401k Plan data: H & G NURSING HOME 401(K) BLUEPRINT PLAN plan

H & G NURSING HOME 401(K) BLUEPRINT PLAN 401k Plan overview

Plan Name	H & G NURSING HOME 401(K) BLUEPRINT PLAN
Plan identification number	001

H & G NURSING HOME 401(K) BLUEPRINT 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.

401k Sponsoring company profile

H&G NURSING HOMES, INC has sponsored the creation of one or more 401k plans.

Company Name: H&G NURSING HOMES, INC

Employer identification number (EIN): 311049100

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan H & G NURSING HOME 401(K) BLUEPRINT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2014-01-01 JOHN B. HOUSER II
001 2013-01-01 JOHN B. HOUSER II
001 2012-01-01 JOHN B. HOUSER II
001 2011-01-01 JOHN B HOUSER II JOHN B HOUSER II 2013-09-05

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2014-01-01	JOHN B. HOUSER II
001	2013-01-01	JOHN B. HOUSER II
001	2012-01-01	JOHN B. HOUSER II
001	2011-01-01	JOHN B HOUSER II	JOHN B HOUSER II	2013-09-05

Plan Statistics for H & G NURSING HOME 401(K) BLUEPRINT PLAN

401k plan membership statisitcs for H & G NURSING HOME 401(K) BLUEPRINT PLAN

Measure Date Value
2014: H & G NURSING HOME 401(K) BLUEPRINT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 15
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 0
Total participants 2014-01-01 0
Number of participants with account balances 2014-01-01 0
2013: H & G NURSING HOME 401(K) BLUEPRINT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 15
Number of other retired or separated participants entitled to future benefits 2013-01-01 15
Total of all active and inactive participants 2013-01-01 15
Total participants 2013-01-01 15
Number of participants with account balances 2013-01-01 15
2012: H & G NURSING HOME 401(K) BLUEPRINT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 15
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 5
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 10
Total of all active and inactive participants 2012-01-01 15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 15
Number of participants with account balances 2012-01-01 15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: H & G NURSING HOME 401(K) BLUEPRINT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 15
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 5
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 10
Total of all active and inactive participants 2011-01-01 15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 15
Number of participants with account balances 2011-01-01 15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0

Measure	Date	Value
2014: H & G NURSING HOME 401(K) BLUEPRINT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	15
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	0
Total participants	2014-01-01	0
Number of participants with account balances	2014-01-01	0
2013: H & G NURSING HOME 401(K) BLUEPRINT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	15
Number of other retired or separated participants entitled to future benefits	2013-01-01	15
Total of all active and inactive participants	2013-01-01	15
Total participants	2013-01-01	15
Number of participants with account balances	2013-01-01	15
2012: H & G NURSING HOME 401(K) BLUEPRINT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	15
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	5
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	10
Total of all active and inactive participants	2012-01-01	15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	15
Number of participants with account balances	2012-01-01	15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: H & G NURSING HOME 401(K) BLUEPRINT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	15
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	5
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	10
Total of all active and inactive participants	2011-01-01	15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	15
Number of participants with account balances	2011-01-01	15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0

Financial Data on H & G NURSING HOME 401(K) BLUEPRINT PLAN

Measure	Date	Value
2014 : H & G NURSING HOME 401(K) BLUEPRINT PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$2,330
Expenses. Total of all expenses incurred	2014-12-31	$59,384
Benefits paid (including direct rollovers)	2014-12-31	$59,183
Total plan assets at end of year	2014-12-31	$0
Total plan assets at beginning of year	2014-12-31	$57,054
Other income received	2014-12-31	$2,330
Net income (gross income less expenses)	2014-12-31	$-57,054
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$57,054
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$201
2013 : H & G NURSING HOME 401(K) BLUEPRINT PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$13,954
Total plan assets at end of year	2013-12-31	$57,054
Total plan assets at beginning of year	2013-12-31	$43,100
Other income received	2013-12-31	$13,954
Net income (gross income less expenses)	2013-12-31	$13,954
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$57,054
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$43,100
2012 : H & G NURSING HOME 401(K) BLUEPRINT PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$5,786
Total plan assets at end of year	2012-12-31	$43,100
Total plan assets at beginning of year	2012-12-31	$37,314
Other income received	2012-12-31	$5,786
Net income (gross income less expenses)	2012-12-31	$5,786
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$43,100
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$37,314
2011 : H & G NURSING HOME 401(K) BLUEPRINT PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$-3,353
Expenses. Total of all expenses incurred	2011-12-31	$0
Benefits paid (including direct rollovers)	2011-12-31	$0
Total plan assets at end of year	2011-12-31	$37,314
Total plan assets at beginning of year	2011-12-31	$40,667
Total contributions received or receivable from participants	2011-12-31	$0
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-3,353
Net income (gross income less expenses)	2011-12-31	$-3,353
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$37,314
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$40,667
Total contributions received or receivable from employer(s)	2011-12-31	$0
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$0

Form 5500 Responses for H & G NURSING HOME 401(K) BLUEPRINT PLAN

2014: H & G NURSING HOME 401(K) BLUEPRINT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	This submission is the final filing	Yes
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: H & G NURSING HOME 401(K) BLUEPRINT PLAN 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 benefit arrangement – Insurance	Yes
2012: H & G NURSING HOME 401(K) BLUEPRINT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	First time form 5500 has been submitted	Yes
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: H & G NURSING HOME 401(K) BLUEPRINT 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 – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes

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Company Name:	H&G NURSING HOMES, INC
Employer identification number (EIN):	311049100
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities