401k Plan data: HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN plan

HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN 401k Plan overview

Plan Name	HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN
Plan identification number	001

HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS 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 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.

401k Sponsoring company profile

ELMWOOD NURSING HOME, INC. HERITAGE OF ELMWOOD NURSING HOME has sponsored the creation of one or more 401k plans.

Company Name: ELMWOOD NURSING HOME, INC. HERITAGE OF ELMWOOD NURSING HOME

Employer identification number (EIN): 391190907

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 HOLLY MALASZUK 2023-10-04
001 2021-01-01 BRYAN BESSA 2022-09-27
001 2020-01-01 AMY DUHR 2021-10-11
001 2019-01-01 AMY DUHR 2020-07-29
001 2018-01-01 MARTIN METTEN 2019-07-29
001 2017-01-01 MARTIN METTEN 2018-07-20
001 2016-01-01 MARTIN METTEN 2017-07-31
001 2015-01-01 BRYAN BESSA
001 2014-01-01 ERIN BASKIN
001 2013-01-01
001 2012-01-01 RODNEY GILLES
001 2011-01-01 RODNEY GILLES
001 2009-01-01 RODNEY GILLES

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-01-01	HOLLY MALASZUK	2023-10-04
001	2021-01-01	BRYAN BESSA	2022-09-27
001	2020-01-01	AMY DUHR	2021-10-11
001	2019-01-01	AMY DUHR	2020-07-29
001	2018-01-01	MARTIN METTEN	2019-07-29
001	2017-01-01	MARTIN METTEN	2018-07-20
001	2016-01-01	MARTIN METTEN	2017-07-31
001	2015-01-01	BRYAN BESSA
001	2014-01-01	ERIN BASKIN
001	2013-01-01
001	2012-01-01	RODNEY GILLES
001	2011-01-01	RODNEY GILLES
001	2009-01-01	RODNEY GILLES

Plan Statistics for HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN

401k plan membership statisitcs for HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN

Measure Date Value
2015: HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 46
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 42
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 0
Total of all active and inactive participants 2015-01-01 42
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 49
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 46
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 0
Total of all active and inactive participants 2014-01-01 46
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 46
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 46
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 49
Total of all active and inactive participants 2013-01-01 49
Total participants 2013-01-01 49
2012: HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 48
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 46
Total of all active and inactive participants 2012-01-01 46
Total participants 2012-01-01 46
2011: HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 43
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 48
Total of all active and inactive participants 2011-01-01 48
Total participants 2011-01-01 48
2009: HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 46
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 44
Total of all active and inactive participants 2009-01-01 44
Total participants 2009-01-01 44

Measure	Date	Value
2015: HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	46
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	42
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	0
Total of all active and inactive participants	2015-01-01	42
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	49
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	46
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	0
Total of all active and inactive participants	2014-01-01	46
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	46
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	46
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	49
Total of all active and inactive participants	2013-01-01	49
Total participants	2013-01-01	49
2012: HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	48
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	46
Total of all active and inactive participants	2012-01-01	46
Total participants	2012-01-01	46
2011: HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	43
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	48
Total of all active and inactive participants	2011-01-01	48
Total participants	2011-01-01	48
2009: HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	46
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	44
Total of all active and inactive participants	2009-01-01	44
Total participants	2009-01-01	44

Financial Data on HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN

Measure	Date	Value
2015 : HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$97,306
Expenses. Total of all expenses incurred	2015-12-31	$59,247
Benefits paid (including direct rollovers)	2015-12-31	$56,318
Total plan assets at end of year	2015-12-31	$1,146,559
Total plan assets at beginning of year	2015-12-31	$1,108,500
Expenses. Other expenses not covered elsewhere	2015-12-31	$2,699
Contributions received from other sources (not participants or employers)	2015-12-31	$77,144
Other income received	2015-12-31	$20,162
Net income (gross income less expenses)	2015-12-31	$38,059
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$1,146,559
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$1,108,500
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$230
2014 : HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$140,677
Expenses. Total of all expenses incurred	2014-12-31	$107,964
Benefits paid (including direct rollovers)	2014-12-31	$102,919
Total plan assets at end of year	2014-12-31	$1,108,500
Total plan assets at beginning of year	2014-12-31	$1,075,787
Expenses. Other expenses not covered elsewhere	2014-12-31	$4,680
Contributions received from other sources (not participants or employers)	2014-12-31	$86,352
Other income received	2014-12-31	$54,325
Net income (gross income less expenses)	2014-12-31	$32,713
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$1,108,500
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$1,075,787
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$365
2013 : HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$204,118
Expenses. Total of all expenses incurred	2013-12-31	$30,866
Benefits paid (including direct rollovers)	2013-12-31	$27,456
Total plan assets at end of year	2013-12-31	$1,075,787
Total plan assets at beginning of year	2013-12-31	$902,535
Expenses. Other expenses not covered elsewhere	2013-12-31	$3,160
Contributions received from other sources (not participants or employers)	2013-12-31	$89,311
Other income received	2013-12-31	$114,807
Net income (gross income less expenses)	2013-12-31	$173,252
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$1,075,787
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$902,535
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$250
2012 : HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$154,154
Expenses. Total of all expenses incurred	2012-12-31	$63,443
Benefits paid (including direct rollovers)	2012-12-31	$63,228
Total plan assets at end of year	2012-12-31	$902,535
Total plan assets at beginning of year	2012-12-31	$811,824
Expenses. Other expenses not covered elsewhere	2012-12-31	$0
Contributions received from other sources (not participants or employers)	2012-12-31	$82,235
Other income received	2012-12-31	$71,919
Net income (gross income less expenses)	2012-12-31	$90,711
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$902,535
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$811,824
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$215
2011 : HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$83,691
Expenses. Total of all expenses incurred	2011-12-31	$231,445
Benefits paid (including direct rollovers)	2011-12-31	$228,673
Total plan assets at end of year	2011-12-31	$811,824
Total plan assets at beginning of year	2011-12-31	$959,578
Contributions received from other sources (not participants or employers)	2011-12-31	$64,245
Other income received	2011-12-31	$19,446
Net income (gross income less expenses)	2011-12-31	$-147,754
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$811,824
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$959,578
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$2,772
2010 : HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$157,402
Expenses. Total of all expenses incurred	2010-12-31	$29,524
Benefits paid (including direct rollovers)	2010-12-31	$21,309
Total plan assets at end of year	2010-12-31	$959,578
Total plan assets at beginning of year	2010-12-31	$831,700
Contributions received from other sources (not participants or employers)	2010-12-31	$69,867
Other income received	2010-12-31	$87,535
Net income (gross income less expenses)	2010-12-31	$127,878
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$959,578
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$831,700
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$8,215

Form 5500 Responses for HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN

2015: HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: HERITAGE OF ELMWOOD NURSING HOME TAX DEFERRED SAVINGS PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

VC4629

Policy instance

Insurance contract or identification number	VC4629
Number of Individuals Covered	42
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,300
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,300
Insurance broker organization code?	6
Insurance broker name	AMERICAN PORTFOLIOS FINANCIAL

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

Policy contract number

VC4629

Policy instance

Insurance contract or identification number	VC4629
Number of Individuals Covered	46
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,247
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,247
Insurance broker organization code?	6
Insurance broker name	AMERICAN PORTFOLIOS FINANCIAL

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

Policy contract number

VC4629

Policy instance

Insurance contract or identification number	VC4629
Number of Individuals Covered	49
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,430
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,430
Amount paid for insurance broker fees	0
Insurance broker organization code?	6
Insurance broker name	AMERICAN PORTFOLIOS FINANCIAL

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

Policy contract number

VC4629

Policy instance

Insurance contract or identification number	VC4629
Number of Individuals Covered	46
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,161
Total amount of fees paid to insurance company	USD $41
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 contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,161
Amount paid for insurance broker fees	41
Additional information about fees paid to insurance broker	SUPPLEMENTAL CASH PAYMENTS
Insurance broker organization code?	6
Insurance broker name	AMERICAN PORTFOLIOS FINANCIAL

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

Policy contract number

VC4629

Policy instance

Insurance contract or identification number	VC4629
Number of Individuals Covered	48
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,933
Total amount of fees paid to insurance company	USD $137
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 contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

VC4629

Policy instance

Insurance contract or identification number	VC4629
Number of Individuals Covered	43
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,775
Total amount of fees paid to insurance company	USD $47
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 contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,362
Amount paid for insurance broker fees	42
Additional information about fees paid to insurance broker	SUPPLEMENTAL CASH PAYMENTS
Insurance broker organization code?	6
Insurance broker name	SAGEPOINT FINANCIAL, INC.

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Company Name:	ELMWOOD NURSING HOME, INC. HERITAGE OF ELMWOOD NURSING HOME
Employer identification number (EIN):	391190907
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities