401k Plan data: CROSSROADS MEDICAL MANAGEMENT, INC. 401K PLAN plan

CROSSROADS MEDICAL MANAGEMENT, INC. 401K PLAN 401k Plan overview

Plan Name	CROSSROADS MEDICAL MANAGEMENT, INC. 401K PLAN
Plan identification number	001

CROSSROADS MEDICAL MANAGEMENT, INC. 401K PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

CROSSROADS MEDICAL MANAGEMENT, INC. has sponsored the creation of one or more 401k plans.

Company Name: CROSSROADS MEDICAL MANAGEMENT, INC.

Employer identification number (EIN): 581330210

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CROSSROADS MEDICAL MANAGEMENT, INC. 401K PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 WILLIAM C DAVIS III 2023-09-08
001 2021-01-01 WILLIAM C DAVIS III 2022-09-28 WILLIAM C DAVIS III 2022-09-28
001 2020-01-01 WILLIAM C DAVIS III 2021-09-29 WILLIAM C DAVIS III 2021-09-29
001 2019-01-01 WILLIAM C DAVIS III 2020-07-25 WILLIAM C DAVIS III 2020-07-25

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	WILLIAM C DAVIS III	2023-09-08
001	2021-01-01	WILLIAM C DAVIS III	2022-09-28	WILLIAM C DAVIS III	2022-09-28
001	2020-01-01	WILLIAM C DAVIS III	2021-09-29	WILLIAM C DAVIS III	2021-09-29
001	2019-01-01	WILLIAM C DAVIS III	2020-07-25	WILLIAM C DAVIS III	2020-07-25

Plan Statistics for CROSSROADS MEDICAL MANAGEMENT, INC. 401K PLAN

401k plan membership statisitcs for CROSSROADS MEDICAL MANAGEMENT, INC. 401K PLAN

Measure Date Value
2022: CROSSROADS MEDICAL MANAGEMENT, INC. 401K PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 1,436
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 522
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 812
Total of all active and inactive participants 2022-01-01 1,334
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 1,334
Number of participants with account balances 2022-01-01 1,259
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 189
2021: CROSSROADS MEDICAL MANAGEMENT, INC. 401K PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 1,346
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 673
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 768
Total of all active and inactive participants 2021-01-01 1,441
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 1,441
Number of participants with account balances 2021-01-01 1,343
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 365
2020: CROSSROADS MEDICAL MANAGEMENT, INC. 401K PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 1,108
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 760
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 531
Total of all active and inactive participants 2020-01-01 1,291
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 1,291
Number of participants with account balances 2020-01-01 1,183
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 307
2019: CROSSROADS MEDICAL MANAGEMENT, INC. 401K PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 833
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 790
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 333
Total of all active and inactive participants 2019-01-01 1,123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 1,123
Number of participants with account balances 2019-01-01 1,016
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 244

Measure	Date	Value
2022: CROSSROADS MEDICAL MANAGEMENT, INC. 401K PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	1,436
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	522
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	812
Total of all active and inactive participants	2022-01-01	1,334
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	1,334
Number of participants with account balances	2022-01-01	1,259
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	189
2021: CROSSROADS MEDICAL MANAGEMENT, INC. 401K PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	1,346
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	673
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	768
Total of all active and inactive participants	2021-01-01	1,441
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	1,441
Number of participants with account balances	2021-01-01	1,343
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	365
2020: CROSSROADS MEDICAL MANAGEMENT, INC. 401K PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	1,108
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	760
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	531
Total of all active and inactive participants	2020-01-01	1,291
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	1,291
Number of participants with account balances	2020-01-01	1,183
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	307
2019: CROSSROADS MEDICAL MANAGEMENT, INC. 401K PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	833
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	790
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	333
Total of all active and inactive participants	2019-01-01	1,123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	1,123
Number of participants with account balances	2019-01-01	1,016
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	244

Financial Data on CROSSROADS MEDICAL MANAGEMENT, INC. 401K PLAN

Measure	Date	Value
2022 : CROSSROADS MEDICAL MANAGEMENT, INC. 401K PLAN 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	$379,692
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$386,645
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$335,293
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$930,999
Value of total assets at end of year	2022-12-31	$3,094,955
Value of total assets at beginning of year	2022-12-31	$3,101,908
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$51,352
Total interest from all sources	2022-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$1,000,000
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	$635,090
Participant contributions at beginning of year	2022-12-31	$518
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$51,202
Value of other receiveables (less allowance for doubtful accounts) at end of year	2022-12-31	$0
Administrative expenses (other) incurred	2022-12-31	$0
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	$-6,953
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$3,094,955
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$3,101,908
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
Investment advisory and management fees	2022-12-31	$51,352
Value of interest in pooled separate accounts at end of year	2022-12-31	$2,972,871
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$3,022,049
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$122,084
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$79,123
Net investment gain/loss from pooled separate accounts	2022-12-31	$-551,307
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	$244,707
Employer contributions (assets) at beginning of year	2022-12-31	$218
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$335,293
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	MCNAIR, MCLEMORE, MIDDLEBROOKS, LLC
Accountancy firm EIN	2022-12-31	581094351
2021 : CROSSROADS MEDICAL MANAGEMENT, INC. 401K PLAN 2021 401k financial data
Total income from all sources (including contributions)	2021-12-31	$1,307,257
Total of all expenses incurred	2021-12-31	$456,279
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$393,146
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$977,664
Value of total assets at end of year	2021-12-31	$3,101,908
Value of total assets at beginning of year	2021-12-31	$2,250,930
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$63,133
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$694,557
Participant contributions at end of year	2021-12-31	$518
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$11,827
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2021-12-31	$0
Other income not declared elsewhere	2021-12-31	$13,718
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	$850,978
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$3,101,908
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$2,250,930
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
Investment advisory and management fees	2021-12-31	$63,133
Value of interest in pooled separate accounts at end of year	2021-12-31	$3,022,049
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$2,205,775
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$79,123
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$45,155
Net investment gain/loss from pooled separate accounts	2021-12-31	$315,875
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
Assets. Invements in employer securities at beginning of year	2021-12-31	$0
Contributions received in cash from employer	2021-12-31	$271,280
Employer contributions (assets) at end of year	2021-12-31	$218
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$393,146
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	JAMES M. MOYNA CPA PC
Accountancy firm EIN	2021-12-31	472940358
2020 : CROSSROADS MEDICAL MANAGEMENT, INC. 401K PLAN 2020 401k financial data
Total income from all sources (including contributions)	2020-12-31	$1,314,404
Total of all expenses incurred	2020-12-31	$279,022
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$221,608
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$1,030,934
Value of total assets at end of year	2020-12-31	$2,250,930
Value of total assets at beginning of year	2020-12-31	$1,215,548
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$57,414
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$719,257
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$22,719
Other income not declared elsewhere	2020-12-31	$60
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	$1,035,382
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$2,250,930
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$1,215,548
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
Investment advisory and management fees	2020-12-31	$57,414
Value of interest in pooled separate accounts at end of year	2020-12-31	$2,205,775
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$1,191,134
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$45,155
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$24,414
Net investment gain/loss from pooled separate accounts	2020-12-31	$283,410
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	$288,958
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$221,608
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	Disclaimer
Accountancy firm name	2020-12-31	JAMES M. MOYNA CPA PC
Accountancy firm EIN	2020-12-31	472940358
2019 : CROSSROADS MEDICAL MANAGEMENT, INC. 401K PLAN 2019 401k financial data
Total income from all sources (including contributions)	2019-12-31	$1,052,265
Total of all expenses incurred	2019-12-31	$41,077
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$41,077
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$936,988
Value of total assets at end of year	2019-12-31	$1,215,548
Value of total assets at beginning of year	2019-12-31	$204,360
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	$1,000,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$665,370
Other income not declared elsewhere	2019-12-31	$188
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	$1,011,188
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$1,215,548
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$204,360
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 pooled separate accounts at end of year	2019-12-31	$1,191,134
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$200,653
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$24,414
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$3,707
Net investment gain/loss from pooled separate accounts	2019-12-31	$115,089
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	$271,618
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$41,077
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	JAMES M. MOYNA CPA PC
Accountancy firm EIN	2019-12-31	472940358
2018 : CROSSROADS MEDICAL MANAGEMENT, INC. 401K PLAN 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	$205,148
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$788
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$788
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$212,511
Value of total assets at end of year	2018-12-31	$204,360
Value of total assets at beginning of year	2018-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$0
Total interest from all sources	2018-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$163
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$163
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$1,000,000
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	$150,835
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	$204,360
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$204,360
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$0
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 pooled separate accounts at end of year	2018-12-31	$200,653
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$3,707
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-7,526
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	$61,676
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$788
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	JAMES M. MOYNA CPA PC
Accountancy firm EIN	2018-12-31	472940358

Form 5500 Responses for CROSSROADS MEDICAL MANAGEMENT, INC. 401K PLAN

2022: CROSSROADS MEDICAL MANAGEMENT, INC. 401K PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
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 - Trust	Yes
2021: CROSSROADS MEDICAL MANAGEMENT, INC. 401K PLAN 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 - Trust	Yes
2020: CROSSROADS MEDICAL MANAGEMENT, INC. 401K PLAN 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 - Trust	Yes
2019: CROSSROADS MEDICAL MANAGEMENT, INC. 401K PLAN 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 - Trust	Yes

Insurance Providers Used on plan

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G39111

Policy instance

Insurance contract or identification number	G39111
Number of Individuals Covered	1258
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with 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

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G39111

Policy instance

Insurance contract or identification number	G39111
Number of Individuals Covered	1350
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with 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

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G39111

Policy instance

Insurance contract or identification number	G39111
Number of Individuals Covered	1195
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 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

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Company Name:	CROSSROADS MEDICAL MANAGEMENT, INC.
Employer identification number (EIN):	581330210
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities