401k Plan data: GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY plan

GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 401k Plan overview

Plan Name	GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY
Plan identification number	001

GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
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(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.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements 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

GRAND VIEW CENTER, INC. has sponsored the creation of one or more 401k plans.

Company Name: GRAND VIEW CENTER, INC.

Employer identification number (EIN): 391080607

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01 STACY SUCHLA
001 2017-01-01 STACY SUCHLA
001 2016-01-01 STACY SUCHLA
001 2015-01-01
001 2014-01-01 STACY SUCHLA 2015-07-24
001 2013-01-01 STACY SUCHLA 2014-05-27
001 2012-01-01 STACY SUCHLA 2013-06-25
001 2011-01-01 STACY SUCHLA 2012-05-01
001 2010-01-01 STACY SUCHLA 2011-07-26

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-01-01
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01	STACY SUCHLA
001	2017-01-01	STACY SUCHLA
001	2016-01-01	STACY SUCHLA
001	2015-01-01
001	2014-01-01	STACY SUCHLA	2015-07-24
001	2013-01-01	STACY SUCHLA	2014-05-27
001	2012-01-01	STACY SUCHLA	2013-06-25
001	2011-01-01	STACY SUCHLA	2012-05-01
001	2010-01-01	STACY SUCHLA	2011-07-26

Plan Statistics for GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY

401k plan membership statisitcs for GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY

Measure Date Value
2022: GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 2022 401k membership
Total participants, beginning-of-year 2022-01-01 169
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 42
Number of retired or separated participants receiving benefits 2022-01-01 10
Number of other retired or separated participants entitled to future benefits 2022-01-01 28
Total of all active and inactive participants 2022-01-01 80
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 80
Number of participants with account balances 2022-01-01 79
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 1
2021: GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 2021 401k membership
Total participants, beginning-of-year 2021-01-01 162
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 147
Number of retired or separated participants receiving benefits 2021-01-01 11
Number of other retired or separated participants entitled to future benefits 2021-01-01 10
Total of all active and inactive participants 2021-01-01 168
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 1
Total participants 2021-01-01 169
Number of participants with account balances 2021-01-01 82
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 2020 401k membership
Total participants, beginning-of-year 2020-01-01 209
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 143
Number of retired or separated participants receiving benefits 2020-01-01 7
Number of other retired or separated participants entitled to future benefits 2020-01-01 12
Total of all active and inactive participants 2020-01-01 162
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 162
Number of participants with account balances 2020-01-01 88
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 2019 401k membership
Total participants, beginning-of-year 2019-01-01 195
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 178
Number of retired or separated participants receiving benefits 2019-01-01 13
Number of other retired or separated participants entitled to future benefits 2019-01-01 18
Total of all active and inactive participants 2019-01-01 209
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 209
Number of participants with account balances 2019-01-01 87
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 2018 401k membership
Total participants, beginning-of-year 2018-01-01 156
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 168
Number of retired or separated participants receiving benefits 2018-01-01 13
Number of other retired or separated participants entitled to future benefits 2018-01-01 14
Total of all active and inactive participants 2018-01-01 195
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 195
Number of participants with account balances 2018-01-01 86
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 2017 401k membership
Total participants, beginning-of-year 2017-01-01 143
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 150
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 6
Total of all active and inactive participants 2017-01-01 156
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 156
Number of participants with account balances 2017-01-01 64
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 2016 401k membership
Total participants, beginning-of-year 2016-01-01 112
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 151
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 23
Total of all active and inactive participants 2016-01-01 174
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 174
Number of participants with account balances 2016-01-01 86
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0

Measure	Date	Value
2022: GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 2022 401k membership
Total participants, beginning-of-year	2022-01-01	169
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	42
Number of retired or separated participants receiving benefits	2022-01-01	10
Number of other retired or separated participants entitled to future benefits	2022-01-01	28
Total of all active and inactive participants	2022-01-01	80
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	80
Number of participants with account balances	2022-01-01	79
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	1
2021: GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 2021 401k membership
Total participants, beginning-of-year	2021-01-01	162
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	147
Number of retired or separated participants receiving benefits	2021-01-01	11
Number of other retired or separated participants entitled to future benefits	2021-01-01	10
Total of all active and inactive participants	2021-01-01	168
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	1
Total participants	2021-01-01	169
Number of participants with account balances	2021-01-01	82
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 2020 401k membership
Total participants, beginning-of-year	2020-01-01	209
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	143
Number of retired or separated participants receiving benefits	2020-01-01	7
Number of other retired or separated participants entitled to future benefits	2020-01-01	12
Total of all active and inactive participants	2020-01-01	162
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	162
Number of participants with account balances	2020-01-01	88
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 2019 401k membership
Total participants, beginning-of-year	2019-01-01	195
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	178
Number of retired or separated participants receiving benefits	2019-01-01	13
Number of other retired or separated participants entitled to future benefits	2019-01-01	18
Total of all active and inactive participants	2019-01-01	209
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	209
Number of participants with account balances	2019-01-01	87
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 2018 401k membership
Total participants, beginning-of-year	2018-01-01	156
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	168
Number of retired or separated participants receiving benefits	2018-01-01	13
Number of other retired or separated participants entitled to future benefits	2018-01-01	14
Total of all active and inactive participants	2018-01-01	195
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	195
Number of participants with account balances	2018-01-01	86
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 2017 401k membership
Total participants, beginning-of-year	2017-01-01	143
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	150
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	6
Total of all active and inactive participants	2017-01-01	156
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	156
Number of participants with account balances	2017-01-01	64
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 2016 401k membership
Total participants, beginning-of-year	2016-01-01	112
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	151
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	23
Total of all active and inactive participants	2016-01-01	174
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	174
Number of participants with account balances	2016-01-01	86
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0

Financial Data on GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY

Measure	Date	Value
2022 : GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-441,948
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$461,235
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$425,077
Expenses. Certain deemed distributions of participant loans	2022-12-31	$14,861
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$201,152
Value of total assets at end of year	2022-12-31	$4,139,052
Value of total assets at beginning of year	2022-12-31	$5,042,235
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$21,297
Total interest from all sources	2022-12-31	$13,467
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$222,901
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$222,901
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$125,323
Participant contributions at end of year	2022-12-31	$6,930
Participant contributions at beginning of year	2022-12-31	$25,357
Other income not declared elsewhere	2022-12-31	$23
Administrative expenses (other) incurred	2022-12-31	$21,297
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-903,183
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$4,139,052
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$5,042,235
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$2,899,347
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$3,766,472
Interest on participant loans	2022-12-31	$416
Interest earned on other investments	2022-12-31	$13,051
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$1,232,775
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$1,250,406
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-878,058
Net investment gain/loss from pooled separate accounts	2022-12-31	$-1,433
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$75,829
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$425,077
Did the plan have assets held for investment	2022-12-31	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	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	WIPFLI LLP
Accountancy firm EIN	2022-12-31	390758449
2021 : GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$834,928
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$477,101
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$452,982
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$193,466
Value of total assets at end of year	2021-12-31	$5,042,235
Value of total assets at beginning of year	2021-12-31	$4,684,408
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$24,119
Total interest from all sources	2021-12-31	$15,623
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$296,873
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$296,873
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$118,183
Participant contributions at end of year	2021-12-31	$25,357
Participant contributions at beginning of year	2021-12-31	$15,123
Administrative expenses (other) incurred	2021-12-31	$24,119
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$357,827
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$5,042,235
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$4,684,408
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$3,766,472
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$3,310,094
Interest on participant loans	2021-12-31	$734
Interest earned on other investments	2021-12-31	$14,889
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$1,250,406
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$1,359,191
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$328,226
Net investment gain/loss from pooled separate accounts	2021-12-31	$740
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$75,283
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$452,982
Did the plan have assets held for investment	2021-12-31	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	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	WIPFLI LLP
Accountancy firm EIN	2021-12-31	390758449
2020 : GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$718,126
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$473,584
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$458,761
Expenses. Certain deemed distributions of participant loans	2020-12-31	$1,909
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$182,833
Value of total assets at end of year	2020-12-31	$4,684,408
Value of total assets at beginning of year	2020-12-31	$4,439,866
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$12,914
Total interest from all sources	2020-12-31	$9,851
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$109,062
Participant contributions at end of year	2020-12-31	$15,123
Participant contributions at beginning of year	2020-12-31	$26,130
Participant contributions at end of year	2020-12-31	$0
Participant contributions at beginning of year	2020-12-31	$4,586
Other income not declared elsewhere	2020-12-31	$125
Administrative expenses (other) incurred	2020-12-31	$12,914
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$244,542
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$4,684,408
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$4,439,866
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$3,310,094
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$2,949,936
Interest on participant loans	2020-12-31	$680
Interest earned on other investments	2020-12-31	$9,171
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$1,359,191
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$1,456,234
Net investment gain/loss from pooled separate accounts	2020-12-31	$525,317
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$73,771
Employer contributions (assets) at end of year	2020-12-31	$0
Employer contributions (assets) at beginning of year	2020-12-31	$2,980
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$458,761
Did the plan have assets held for investment	2020-12-31	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	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Unqualified
Accountancy firm name	2020-12-31	WIPFLI LLP
Accountancy firm EIN	2020-12-31	390758449
2019 : GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$845,122
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$115,717
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$113,131
Expenses. Certain deemed distributions of participant loans	2019-12-31	$1,931
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$194,046
Value of total assets at end of year	2019-12-31	$4,439,866
Value of total assets at beginning of year	2019-12-31	$3,710,461
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$655
Total interest from all sources	2019-12-31	$54,136
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$372,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$116,056
Participant contributions at end of year	2019-12-31	$26,130
Participant contributions at beginning of year	2019-12-31	$22,462
Participant contributions at end of year	2019-12-31	$4,586
Participant contributions at beginning of year	2019-12-31	$4,506
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$729,405
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$4,439,866
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$3,710,461
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$2,949,936
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$2,258,118
Interest on participant loans	2019-12-31	$683
Interest earned on other investments	2019-12-31	$53,453
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$1,456,234
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$1,422,235
Net investment gain/loss from pooled separate accounts	2019-12-31	$596,940
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$77,990
Employer contributions (assets) at end of year	2019-12-31	$2,980
Employer contributions (assets) at beginning of year	2019-12-31	$3,140
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$113,131
Contract administrator fees	2019-12-31	$655
Did the plan have assets held for investment	2019-12-31	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	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	WIPFLI LLP
Accountancy firm EIN	2019-12-31	390758449
2018 : GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$90,840
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$163,797
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$163,069
Expenses. Certain deemed distributions of participant loans	2018-12-31	$208
Value of total corrective distributions	2018-12-31	$183
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$200,876
Value of total assets at end of year	2018-12-31	$3,710,461
Value of total assets at beginning of year	2018-12-31	$3,783,418
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$337
Total interest from all sources	2018-12-31	$54,262
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$379,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$119,732
Participant contributions at end of year	2018-12-31	$22,462
Participant contributions at beginning of year	2018-12-31	$22,209
Participant contributions at end of year	2018-12-31	$4,506
Participant contributions at beginning of year	2018-12-31	$4,473
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$-72,957
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$3,710,461
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$3,783,418
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$2,258,118
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$2,358,365
Interest on participant loans	2018-12-31	$672
Interest earned on other investments	2018-12-31	$53,590
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$1,422,235
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$1,395,462
Net investment gain/loss from pooled separate accounts	2018-12-31	$-164,298
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$81,144
Employer contributions (assets) at end of year	2018-12-31	$3,140
Employer contributions (assets) at beginning of year	2018-12-31	$2,909
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$163,069
Contract administrator fees	2018-12-31	$337
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	WIPFLI LLP
Accountancy firm EIN	2018-12-31	390758449
2017 : GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$633,434
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$145,389
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$142,118
Expenses. Certain deemed distributions of participant loans	2017-12-31	$1,404
Value of total corrective distributions	2017-12-31	$1,382
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$199,111
Value of total assets at end of year	2017-12-31	$3,783,418
Value of total assets at beginning of year	2017-12-31	$3,295,373
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$485
Total interest from all sources	2017-12-31	$39,860
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$330,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$119,226
Participant contributions at end of year	2017-12-31	$22,209
Participant contributions at beginning of year	2017-12-31	$23,302
Participant contributions at end of year	2017-12-31	$4,473
Participant contributions at beginning of year	2017-12-31	$4,373
Administrative expenses (other) incurred	2017-12-31	$485
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$488,045
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$3,783,418
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$3,295,373
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in pooled separate accounts at end of year	2017-12-31	$2,358,365
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$1,957,817
Interest on participant loans	2017-12-31	$633
Interest earned on other investments	2017-12-31	$39,227
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$1,395,462
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$1,306,902
Net investment gain/loss from pooled separate accounts	2017-12-31	$394,463
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$79,885
Employer contributions (assets) at end of year	2017-12-31	$2,909
Employer contributions (assets) at beginning of year	2017-12-31	$2,979
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$142,118
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	WIPFLI LLP
Accountancy firm EIN	2017-12-31	390758449
2016 : GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 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	$394,231
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$280,560
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$279,008
Value of total corrective distributions	2016-12-31	$887
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$198,461
Value of total assets at end of year	2016-12-31	$3,295,373
Value of total assets at beginning of year	2016-12-31	$3,181,702
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$665
Total interest from all sources	2016-12-31	$49,015
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	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
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	$117,909
Participant contributions at end of year	2016-12-31	$23,302
Participant contributions at beginning of year	2016-12-31	$9,759
Participant contributions at end of year	2016-12-31	$4,373
Participant contributions at beginning of year	2016-12-31	$4,289
Administrative expenses (other) incurred	2016-12-31	$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	2016-12-31	No
Value of net income/loss	2016-12-31	$113,671
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$3,295,373
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$3,181,702
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 pooled separate accounts at end of year	2016-12-31	$1,957,817
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$1,976,158
Interest on participant loans	2016-12-31	$474
Interest earned on other investments	2016-12-31	$48,541
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$1,306,902
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$1,188,512
Net investment gain/loss from pooled separate accounts	2016-12-31	$146,755
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	$80,552
Employer contributions (assets) at end of year	2016-12-31	$2,979
Employer contributions (assets) at beginning of year	2016-12-31	$2,984
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$279,008
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	WIPFLI LLP
Accountancy firm EIN	2016-12-31	390758449

Form 5500 Responses for GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY

2022: GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	Yes
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: GRAND VIEW CARE CENTER, INC. WAHA TAX SHELTERED ANNUITY 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VC3783

Policy instance

Insurance contract or identification number	VC3783
Number of Individuals Covered	5
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $10
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10
Insurance broker organization code?	3

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

664549

Policy instance

Insurance contract or identification number	664549
Number of Individuals Covered	80
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,455
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,455
Insurance broker organization code?	3

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

664549

Policy instance

Insurance contract or identification number	664549
Number of Individuals Covered	84
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,628
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,628
Insurance broker organization code?	3

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VC3783

Policy instance

Insurance contract or identification number	VC3783
Number of Individuals Covered	5
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $6
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $6
Insurance broker organization code?	3

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

664549

Policy instance

Insurance contract or identification number	664549
Number of Individuals Covered	150
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VC3783

Policy instance

Insurance contract or identification number	VC3783
Number of Individuals Covered	12
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $3,896
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,896
Insurance broker organization code?	3

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VC3783

Policy instance

Insurance contract or identification number	VC3783
Number of Individuals Covered	86
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $6,689
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,689
Insurance broker organization code?	3

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VC3783

Policy instance

Insurance contract or identification number	VC3783
Number of Individuals Covered	85
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $6,562
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,562
Insurance broker organization code?	3

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VC3783

Policy instance

Insurance contract or identification number	VC3783
Number of Individuals Covered	86
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $6,172
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,172
Insurance broker organization code?	3
Insurance broker name	AMERICAN PORTFOLIOS FINANCIAL SERV

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Company Name:	GRAND VIEW CENTER, INC.
Employer identification number (EIN):	391080607
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities