401k Plan data: PLEASANT BAY NURSING AND REHABILITATION CENTER 401(K) PLAN plan

PLEASANT BAY NURSING AND REHABILITATION CENTER 401(K) PLAN 401k Plan overview

Plan Name	PLEASANT BAY NURSING AND REHABILITATION CENTER 401(K) PLAN
Plan identification number	001

PLEASANT BAY NURSING AND REHABILITATION CENTER 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

PLEASANT BAY NURSING AND REHABILITATION CENTER has sponsored the creation of one or more 401k plans.

Company Name: PLEASANT BAY NURSING AND REHABILITATION CENTER

Employer identification number (EIN): 042839136

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PLEASANT BAY NURSING AND REHABILITATION CENTER 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2012-01-01 JOSHUA ZUCKERMAN
001 2011-01-01 JOSHUA ZUCKERMAN
001 2010-01-01 JOSHUA ZUCKERMAN
001 2009-01-01 JOSHUA ZUCKERMAN
001 2009-01-01 JOSHUA ZUCKERMAN

Plan id#	Filing Submission Date	Name of Administrator
001	2012-01-01	JOSHUA ZUCKERMAN
001	2011-01-01	JOSHUA ZUCKERMAN
001	2010-01-01	JOSHUA ZUCKERMAN
001	2009-01-01	JOSHUA ZUCKERMAN
001	2009-01-01	JOSHUA ZUCKERMAN

Plan Statistics for PLEASANT BAY NURSING AND REHABILITATION CENTER 401(K) PLAN

401k plan membership statisitcs for PLEASANT BAY NURSING AND REHABILITATION CENTER 401(K) PLAN

Measure Date Value
2012: PLEASANT BAY NURSING AND REHABILITATION CENTER 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 28
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 0
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 0
Total of all active and inactive participants 2012-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 0
Number of participants with account balances 2012-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: PLEASANT BAY NURSING AND REHABILITATION CENTER 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 169
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 0
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 28
Total of all active and inactive participants 2011-01-01 28
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 28
Number of participants with account balances 2011-01-01 28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: PLEASANT BAY NURSING AND REHABILITATION CENTER 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 145
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 155
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 14
Total of all active and inactive participants 2010-01-01 169
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 169
Number of participants with account balances 2010-01-01 33
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: PLEASANT BAY NURSING AND REHABILITATION CENTER 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 32
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 132
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 13
Total of all active and inactive participants 2009-01-01 145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 145
Number of participants with account balances 2009-01-01 38
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2012: PLEASANT BAY NURSING AND REHABILITATION CENTER 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	28
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	0
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	0
Total of all active and inactive participants	2012-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	0
Number of participants with account balances	2012-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: PLEASANT BAY NURSING AND REHABILITATION CENTER 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	169
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	0
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	28
Total of all active and inactive participants	2011-01-01	28
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	28
Number of participants with account balances	2011-01-01	28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: PLEASANT BAY NURSING AND REHABILITATION CENTER 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	145
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	155
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	14
Total of all active and inactive participants	2010-01-01	169
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	169
Number of participants with account balances	2010-01-01	33
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: PLEASANT BAY NURSING AND REHABILITATION CENTER 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	32
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	132
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	13
Total of all active and inactive participants	2009-01-01	145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	145
Number of participants with account balances	2009-01-01	38
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on PLEASANT BAY NURSING AND REHABILITATION CENTER 401(K) PLAN

Measure	Date	Value
2012 : PLEASANT BAY NURSING AND REHABILITATION CENTER 401(K) PLAN 2012 401k financial data
Total income from all sources	2012-01-30	$8,053
Expenses. Total of all expenses incurred	2012-01-30	$480,083
Benefits paid (including direct rollovers)	2012-01-30	$480,058
Total plan assets at end of year	2012-01-30	$0
Total plan assets at beginning of year	2012-01-30	$472,030
Other income received	2012-01-30	$8,053
Net income (gross income less expenses)	2012-01-30	$-472,030
Net plan assets at end of year (total assets less liabilities)	2012-01-30	$0
Net plan assets at beginning of year (total assets less liabilities)	2012-01-30	$472,030
Assets. Value of participant loans	2012-01-30	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-01-30	$25
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-01-30	$0
2011 : PLEASANT BAY NURSING AND REHABILITATION CENTER 401(K) PLAN 2011 401k financial data
Total income from all sources (including contributions)	2011-12-31	$44,935
Total of all expenses incurred	2011-12-31	$217,495
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$217,345
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$56,375
Value of total assets at end of year	2011-12-31	$472,030
Value of total assets at beginning of year	2011-12-31	$644,590
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$150
Total interest from all sources	2011-12-31	$568
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$9,451
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$9,451
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$250,000
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	$56,375
Participant contributions at end of year	2011-12-31	$12,788
Participant contributions at beginning of year	2011-12-31	$4,997
Administrative expenses (other) incurred	2011-12-31	$150
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	$-172,560
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$472,030
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$644,590
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$321,821
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$360,437
Interest on participant loans	2011-12-31	$545
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$137,421
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$279,156
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$279,156
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$23
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-21,459
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$217,345
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	2011-12-31	No
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	CLIFTON LARSON & ALLEN LLC
Accountancy firm EIN	2011-12-31	410746749
2010 : PLEASANT BAY NURSING AND REHABILITATION CENTER 401(K) PLAN 2010 401k financial data
Total income from all sources (including contributions)	2010-12-31	$113,581
Total of all expenses incurred	2010-12-31	$42,163
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$36,244
Expenses. Certain deemed distributions of participant loans	2010-12-31	$4,622
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$65,273
Value of total assets at end of year	2010-12-31	$644,590
Value of total assets at beginning of year	2010-12-31	$573,172
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$1,297
Total interest from all sources	2010-12-31	$851
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$5,503
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2010-12-31	$5,503
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$250,000
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	$65,273
Participant contributions at end of year	2010-12-31	$4,997
Participant contributions at beginning of year	2010-12-31	$23,859
Administrative expenses (other) incurred	2010-12-31	$1,297
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	$71,418
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$644,590
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$573,172
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$360,437
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$277,217
Interest on participant loans	2010-12-31	$797
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$279,156
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$272,096
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$272,096
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$54
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$41,954
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$36,244
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	2010-12-31	No
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	LARSONALLEN PC
Accountancy firm EIN	2010-12-31	410746749
2009 : PLEASANT BAY NURSING AND REHABILITATION CENTER 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 PLEASANT BAY NURSING AND REHABILITATION CENTER 401(K) PLAN

2012: PLEASANT BAY NURSING AND REHABILITATION CENTER 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	Yes
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: PLEASANT BAY NURSING AND REHABILITATION CENTER 401(K) PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	Yes
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 – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: PLEASANT BAY NURSING AND REHABILITATION CENTER 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 – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: PLEASANT BAY NURSING AND REHABILITATION CENTER 401(K) PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
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 – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	PLEASANT BAY NURSING AND REHABILITATION CENTER
Employer identification number (EIN):	042839136
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities