401k Plan data: ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN plan

ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN 401k Plan overview

Plan Name	ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN
Plan identification number	001

ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN 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.
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

ST JOSEPH CARE CENTER has sponsored the creation of one or more 401k plans.

Company Name: ST JOSEPH CARE CENTER

Employer identification number (EIN): 340714512

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 ROBERT CAMERON
001 2015-01-01 ROBERT CAMERON
001 2014-01-01 ROBERT CAMERON
001 2013-01-01 ROBERT CAMERON
001 2012-01-01 JOHN T BANKS SAINT JOSEPH CARE CENTER 2013-10-10
001 2011-01-01 JOHN T BANKS
001 2009-01-01 JOHN T BANKS
001 2009-01-01 JOHN T BANKS

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2016-01-01	ROBERT CAMERON
001	2015-01-01	ROBERT CAMERON
001	2014-01-01	ROBERT CAMERON
001	2013-01-01	ROBERT CAMERON
001	2012-01-01	JOHN T BANKS	SAINT JOSEPH CARE CENTER	2013-10-10
001	2011-01-01	JOHN T BANKS
001	2009-01-01	JOHN T BANKS
001	2009-01-01	JOHN T BANKS

Plan Statistics for ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN

401k plan membership statisitcs for ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN

Measure Date Value
2016: ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 355
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 0
Number of participants with account balances 2016-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 335
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 250
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 105
Total of all active and inactive participants 2015-01-01 355
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 355
Number of participants with account balances 2015-01-01 256
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 330
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 241
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 94
Total of all active and inactive participants 2014-01-01 335
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 335
Number of participants with account balances 2014-01-01 223
2013: ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 324
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 250
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 78
Total of all active and inactive participants 2013-01-01 328
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 2
Total participants 2013-01-01 330
Number of participants with account balances 2013-01-01 215
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 5
2012: ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 286
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 246
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 78
Total of all active and inactive participants 2012-01-01 324
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 324
Number of participants with account balances 2012-01-01 207
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 7
2011: ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 176
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 198
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 86
Total of all active and inactive participants 2011-01-01 284
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 2
Total participants 2011-01-01 286
Number of participants with account balances 2011-01-01 199
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 1
2009: ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 309
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 240
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 69
Total of all active and inactive participants 2009-01-01 309
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 1
Total participants 2009-01-01 310
Number of participants with account balances 2009-01-01 191
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 2

Measure	Date	Value
2016: ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	355
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	0
Number of participants with account balances	2016-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	335
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	250
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	105
Total of all active and inactive participants	2015-01-01	355
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	355
Number of participants with account balances	2015-01-01	256
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	330
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	241
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	94
Total of all active and inactive participants	2014-01-01	335
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	335
Number of participants with account balances	2014-01-01	223
2013: ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	324
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	250
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	78
Total of all active and inactive participants	2013-01-01	328
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	2
Total participants	2013-01-01	330
Number of participants with account balances	2013-01-01	215
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	5
2012: ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	286
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	246
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	78
Total of all active and inactive participants	2012-01-01	324
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	324
Number of participants with account balances	2012-01-01	207
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	7
2011: ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	176
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	198
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	86
Total of all active and inactive participants	2011-01-01	284
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	2
Total participants	2011-01-01	286
Number of participants with account balances	2011-01-01	199
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	1
2009: ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	309
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	240
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	69
Total of all active and inactive participants	2009-01-01	309
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	1
Total participants	2009-01-01	310
Number of participants with account balances	2009-01-01	191
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	2

Financial Data on ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN

Measure	Date	Value
2016 : ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN 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	$116,450
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$2,259,562
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$2,253,347
Expenses. Certain deemed distributions of participant loans	2016-12-31	$6,215
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$90,153
Value of total assets at end of year	2016-12-31	$0
Value of total assets at beginning of year	2016-12-31	$2,143,112
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$0
Total interest from all sources	2016-12-31	$15,480
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2016-12-31	$0
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$180,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$156
Participant contributions at end of year	2016-12-31	$0
Participant contributions at beginning of year	2016-12-31	$54,450
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$14,080
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	$-2,143,112
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$2,143,112
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	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$1,285,861
Interest earned on other investments	2016-12-31	$15,480
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$802,801
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$10,817
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	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$75,917
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$2,253,347
Did the plan have assets held for investment	2016-12-31	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	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	Yes
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	D.A. BAGNOLA & CO, INC.
Accountancy firm EIN	2016-12-31	341411715
2015 : ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$231,570
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$255,892
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$252,730
Expenses. Certain deemed distributions of participant loans	2015-12-31	$2,862
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$212,175
Value of total assets at end of year	2015-12-31	$2,143,112
Value of total assets at beginning of year	2015-12-31	$2,167,434
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$300
Total interest from all sources	2015-12-31	$23,503
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$180,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$117,680
Participant contributions at end of year	2015-12-31	$54,450
Participant contributions at beginning of year	2015-12-31	$61,313
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$2,862
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	$-24,322
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$2,143,112
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$2,167,434
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$1,285,861
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$1,344,967
Interest earned on other investments	2015-12-31	$23,503
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$802,801
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$761,154
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-4,108
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$91,633
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$252,730
Contract administrator fees	2015-12-31	$300
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	D.A. BAGNOLA & CO, INC.
Accountancy firm EIN	2015-12-31	341411715
2014 : ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$318,896
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$530,635
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$530,535
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$196,437
Value of total assets at end of year	2014-12-31	$2,167,434
Value of total assets at beginning of year	2014-12-31	$2,379,173
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$100
Total interest from all sources	2014-12-31	$23,433
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$180,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$114,452
Participant contributions at end of year	2014-12-31	$61,313
Participant contributions at beginning of year	2014-12-31	$65,070
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-211,739
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$2,167,434
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$2,379,173
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$1,344,967
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$1,484,665
Interest earned on other investments	2014-12-31	$23,433
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$761,154
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$829,438
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$99,026
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$81,985
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$530,535
Contract administrator fees	2014-12-31	$100
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	D.A. BAGNOLA & CO, INC.
Accountancy firm EIN	2014-12-31	341411715
2013 : ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$513,409
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$102,319
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$99,618
Expenses. Certain deemed distributions of participant loans	2013-12-31	$2,601
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$209,163
Value of total assets at end of year	2013-12-31	$2,379,173
Value of total assets at beginning of year	2013-12-31	$1,968,083
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$100
Total interest from all sources	2013-12-31	$24,789
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$180,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$127,836
Participant contributions at end of year	2013-12-31	$65,070
Participant contributions at beginning of year	2013-12-31	$78,682
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$2,601
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$411,090
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$2,379,173
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$1,968,083
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$1,484,665
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$1,075,340
Interest on participant loans	2013-12-31	$9
Interest earned on other investments	2013-12-31	$24,780
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$829,438
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$814,061
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$279,457
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$78,726
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$99,618
Contract administrator fees	2013-12-31	$100
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	D.A. BAGNOLA & CO, INC.
Accountancy firm EIN	2013-12-31	341411715
2012 : ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$385,656
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$233,117
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$209,618
Expenses. Certain deemed distributions of participant loans	2012-12-31	$22,942
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$224,712
Value of total assets at end of year	2012-12-31	$1,968,083
Value of total assets at beginning of year	2012-12-31	$1,815,544
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$557
Total interest from all sources	2012-12-31	$24,346
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$180,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$121,295
Participant contributions at end of year	2012-12-31	$78,682
Participant contributions at beginning of year	2012-12-31	$74,678
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$22,942
Administrative expenses (other) incurred	2012-12-31	$257
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$152,539
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$1,968,083
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$1,815,544
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$1,075,340
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$929,466
Interest on participant loans	2012-12-31	$24
Interest earned on other investments	2012-12-31	$24,322
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$814,061
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$811,400
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$136,598
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$80,475
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$209,618
Contract administrator fees	2012-12-31	$300
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	D.A. BAGNOLA & CO, INC.
Accountancy firm EIN	2012-12-31	341411715
2011 : ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$183,289
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$195,183
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$192,188
Expenses. Certain deemed distributions of participant loans	2011-12-31	$2,665
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$179,436
Value of total assets at end of year	2011-12-31	$1,815,544
Value of total assets at beginning of year	2011-12-31	$1,827,438
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$330
Total interest from all sources	2011-12-31	$24,281
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$180,000
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	$104,749
Participant contributions at end of year	2011-12-31	$74,678
Participant contributions at beginning of year	2011-12-31	$66,352
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$2,665
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	$-11,894
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$1,815,544
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$1,827,438
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	$929,466
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$930,626
Interest on participant loans	2011-12-31	$44
Interest earned on other investments	2011-12-31	$24,237
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$811,400
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$830,460
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-20,428
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$72,022
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$192,188
Contract administrator fees	2011-12-31	$330
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	D.A. BAGNOLA & CO, INC.
Accountancy firm EIN	2011-12-31	341411715
2010 : ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$322,654
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$224,763
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$220,828
Expenses. Certain deemed distributions of participant loans	2010-12-31	$2,074
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$171,096
Value of total assets at end of year	2010-12-31	$1,827,438
Value of total assets at beginning of year	2010-12-31	$1,729,547
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$1,861
Total interest from all sources	2010-12-31	$23,820
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$180,000
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	$98,171
Participant contributions at end of year	2010-12-31	$66,352
Participant contributions at beginning of year	2010-12-31	$59,274
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$2,074
Administrative expenses (other) incurred	2010-12-31	$477
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	$97,891
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$1,827,438
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$1,729,547
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	$930,626
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$859,094
Interest on participant loans	2010-12-31	$72
Interest earned on other investments	2010-12-31	$23,748
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$830,460
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$811,179
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$127,738
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$70,851
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$220,828
Contract administrator fees	2010-12-31	$1,384
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	D.A. BAGNOLA & CO, INC.
Accountancy firm EIN	2010-12-31	341411715

Form 5500 Responses for ST JOSEPH CARE CENTER TAX SHELTERED ANNUITY PLAN

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

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

891580+006

Policy instance

Insurance contract or identification number	891580+006
Number of Individuals Covered	256
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $6,279
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,279
Insurance broker organization code?	4
Insurance broker name	M HOLDINGS SECURITIES, INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

891580+006

Policy instance

Insurance contract or identification number	891580+006
Number of Individuals Covered	223
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,893
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,893
Insurance broker organization code?	4
Insurance broker name	M HOLDINGS SECURITIES, INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

891580+006

Policy instance

Insurance contract or identification number	891580+006
Number of Individuals Covered	215
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $6,197
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,197
Insurance broker organization code?	4
Insurance broker name	M HOLDINGS SECURITIES, INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

891580+006

Policy instance

Insurance contract or identification number	891580+006
Number of Individuals Covered	210
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $6,045
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,045
Insurance broker organization code?	4
Insurance broker name	M HOLDINGS SECURITIES, INC.

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

891580+006

Policy instance

Insurance contract or identification number	891580+006
Number of Individuals Covered	199
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $5,510
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

891580+006

Policy instance

Insurance contract or identification number	891580+006
Number of Individuals Covered	176
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $5,024
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	ST JOSEPH CARE CENTER
Employer identification number (EIN):	340714512
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities