401k Plan data: TRI COMMUNITY NURSING CENTER 401(K) PLAN plan

TRI COMMUNITY NURSING CENTER 401(K) PLAN 401k Plan overview

Plan Name	TRI COMMUNITY NURSING CENTER 401(K) PLAN
Plan identification number	001

TRI COMMUNITY NURSING CENTER 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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

401k Sponsoring company profile

PEACE INC. DBA TRI COMMUNITY NURSING CENTER has sponsored the creation of one or more 401k plans.

Company Name: PEACE INC. DBA TRI COMMUNITY NURSING CENTER

Employer identification number (EIN): 581847649

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TRI COMMUNITY NURSING CENTER 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 JILL DEVILLER
001 2015-01-01 JILL DEVILLER
001 2015-01-01 GERARD LACOUR
001 2014-01-01 JILL DEVILLIER
001 2014-01-01 GERARD LACOUR
001 2013-01-01 GERARD LACOUR
001 2012-01-01 GERARD LACOUR GERARD LACOUR 2013-07-05
001 2011-01-01 GERARD LACOUR GERARD LACOUR 2013-07-05
001 2010-01-01 GERARD LACOUR GERARD LACOUR 2013-07-05
001 2009-01-01 GERARD LACOUR GERARD LACOUR 2013-07-05
001 2009-01-01
001 2008-01-01
001 2008-01-01 GERARD LACOUR GERARD LACOUR 2013-07-05
001 2007-01-01
001 2007-01-01 GERARD LACOUR GERARD LACOUR 2013-07-05
001 2006-01-01 GERARD LACOUR GERARD LACOUR 2013-07-05
001 2006-01-01
001 2005-01-01 GERARD LACOUR GERARD LACOUR 2013-07-05
001 2005-01-01
001 2004-01-01 GERARD LACOUR GERARD LACOUR 2013-07-05
001 2004-01-01
001 2003-02-01 GERALD LACOUR GERALD LACOUR 2013-07-05
001 2003-02-01

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2016-01-01	JILL DEVILLER
001	2015-01-01	JILL DEVILLER
001	2015-01-01	GERARD LACOUR
001	2014-01-01	JILL DEVILLIER
001	2014-01-01	GERARD LACOUR
001	2013-01-01	GERARD LACOUR
001	2012-01-01	GERARD LACOUR	GERARD LACOUR	2013-07-05
001	2011-01-01	GERARD LACOUR	GERARD LACOUR	2013-07-05
001	2010-01-01	GERARD LACOUR	GERARD LACOUR	2013-07-05
001	2009-01-01	GERARD LACOUR	GERARD LACOUR	2013-07-05
001	2009-01-01
001	2008-01-01
001	2008-01-01	GERARD LACOUR	GERARD LACOUR	2013-07-05
001	2007-01-01
001	2007-01-01	GERARD LACOUR	GERARD LACOUR	2013-07-05
001	2006-01-01	GERARD LACOUR	GERARD LACOUR	2013-07-05
001	2006-01-01
001	2005-01-01	GERARD LACOUR	GERARD LACOUR	2013-07-05
001	2005-01-01
001	2004-01-01	GERARD LACOUR	GERARD LACOUR	2013-07-05
001	2004-01-01
001	2003-02-01	GERALD LACOUR	GERALD LACOUR	2013-07-05
001	2003-02-01

Plan Statistics for TRI COMMUNITY NURSING CENTER 401(K) PLAN

401k plan membership statisitcs for TRI COMMUNITY NURSING CENTER 401(K) PLAN

Measure Date Value
2016: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 161
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 139
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 21
Total of all active and inactive participants 2016-01-01 160
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 160
Number of participants with account balances 2016-01-01 105
2015: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 165
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 128
Number of retired or separated participants receiving benefits 2015-01-01 19
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 147
Number of participants with account balances 2015-01-01 110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 145
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 141
Number of retired or separated participants receiving benefits 2014-01-01 14
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 155
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 155
Number of participants with account balances 2014-01-01 122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 8
2013: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 133
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 138
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 1
Total of all active and inactive participants 2013-01-01 139
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 139
Number of participants with account balances 2013-01-01 91
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 132
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 133
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 133
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 133
Number of participants with account balances 2012-01-01 18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 142
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 130
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 130
Number of participants with account balances 2011-01-01 19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 4
2010: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 133
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 156
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 1
Total of all active and inactive participants 2010-01-01 157
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 157
Number of participants with account balances 2010-01-01 22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 1
2009: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 122
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 126
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 7
Total of all active and inactive participants 2009-01-01 133
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 133
Number of participants with account balances 2009-01-01 26
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 3
2008: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2008 401k membership
Total participants, beginning-of-year 2008-01-01 118
Total number of active participants reported on line 7a of the Form 5500 2008-01-01 120
Total of all active and inactive participants 2008-01-01 120
Total participants 2008-01-01 120
Number of participants with account balances 2008-01-01 29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2008-01-01 2
Number of retired or separated participants receiving benefits 2008-01-01 0
Number of other retired or separated participants entitled to future benefits 2008-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2008-01-01 0
2007: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2007 401k membership
Total participants, beginning-of-year 2007-01-01 159
Total number of active participants reported on line 7a of the Form 5500 2007-01-01 158
Total of all active and inactive participants 2007-01-01 158
Total participants 2007-01-01 158
Number of participants with account balances 2007-01-01 30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2007-01-01 1
Number of retired or separated participants receiving benefits 2007-01-01 0
Number of other retired or separated participants entitled to future benefits 2007-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2007-01-01 0
2006: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2006 401k membership
Total participants, beginning-of-year 2006-01-01 153
Total number of active participants reported on line 7a of the Form 5500 2006-01-01 153
Number of retired or separated participants receiving benefits 2006-01-01 0
Number of other retired or separated participants entitled to future benefits 2006-01-01 0
Total of all active and inactive participants 2006-01-01 153
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2006-01-01 0
Total participants 2006-01-01 153
Number of participants with account balances 2006-01-01 27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2006-01-01 0
2005: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2005 401k membership
Total participants, beginning-of-year 2005-01-01 154
Total number of active participants reported on line 7a of the Form 5500 2005-01-01 154
Number of retired or separated participants receiving benefits 2005-01-01 0
Number of other retired or separated participants entitled to future benefits 2005-01-01 0
Total of all active and inactive participants 2005-01-01 154
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2005-01-01 0
Total participants 2005-01-01 154
Number of participants with account balances 2005-01-01 25
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2005-01-01 0
2004: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2004 401k membership
Total participants, beginning-of-year 2004-01-01 154
Total number of active participants reported on line 7a of the Form 5500 2004-01-01 154
Number of retired or separated participants receiving benefits 2004-01-01 0
Number of other retired or separated participants entitled to future benefits 2004-01-01 0
Total of all active and inactive participants 2004-01-01 154
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2004-01-01 0
Total participants 2004-01-01 154
Number of participants with account balances 2004-01-01 22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2004-01-01 0
2003: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2003 401k membership
Total participants, beginning-of-year 2003-02-01 118
Total number of active participants reported on line 7a of the Form 5500 2003-02-01 140
Number of retired or separated participants receiving benefits 2003-02-01 0
Number of other retired or separated participants entitled to future benefits 2003-02-01 0
Total of all active and inactive participants 2003-02-01 140
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2003-02-01 0
Total participants 2003-02-01 140
Number of participants with account balances 2003-02-01 23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2003-02-01 0

Measure	Date	Value
2016: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	161
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	139
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	21
Total of all active and inactive participants	2016-01-01	160
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	160
Number of participants with account balances	2016-01-01	105
2015: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	165
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	128
Number of retired or separated participants receiving benefits	2015-01-01	19
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	147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	147
Number of participants with account balances	2015-01-01	110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	145
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	141
Number of retired or separated participants receiving benefits	2014-01-01	14
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	155
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	155
Number of participants with account balances	2014-01-01	122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	8
2013: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	133
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	138
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	1
Total of all active and inactive participants	2013-01-01	139
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	139
Number of participants with account balances	2013-01-01	91
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	132
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	133
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	133
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	133
Number of participants with account balances	2012-01-01	18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	142
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	130
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	130
Number of participants with account balances	2011-01-01	19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	4
2010: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	133
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	156
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	1
Total of all active and inactive participants	2010-01-01	157
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	157
Number of participants with account balances	2010-01-01	22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	1
2009: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	122
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	126
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	7
Total of all active and inactive participants	2009-01-01	133
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	133
Number of participants with account balances	2009-01-01	26
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	3
2008: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2008 401k membership
Total participants, beginning-of-year	2008-01-01	118
Total number of active participants reported on line 7a of the Form 5500	2008-01-01	120
Total of all active and inactive participants	2008-01-01	120
Total participants	2008-01-01	120
Number of participants with account balances	2008-01-01	29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2008-01-01	2
Number of retired or separated participants receiving benefits	2008-01-01	0
Number of other retired or separated participants entitled to future benefits	2008-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2008-01-01	0
2007: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2007 401k membership
Total participants, beginning-of-year	2007-01-01	159
Total number of active participants reported on line 7a of the Form 5500	2007-01-01	158
Total of all active and inactive participants	2007-01-01	158
Total participants	2007-01-01	158
Number of participants with account balances	2007-01-01	30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2007-01-01	1
Number of retired or separated participants receiving benefits	2007-01-01	0
Number of other retired or separated participants entitled to future benefits	2007-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2007-01-01	0
2006: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2006 401k membership
Total participants, beginning-of-year	2006-01-01	153
Total number of active participants reported on line 7a of the Form 5500	2006-01-01	153
Number of retired or separated participants receiving benefits	2006-01-01	0
Number of other retired or separated participants entitled to future benefits	2006-01-01	0
Total of all active and inactive participants	2006-01-01	153
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2006-01-01	0
Total participants	2006-01-01	153
Number of participants with account balances	2006-01-01	27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2006-01-01	0
2005: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2005 401k membership
Total participants, beginning-of-year	2005-01-01	154
Total number of active participants reported on line 7a of the Form 5500	2005-01-01	154
Number of retired or separated participants receiving benefits	2005-01-01	0
Number of other retired or separated participants entitled to future benefits	2005-01-01	0
Total of all active and inactive participants	2005-01-01	154
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2005-01-01	0
Total participants	2005-01-01	154
Number of participants with account balances	2005-01-01	25
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2005-01-01	0
2004: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2004 401k membership
Total participants, beginning-of-year	2004-01-01	154
Total number of active participants reported on line 7a of the Form 5500	2004-01-01	154
Number of retired or separated participants receiving benefits	2004-01-01	0
Number of other retired or separated participants entitled to future benefits	2004-01-01	0
Total of all active and inactive participants	2004-01-01	154
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2004-01-01	0
Total participants	2004-01-01	154
Number of participants with account balances	2004-01-01	22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2004-01-01	0
2003: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2003 401k membership
Total participants, beginning-of-year	2003-02-01	118
Total number of active participants reported on line 7a of the Form 5500	2003-02-01	140
Number of retired or separated participants receiving benefits	2003-02-01	0
Number of other retired or separated participants entitled to future benefits	2003-02-01	0
Total of all active and inactive participants	2003-02-01	140
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2003-02-01	0
Total participants	2003-02-01	140
Number of participants with account balances	2003-02-01	23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2003-02-01	0

Financial Data on TRI COMMUNITY NURSING CENTER 401(K) PLAN

Measure	Date	Value
2016 : TRI COMMUNITY NURSING CENTER 401(K) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$137,288
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$46,125
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$40,629
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$108,579
Value of total assets at end of year	2016-12-31	$386,532
Value of total assets at beginning of year	2016-12-31	$295,369
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$5,496
Total interest from all sources	2016-12-31	$0
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	$125,000
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	$63,632
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$1,567
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	$91,163
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$386,532
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$295,369
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$0
Value of interest in pooled separate accounts at end of year	2016-12-31	$386,510
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$295,347
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$0
Net investment gain/loss from pooled separate accounts	2016-12-31	$28,709
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	Yes
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	$43,380
Employer contributions (assets) at end of year	2016-12-31	$22
Employer contributions (assets) at beginning of year	2016-12-31	$22
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$40,629
Contract administrator fees	2016-12-31	$5,496
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	BROUSSARD AND COMPANY, CPAS, LLC
Accountancy firm EIN	2016-12-31	721447940
2015 : TRI COMMUNITY NURSING CENTER 401(K) PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$122,097
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$84,425
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$78,806
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$125,859
Value of total assets at end of year	2015-12-31	$295,347
Value of total assets at beginning of year	2015-12-31	$257,675
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$5,619
Total interest from all sources	2015-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$125,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$74,215
Other income not declared elsewhere	2015-12-31	$21
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$37,672
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$295,347
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$257,675
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in pooled separate accounts at end of year	2015-12-31	$292,616
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$256,976
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$2,731
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$699
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-1,751
Net investment gain/loss from pooled separate accounts	2015-12-31	$-3,783
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$51,644
Employer contributions (assets) at end of year	2015-12-31	$22
Employer contributions (assets) at beginning of year	2015-12-31	$22
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$78,806
Contract administrator fees	2015-12-31	$5,619
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	T.E. LOTT & COMPANY
Accountancy firm EIN	2015-12-31	640575804
2014 : TRI COMMUNITY NURSING CENTER 401(K) PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$160,976
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$6,256
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$3,878
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$150,355
Value of total assets at end of year	2014-12-31	$257,675
Value of total assets at beginning of year	2014-12-31	$102,955
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$2,378
Total interest from all sources	2014-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$125,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$89,296
Other income not declared elsewhere	2014-12-31	$1
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$154,720
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$257,675
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$102,955
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$0
Value of interest in pooled separate accounts at end of year	2014-12-31	$256,976
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$102,955
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$699
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$10,621
Net investment gain/loss from pooled separate accounts	2014-12-31	$10,620
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$61,059
Employer contributions (assets) at end of year	2014-12-31	$22
Employer contributions (assets) at beginning of year	2014-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$3,878
Contract administrator fees	2014-12-31	$2,378
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	T.E. LOTT & COMPANY
Accountancy firm EIN	2014-12-31	640575804
2013 : TRI COMMUNITY NURSING CENTER 401(K) PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$26,185
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$83,268
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$70,204
Value of total corrective distributions	2013-12-31	$13,020
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$15,651
Value of total assets at end of year	2013-12-31	$102,955
Value of total assets at beginning of year	2013-12-31	$160,038
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$44
Total interest from all sources	2013-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	No
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$15,651
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$-57,083
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$102,955
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$160,038
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in pooled separate accounts at end of year	2013-12-31	$102,955
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$134,540
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$25,498
Net investment gain/loss from pooled separate accounts	2013-12-31	$10,534
