009-01-01 PAUL LANZIKOS

Plan Statistics for NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU

401k plan membership statisitcs for NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU

Measure Date Value
2019: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2019 401k membership
Total participants, beginning-of-year 2019-01-01 210
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 0
Total of all active and inactive participants 2019-01-01 0
Total participants 2019-01-01 0
Number of participants with account balances 2019-01-01 0
2018: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2018 401k membership
Total participants, beginning-of-year 2018-01-01 202
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 129
Number of retired or separated participants receiving benefits 2018-01-01 13
Number of other retired or separated participants entitled to future benefits 2018-01-01 68
Total of all active and inactive participants 2018-01-01 210
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 210
Number of participants with account balances 2018-01-01 151
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2017 401k membership
Total participants, beginning-of-year 2017-01-01 204
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 132
Number of retired or separated participants receiving benefits 2017-01-01 13
Number of other retired or separated participants entitled to future benefits 2017-01-01 56
Total of all active and inactive participants 2017-01-01 201
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 201
Number of participants with account balances 2017-01-01 138
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2016 401k membership
Total participants, beginning-of-year 2016-01-01 155
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 134
Number of retired or separated participants receiving benefits 2016-01-01 8
Number of other retired or separated participants entitled to future benefits 2016-01-01 63
Total of all active and inactive participants 2016-01-01 205
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 205
Number of participants with account balances 2016-01-01 137
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2015 401k membership
Total participants, beginning-of-year 2015-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 84
Number of retired or separated participants receiving benefits 2015-01-01 7
Number of other retired or separated participants entitled to future benefits 2015-01-01 29
Total of all active and inactive participants 2015-01-01 120
Total participants 2015-01-01 120
Number of participants with account balances 2015-01-01 120
2014: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2014 401k membership
Total participants, beginning-of-year 2014-01-01 90
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 78
Number of retired or separated participants receiving benefits 2014-01-01 6
Number of other retired or separated participants entitled to future benefits 2014-01-01 16
Total of all active and inactive participants 2014-01-01 100
Total participants 2014-01-01 100
Number of participants with account balances 2014-01-01 100
2013: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2013 401k membership
Total participants, beginning-of-year 2013-01-01 85
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 67
Number of retired or separated participants receiving benefits 2013-01-01 6
Number of other retired or separated participants entitled to future benefits 2013-01-01 16
Total of all active and inactive participants 2013-01-01 89
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 1
Total participants 2013-01-01 90
Number of participants with account balances 2013-01-01 90
2012: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2012 401k membership
Total participants, beginning-of-year 2012-01-01 92
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 82
Number of retired or separated participants receiving benefits 2012-01-01 3
Total of all active and inactive participants 2012-01-01 85
Total participants 2012-01-01 85
Number of participants with account balances 2012-01-01 82
2011: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2011 401k membership
Total participants, beginning-of-year 2011-01-01 85
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 90
Number of retired or separated participants receiving benefits 2011-01-01 2
Total of all active and inactive participants 2011-01-01 92
Total participants 2011-01-01 92
Number of participants with account balances 2011-01-01 90
2009: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2009 401k membership
Total participants, beginning-of-year 2009-01-01 90
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 83
Number of other retired or separated participants entitled to future benefits 2009-01-01 2
Total of all active and inactive participants 2009-01-01 85
Total participants 2009-01-01 85
Number of participants with account balances 2009-01-01 85

Measure	Date	Value
2019: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2019 401k membership
Total participants, beginning-of-year	2019-01-01	210
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	0
Total of all active and inactive participants	2019-01-01	0
Total participants	2019-01-01	0
Number of participants with account balances	2019-01-01	0
2018: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2018 401k membership
Total participants, beginning-of-year	2018-01-01	202
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	129
Number of retired or separated participants receiving benefits	2018-01-01	13
Number of other retired or separated participants entitled to future benefits	2018-01-01	68
Total of all active and inactive participants	2018-01-01	210
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	210
Number of participants with account balances	2018-01-01	151
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2017 401k membership
Total participants, beginning-of-year	2017-01-01	204
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	132
Number of retired or separated participants receiving benefits	2017-01-01	13
Number of other retired or separated participants entitled to future benefits	2017-01-01	56
Total of all active and inactive participants	2017-01-01	201
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	201
Number of participants with account balances	2017-01-01	138
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2016 401k membership
Total participants, beginning-of-year	2016-01-01	155
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	134
Number of retired or separated participants receiving benefits	2016-01-01	8
Number of other retired or separated participants entitled to future benefits	2016-01-01	63
Total of all active and inactive participants	2016-01-01	205
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	205
Number of participants with account balances	2016-01-01	137
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2015 401k membership
Total participants, beginning-of-year	2015-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	84
Number of retired or separated participants receiving benefits	2015-01-01	7
Number of other retired or separated participants entitled to future benefits	2015-01-01	29
Total of all active and inactive participants	2015-01-01	120
Total participants	2015-01-01	120
Number of participants with account balances	2015-01-01	120
2014: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2014 401k membership
Total participants, beginning-of-year	2014-01-01	90
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	78
Number of retired or separated participants receiving benefits	2014-01-01	6
Number of other retired or separated participants entitled to future benefits	2014-01-01	16
Total of all active and inactive participants	2014-01-01	100
Total participants	2014-01-01	100
Number of participants with account balances	2014-01-01	100
2013: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2013 401k membership
Total participants, beginning-of-year	2013-01-01	85
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	67
Number of retired or separated participants receiving benefits	2013-01-01	6
Number of other retired or separated participants entitled to future benefits	2013-01-01	16
Total of all active and inactive participants	2013-01-01	89
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	1
Total participants	2013-01-01	90
Number of participants with account balances	2013-01-01	90
2012: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2012 401k membership
Total participants, beginning-of-year	2012-01-01	92
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	82
Number of retired or separated participants receiving benefits	2012-01-01	3
Total of all active and inactive participants	2012-01-01	85
Total participants	2012-01-01	85
Number of participants with account balances	2012-01-01	82
2011: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2011 401k membership
Total participants, beginning-of-year	2011-01-01	85
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	90
Number of retired or separated participants receiving benefits	2011-01-01	2
Total of all active and inactive participants	2011-01-01	92
Total participants	2011-01-01	92
Number of participants with account balances	2011-01-01	90
2009: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2009 401k membership
Total participants, beginning-of-year	2009-01-01	90
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	83
Number of other retired or separated participants entitled to future benefits	2009-01-01	2
Total of all active and inactive participants	2009-01-01	85
Total participants	2009-01-01	85
Number of participants with account balances	2009-01-01	85

Financial Data on NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU

Measure	Date	Value
2019 : NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2019 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2019-12-31	$400,716
Total unrealized appreciation/depreciation of assets	2019-12-31	$400,716
Total transfer of assets from this plan	2019-12-31	$4,652,049
Total transfer of assets from this plan	2019-12-31	$4,652,049
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$701,710
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$259,014
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$257,344
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$104,522
Value of total assets at end of year	2019-12-31	$0
Value of total assets at beginning of year	2019-12-31	$4,209,353
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$1,670
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$1,670
Total interest from all sources	2019-12-31	$3,209
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	Yes
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2019-12-31	$0
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2019-12-31	$0
Administrative expenses professional fees incurred	2019-12-31	$338
Was this plan covered by a fidelity bond	2019-12-31	Yes
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	Yes
If this is an individual account plan, was there a blackout period	2019-12-31	Yes
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$104,522
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$32,656
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$442,696
Value of net income/loss	2019-12-31	$442,696
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$4,209,353
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Investment advisory and management fees	2019-12-31	$36
Investment advisory and management fees	2019-12-31	$36
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$2,697,740
Interest on participant loans	2019-12-31	$170
Interest earned on other investments	2019-12-31	$3,039
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$1,478,957
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$193,263
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$257,344
Contract administrator fees	2019-12-31	$1,296
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2019-12-31	Yes
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2019-12-31	Yes
Did the plan have assets held for investment	2019-12-31	No
Did the plan have assets held for investment	2019-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	Yes
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	ANTISS & CO., P.C.
Accountancy firm name	2019-12-31	ANTISS & CO., P.C.
Accountancy firm EIN	2019-12-31	042917204
Accountancy firm EIN	2019-12-31	042917204
2018 : NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$52,012
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$258,317
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$254,556
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$186,676
Value of total assets at end of year	2018-12-31	$4,209,353
Value of total assets at beginning of year	2018-12-31	$4,415,658
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$3,761
Total interest from all sources	2018-12-31	$-250,997
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$116,333
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$116,333
Was this plan covered by a fidelity bond	2018-12-31	No
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$183,190
Participant contributions at end of year	2018-12-31	$32,656
Participant contributions at beginning of year	2018-12-31	$49,592
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$3,486
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$-206,305
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$4,209,353
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$4,415,658
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Investment advisory and management fees	2018-12-31	$3,260
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$2,697,740
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$2,833,836
Interest on participant loans	2018-12-31	$1,333
Interest earned on other investments	2018-12-31	$-252,330
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$1,478,957
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$1,532,230
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$254,556
Contract administrator fees	2018-12-31	$501
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	ANSTISS & CO., P.C.
Accountancy firm EIN	2018-12-31	042917204
2017 : NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$685,169
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$157,584
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$152,894
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$240,008
Value of total assets at end of year	2017-12-31	$4,414,802
Value of total assets at beginning of year	2017-12-31	$3,887,217
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$4,690
Total interest from all sources	2017-12-31	$401,961
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$43,200
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$43,200
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$1,500,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$202,031
Participant contributions at end of year	2017-12-31	$48,736
Participant contributions at beginning of year	2017-12-31	$53,854
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$37,977
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$527,585
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$4,414,802
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$3,887,217
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Investment advisory and management fees	2017-12-31	$4,088
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$2,769,396
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$2,288,254
Interest on participant loans	2017-12-31	$1,555
Interest earned on other investments	2017-12-31	$400,406
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$1,596,670
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$1,545,109
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$152,894
Contract administrator fees	2017-12-31	$602
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	ANSTISS & CO., P.C.
Accountancy firm EIN	2017-12-31	042917204
2016 : NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$499,895
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$142,280
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$137,695
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$293,638
Value of total assets at end of year	2016-12-31	$3,887,217
Value of total assets at beginning of year	2016-12-31	$3,529,602
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$4,585
Total interest from all sources	2016-12-31	$49,935
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$14,424
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$14,424
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$1,500,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$189,791
Participant contributions at end of year	2016-12-31	$53,854
Participant contributions at beginning of year	2016-12-31	$63,541
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$103,847
Administrative expenses (other) incurred	2016-12-31	$74
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$357,615
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$3,887,217
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$3,529,602
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$2,288,254
Interest on participant loans	2016-12-31	$1,842
Interest earned on other investments	2016-12-31	$48,093
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$1,545,109
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$1,563,441
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$141,898
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$137,695
Contract administrator fees	2016-12-31	$4,511
Assets. Corporate common stocks other than exployer securities at beginning of year	2016-12-31	$1,902,620
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	ANSTISS & CO., P.C.
Accountancy firm EIN	2016-12-31	042917204
2015 : NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2015 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2015-12-31	$2,031
Total unrealized appreciation/depreciation of assets	2015-12-31	$2,031
Total income from all sources (including contributions)	2015-12-31	$269,814
Total of all expenses incurred	2015-12-31	$428,938
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$427,078
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$210,761
Value of total assets at end of year	2015-12-31	$3,529,602
Value of total assets at beginning of year	2015-12-31	$3,688,726
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$1,860
Total interest from all sources	2015-12-31	$57,022
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	$400,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$210,761
Participant contributions at end of year	2015-12-31	$63,541
Administrative expenses (other) incurred	2015-12-31	$1,860
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	$-159,124
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$3,529,602
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$3,688,726
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Interest on participant loans	2015-12-31	$1,360
Interest earned on other investments	2015-12-31	$55,662
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$1,563,441
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	Yes
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$427,078
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2015-12-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2015-12-31	$1,902,620
Assets. Corporate common stocks other than exployer securities at beginning of year	2015-12-31	$3,688,726
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	ANSTISS & CO., P.C.
Accountancy firm EIN	2015-12-31	042917204
2014 : NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2014 401k financial data
Total income from all sources	2014-12-31	$365,800
Expenses. Total of all expenses incurred	2014-12-31	$23,703
Benefits paid (including direct rollovers)	2014-12-31	$23,643
Total plan assets at end of year	2014-12-31	$3,688,726
Total plan assets at beginning of year	2014-12-31	$3,346,629
Total contributions received or receivable from participants	2014-12-31	$144,695
Other income received	2014-12-31	$221,105
Net income (gross income less expenses)	2014-12-31	$342,097
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$3,688,726
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$3,346,629
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$60
2013 : NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2013 401k financial data
Total income from all sources	2013-12-31	$695,250
Expenses. Total of all expenses incurred	2013-12-31	$43,207
Benefits paid (including direct rollovers)	2013-12-31	$43,147
Total plan assets at end of year	2013-12-31	$3,346,629
Total plan assets at beginning of year	2013-12-31	$2,694,586
Total contributions received or receivable from participants	2013-12-31	$302,877
Other income received	2013-12-31	$392,373
Net income (gross income less expenses)	2013-12-31	$652,043
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$3,346,629
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$2,694,586
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$60
2012 : NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2012 401k financial data
Total income from all sources	2012-12-31	$391,592
Expenses. Total of all expenses incurred	2012-12-31	$160,709
Benefits paid (including direct rollovers)	2012-12-31	$160,647
Total plan assets at end of year	2012-12-31	$2,694,586
Total plan assets at beginning of year	2012-12-31	$2,463,703
Total contributions received or receivable from participants	2012-12-31	$188,166
Other income received	2012-12-31	$203,426
Net income (gross income less expenses)	2012-12-31	$230,883
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$2,694,586
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$2,463,703
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$62
2011 : NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2011 401k financial data
Total income from all sources	2011-12-31	$255,069
Expenses. Total of all expenses incurred	2011-12-31	$138,179
Benefits paid (including direct rollovers)	2011-12-31	$138,111
Total plan assets at end of year	2011-12-31	$2,463,703
Total plan assets at beginning of year	2011-12-31	$2,346,813
Total contributions received or receivable from participants	2011-12-31	$204,477
Other income received	2011-12-31	$50,592
Net income (gross income less expenses)	2011-12-31	$116,890
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$2,463,703
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$2,346,813
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$68
2010 : NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2010 401k financial data
Total income from all sources	2010-12-31	$386,284
Expenses. Total of all expenses incurred	2010-12-31	$255,652
Benefits paid (including direct rollovers)	2010-12-31	$255,549
Total plan assets at end of year	2010-12-31	$2,346,813
Total plan assets at beginning of year	2010-12-31	$2,216,181
Total contributions received or receivable from participants	2010-12-31	$186,994
Other income received	2010-12-31	$199,290
Net income (gross income less expenses)	2010-12-31	$130,632
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$2,346,813
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$2,216,181
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$103
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 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 NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU

2019: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	Yes
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
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: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
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: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
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: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
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: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: NORTH SHORE ELDER SERVICES, INC. TAX DEFERRED ANNU 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )

Policy contract number

FA065663

Policy instance

Insurance contract or identification number	FA065663
Number of Individuals Covered	3
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

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

Policy contract number

MR61785-1

Policy instance

Insurance contract or identification number	MR61785-1
Number of Individuals Covered	85
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )

Policy contract number

FA065663

Policy instance

Insurance contract or identification number	FA065663
Number of Individuals Covered	3
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

03679

Policy instance

Insurance contract or identification number	03679
Number of Individuals Covered	51
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $1,054
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $884
Insurance broker organization code?	3

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

Policy contract number

MR61785-1

Policy instance

Insurance contract or identification number	MR61785-1
Number of Individuals Covered	80
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )

Policy contract number

FA065663

Policy instance

Insurance contract or identification number	FA065663
Number of Individuals Covered	3
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

03679

Policy instance

Insurance contract or identification number	03679
Number of Individuals Covered	82
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,142
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $926
Insurance broker organization code?	3
Insurance broker name

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )

Policy contract number

FA065663

Policy instance

Insurance contract or identification number	FA065663
Number of Individuals Covered	8
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

03679

Policy instance

Insurance contract or identification number	03679
Number of Individuals Covered	83
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,045
Total amount of fees paid to insurance company	USD $0
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $939
Additional information about fees paid to insurance broker	INSURANCE FEES AND COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	ROBERT TRUDO

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

Policy contract number

MR61785-1

Policy instance

Insurance contract or identification number	MR61785-1
Number of Individuals Covered	56
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )

Policy contract number

FA065663

Policy instance

Insurance contract or identification number	FA065663
Number of Individuals Covered	8
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
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 guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )

Policy contract number

FA065663

Policy instance

Insurance contract or identification number	FA065663
Number of Individuals Covered	8
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
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 guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )

Policy contract number

FA065663

Policy instance

Insurance contract or identification number	FA065663
Number of Individuals Covered	8
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
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 guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )

Policy contract number

FA065663

Policy instance

Insurance contract or identification number	FA065663
Number of Individuals Covered	9
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
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 guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )

Policy contract number

FA065663

Policy instance

Insurance contract or identification number	FA065663
Number of Individuals Covered	9
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
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 guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	NORTH SHORE ELDER SERVICES, INC.
Employer identification number (EIN):	042595072
NAIC Classification:	624100
NAIC Description:	Individual and Family Services