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$70,204
Contract administrator fees	2013-12-31	$44
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	T.E. LOTT & COMPANY
Accountancy firm EIN	2013-12-31	640575804
2012 : TRI COMMUNITY NURSING CENTER 401(K) PLAN 2012 401k financial data
Total income from all sources (including contributions)	2012-12-31	$36,097
Total of all expenses incurred	2012-12-31	$94,462
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$82,151
Value of total corrective distributions	2012-12-31	$12,311
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$21,560
Value of total assets at end of year	2012-12-31	$160,038
Value of total assets at beginning of year	2012-12-31	$218,403
Total interest from all sources	2012-12-31	$205
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	No
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$21,560
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$-58,365
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$160,038
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$218,403
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in pooled separate accounts at end of year	2012-12-31	$134,540
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$198,379
Interest earned on other investments	2012-12-31	$205
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$25,498
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$20,024
Net investment gain/loss from pooled separate accounts	2012-12-31	$14,332
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$82,151
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	T.E. LOTT & COMPANY
Accountancy firm EIN	2012-12-31	640575804
2011 : TRI COMMUNITY NURSING CENTER 401(K) PLAN 2011 401k financial data
Unrealized appreciation/depreciation of real estate assets	2011-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2011-12-31	$0
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total transfer of assets to this plan	2011-12-31	$0
Total transfer of assets from this plan	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$44,117
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$34,333
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$34,333
Value of total corrective distributions	2011-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$41,334
Value of total assets at end of year	2011-12-31	$218,403
Value of total assets at beginning of year	2011-12-31	$208,619
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$0
Total income from rents	2011-12-31	$0
Total interest from all sources	2011-12-31	$186
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$0
Administrative expenses professional fees incurred	2011-12-31	$0
Was this plan covered by a fidelity bond	2011-12-31	No
Value of fidelity bond cover	2011-12-31	$0
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Amount of non-exempt transactions with any party-in-interest	2011-12-31	$0
Contributions received from participants	2011-12-31	$41,334
Participant contributions at end of year	2011-12-31	$0
Participant contributions at beginning of year	2011-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2011-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$0
Other income not declared elsewhere	2011-12-31	$95
Administrative expenses (other) incurred	2011-12-31	$0
Liabilities. Value of operating payables at beginning of year	2011-12-31	$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	2011-12-31	No
Value of net income/loss	2011-12-31	$9,784
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$218,403
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$208,619
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2011-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2011-12-31	$0
Investment advisory and management fees	2011-12-31	$0
Value of interest in pooled separate accounts at end of year	2011-12-31	$198,379
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$193,978
Income. Interest from loans (other than to participants)	2011-12-31	$0
Interest earned on other investments	2011-12-31	$186
Income. Interest from US Government securities	2011-12-31	$0
Income. Interest from corporate debt instruments	2011-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$20,024
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$14,641
Expenses. Payments to insurance carriers foe the provision of benefits	2011-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$0
Net investment gain/loss from pooled separate accounts	2011-12-31	$2,502
Net investment gain or loss from common/collective trusts	2011-12-31	$0
Net gain/loss from 103.12 investment entities	2011-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$0
Employer contributions (assets) at end of year	2011-12-31	$0
Employer contributions (assets) at beginning of year	2011-12-31	$0
Income. Dividends from preferred stock	2011-12-31	$0
Income. Dividends from common stock	2011-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$34,333
Contract administrator fees	2011-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2011-12-31	$0
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Aggregate proceeds on sale of assets	2011-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2011-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2011-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	HANNIS T BOURGEOIS, LLP
Accountancy firm EIN	2011-12-31	720636725
2010 : TRI COMMUNITY NURSING CENTER 401(K) PLAN 2010 401k financial data
Unrealized appreciation/depreciation of real estate assets	2010-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2010-12-31	$0
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total transfer of assets to this plan	2010-12-31	$0
Total transfer of assets from this plan	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$67,499
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$40,949
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$35,520
Value of total corrective distributions	2010-12-31	$5,429
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$49,665
Value of total assets at end of year	2010-12-31	$208,619
Value of total assets at beginning of year	2010-12-31	$182,069
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$0
Total income from rents	2010-12-31	$0
Total interest from all sources	2010-12-31	$163
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2010-12-31	$0
Administrative expenses professional fees incurred	2010-12-31	$0
Was this plan covered by a fidelity bond	2010-12-31	No
Value of fidelity bond cover	2010-12-31	$0
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Amount of non-exempt transactions with any party-in-interest	2010-12-31	$0
Contributions received from participants	2010-12-31	$49,665
Participant contributions at end of year	2010-12-31	$0
Participant contributions at beginning of year	2010-12-31	$780
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2010-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$0
Other income not declared elsewhere	2010-12-31	$103
Administrative expenses (other) incurred	2010-12-31	$0
Liabilities. Value of operating payables at beginning of year	2010-12-31	$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	2010-12-31	No
Value of net income/loss	2010-12-31	$26,550
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$208,619
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$182,069
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2010-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2010-12-31	$0
Investment advisory and management fees	2010-12-31	$0
Value of interest in pooled separate accounts at end of year	2010-12-31	$193,978
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$172,158
Income. Interest from loans (other than to participants)	2010-12-31	$0
Interest earned on other investments	2010-12-31	$163
Income. Interest from US Government securities	2010-12-31	$0
Income. Interest from corporate debt instruments	2010-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$14,641
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$9,131
Expenses. Payments to insurance carriers foe the provision of benefits	2010-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$0
Net investment gain/loss from pooled separate accounts	2010-12-31	$17,568
Net investment gain or loss from common/collective trusts	2010-12-31	$0
Net gain/loss from 103.12 investment entities	2010-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$0
Employer contributions (assets) at end of year	2010-12-31	$0
Employer contributions (assets) at beginning of year	2010-12-31	$0
Income. Dividends from preferred stock	2010-12-31	$0
Income. Dividends from common stock	2010-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$35,520
Contract administrator fees	2010-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2010-12-31	$0
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Aggregate proceeds on sale of assets	2010-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2010-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2010-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	HANNIS T. BOURGEOIS, LLP
Accountancy firm EIN	2010-12-31	720636725
2008 : TRI COMMUNITY NURSING CENTER 401(K) PLAN 2008 401k financial data
Total income from all sources (including contributions)	2008-12-31	$-10,940
Total of all expenses incurred	2008-12-31	$5,591
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2008-12-31	$5,591
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2008-12-31	$39,788
Value of total assets at end of year	2008-12-31	$113,397
Value of total assets at beginning of year	2008-12-31	$129,928
Total interest from all sources	2008-12-31	$21
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2008-12-31	No
Was this plan covered by a fidelity bond	2008-12-31	No
If this is an individual account plan, was there a blackout period	2008-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2008-12-31	No
Contributions received from participants	2008-12-31	$39,788
Participant contributions at end of year	2008-12-31	$186
Participant contributions at beginning of year	2008-12-31	$928
Other income not declared elsewhere	2008-12-31	$3
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2008-12-31	No
Value of net income/loss	2008-12-31	$-16,531
Value of net assets at end of year (total assets less liabilities)	2008-12-31	$113,397
Value of net assets at beginning of year (total assets less liabilities)	2008-12-31	$129,928
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2008-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2008-12-31	No
Were any leases to which the plan was party in default or uncollectible	2008-12-31	No
Value of interest in pooled separate accounts at end of year	2008-12-31	$109,046
Value of interest in pooled separate accounts at beginning of year	2008-12-31	$128,333
Interest earned on other investments	2008-12-31	$21
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2008-12-31	$4,165
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2008-12-31	$467
Net investment gain/loss from pooled separate accounts	2008-12-31	$-50,752
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2008-12-31	No
Was there a failure to transmit to the plan any participant contributions	2008-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2008-12-31	No
Employer contributions (assets) at beginning of year	2008-12-31	$200
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2008-12-31	$5,591
Did the plan have assets held for investment	2008-12-31	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	2008-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2008-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2008-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2008-12-31	Disclaimer
Accountancy firm name	2008-12-31	T.E. LOTT & COMPANY
Accountancy firm EIN	2008-12-31	640575804
2007 : TRI COMMUNITY NURSING CENTER 401(K) PLAN 2007 401k financial data
Total income from all sources (including contributions)	2007-12-31	$41,071
Total of all expenses incurred	2007-12-31	$20,980
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2007-12-31	$20,980
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2007-12-31	$38,378
Value of total assets at end of year	2007-12-31	$129,928
Value of total assets at beginning of year	2007-12-31	$109,837
Total interest from all sources	2007-12-31	$9
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2007-12-31	No
Was this plan covered by a fidelity bond	2007-12-31	No
If this is an individual account plan, was there a blackout period	2007-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2007-12-31	No
Contributions received from participants	2007-12-31	$38,378
Participant contributions at end of year	2007-12-31	$1,128
Participant contributions at beginning of year	2007-12-31	$843
Other income not declared elsewhere	2007-12-31	$16
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2007-12-31	No
Value of net income/loss	2007-12-31	$20,091
Value of net assets at end of year (total assets less liabilities)	2007-12-31	$129,928
Value of net assets at beginning of year (total assets less liabilities)	2007-12-31	$109,837
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2007-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2007-12-31	No
Were any leases to which the plan was party in default or uncollectible	2007-12-31	No
Value of interest in pooled separate accounts at end of year	2007-12-31	$128,333
Value of interest in pooled separate accounts at beginning of year	2007-12-31	$85,205
Interest earned on other investments	2007-12-31	$9
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2007-12-31	$467
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2007-12-31	$443
Net investment gain/loss from pooled separate accounts	2007-12-31	$2,668
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2007-12-31	No
Was there a failure to transmit to the plan any participant contributions	2007-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2007-12-31	No
Employer contributions (assets) at beginning of year	2007-12-31	$23,346
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2007-12-31	$20,980
Did the plan have assets held for investment	2007-12-31	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	2007-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2007-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2007-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2007-12-31	Disclaimer
Accountancy firm name	2007-12-31	T.E. LOTT & COMPANY
Accountancy firm EIN	2007-12-31	640575804
2006 : TRI COMMUNITY NURSING CENTER 401(K) PLAN 2006 401k financial data
Total income from all sources (including contributions)	2006-12-31	$58,684
Total of all expenses incurred	2006-12-31	$500
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2006-12-31	$500
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2006-12-31	$52,155
Value of total assets at end of year	2006-12-31	$109,837
Value of total assets at beginning of year	2006-12-31	$51,653
Total interest from all sources	2006-12-31	$8
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2006-12-31	No
Was this plan covered by a fidelity bond	2006-12-31	No
If this is an individual account plan, was there a blackout period	2006-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2006-12-31	No
Contributions received from participants	2006-12-31	$28,809
Participant contributions at end of year	2006-12-31	$843
Participant contributions at beginning of year	2006-12-31	$2,321
Other income not declared elsewhere	2006-12-31	$5
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2006-12-31	No
Value of net income/loss	2006-12-31	$58,184
Value of net assets at end of year (total assets less liabilities)	2006-12-31	$109,837
Value of net assets at beginning of year (total assets less liabilities)	2006-12-31	$51,653
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2006-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2006-12-31	No
Were any leases to which the plan was party in default or uncollectible	2006-12-31	No
Value of interest in pooled separate accounts at end of year	2006-12-31	$85,205
Value of interest in pooled separate accounts at beginning of year	2006-12-31	$48,902
Interest earned on other investments	2006-12-31	$8
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2006-12-31	$443
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2006-12-31	$430
Net investment gain/loss from pooled separate accounts	2006-12-31	$6,516
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2006-12-31	No
Was there a failure to transmit to the plan any participant contributions	2006-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2006-12-31	No
Contributions received in cash from employer	2006-12-31	$23,346
Employer contributions (assets) at end of year	2006-12-31	$23,346
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2006-12-31	$500
Did the plan have assets held for investment	2006-12-31	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	2006-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2006-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2006-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2006-12-31	Disclaimer
Accountancy firm name	2006-12-31	T.E. LOTT & COMPANY
Accountancy firm EIN	2006-12-31	640575804
2005 : TRI COMMUNITY NURSING CENTER 401(K) PLAN 2005 401k financial data
Total income from all sources (including contributions)	2005-12-31	$24,125
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2005-12-31	$22,183
Value of total assets at end of year	2005-12-31	$51,653
Value of total assets at beginning of year	2005-12-31	$27,528
Total interest from all sources	2005-12-31	$8
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2005-12-31	No
Was this plan covered by a fidelity bond	2005-12-31	No
If this is an individual account plan, was there a blackout period	2005-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2005-12-31	No
Contributions received from participants	2005-12-31	$22,183
Participant contributions at end of year	2005-12-31	$2,321
Participant contributions at beginning of year	2005-12-31	$363
Other income not declared elsewhere	2005-12-31	$-7
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2005-12-31	No
Value of net income/loss	2005-12-31	$24,125
Value of net assets at end of year (total assets less liabilities)	2005-12-31	$51,653
Value of net assets at beginning of year (total assets less liabilities)	2005-12-31	$27,528
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2005-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2005-12-31	No
Were any leases to which the plan was party in default or uncollectible	2005-12-31	No
Value of interest in pooled separate accounts at end of year	2005-12-31	$48,902
Value of interest in pooled separate accounts at beginning of year	2005-12-31	$26,736
Interest earned on other investments	2005-12-31	$8
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2005-12-31	$430
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2005-12-31	$429
Net investment gain/loss from pooled separate accounts	2005-12-31	$1,941
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2005-12-31	No
Was there a failure to transmit to the plan any participant contributions	2005-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2005-12-31	No
Did the plan have assets held for investment	2005-12-31	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	2005-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2005-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2005-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2005-12-31	Disclaimer
Accountancy firm name	2005-12-31	T.E. LOTT & COMPANY
Accountancy firm EIN	2005-12-31	640575804
2004 : TRI COMMUNITY NURSING CENTER 401(K) PLAN 2004 401k financial data
Total income from all sources (including contributions)	2004-12-31	$21,288
Total of all expenses incurred	2004-12-31	$2,185
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2004-12-31	$2,185
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2004-12-31	$19,210
Value of total assets at end of year	2004-12-31	$27,528
Value of total assets at beginning of year	2004-12-31	$8,425
Total interest from all sources	2004-12-31	$25
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2004-12-31	No
Was this plan covered by a fidelity bond	2004-12-31	No
If this is an individual account plan, was there a blackout period	2004-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2004-12-31	No
Contributions received from participants	2004-12-31	$19,210
Participant contributions at end of year	2004-12-31	$363
Participant contributions at beginning of year	2004-12-31	$862
Other income not declared elsewhere	2004-12-31	$1
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2004-12-31	No
Value of net income/loss	2004-12-31	$19,103
Value of net assets at end of year (total assets less liabilities)	2004-12-31	$27,528
Value of net assets at beginning of year (total assets less liabilities)	2004-12-31	$8,425
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2004-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2004-12-31	No
Were any leases to which the plan was party in default or uncollectible	2004-12-31	No
Value of interest in pooled separate accounts at end of year	2004-12-31	$26,736
Value of interest in pooled separate accounts at beginning of year	2004-12-31	$6,612
Interest earned on other investments	2004-12-31	$25
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2004-12-31	$429
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2004-12-31	$951
Net investment gain/loss from pooled separate accounts	2004-12-31	$2,052
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2004-12-31	No
Was there a failure to transmit to the plan any participant contributions	2004-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2004-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2004-12-31	$2,185
Did the plan have assets held for investment	2004-12-31	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	2004-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2004-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2004-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2004-12-31	Disclaimer
Accountancy firm name	2004-12-31	T.E. LOTT & COMPANY
Accountancy firm EIN	2004-12-31	640575804
2003 : TRI COMMUNITY NURSING CENTER 401(K) PLAN 2003 401k financial data
Total income from all sources (including contributions)	2003-12-31	$8,425
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2003-12-31	$8,218
Value of total assets at end of year	2003-12-31	$8,425
Total interest from all sources	2003-12-31	$4
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2003-12-31	No
Was this plan covered by a fidelity bond	2003-12-31	No
If this is an individual account plan, was there a blackout period	2003-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2003-12-31	No
Contributions received from participants	2003-12-31	$8,218
Participant contributions at end of year	2003-12-31	$862
Other income not declared elsewhere	2003-12-31	$-19
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2003-12-31	No
Value of net income/loss	2003-12-31	$8,425
Value of net assets at end of year (total assets less liabilities)	2003-12-31	$8,425
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2003-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2003-12-31	No
Were any leases to which the plan was party in default or uncollectible	2003-12-31	No
Value of interest in pooled separate accounts at end of year	2003-12-31	$6,612
Interest earned on other investments	2003-12-31	$4
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2003-12-31	$951
Net investment gain/loss from pooled separate accounts	2003-12-31	$222
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2003-12-31	No
Was there a failure to transmit to the plan any participant contributions	2003-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2003-12-31	No
Did the plan have assets held for investment	2003-12-31	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	2003-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2003-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2003-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2003-12-31	Disclaimer
Accountancy firm name	2003-12-31	T.E. LOTT & COMPANY
Accountancy firm EIN	2003-12-31	640575804

Form 5500 Responses for TRI COMMUNITY NURSING CENTER 401(K) PLAN

2016: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	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
2015: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	Yes
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	Yes
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	Yes
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes
2008: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2008 form 5500 responses
2008-01-01	Type of plan entity	Single employer plan
2008-01-01	Submission has been amended	No
2008-01-01	This submission is the final filing	No
2008-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-01-01	Plan is a collectively bargained plan	No
2008-01-01	Plan funding arrangement – Insurance	Yes
2008-01-01	Plan funding arrangement – Trust	Yes
2008-01-01	Plan benefit arrangement – Insurance	Yes
2008-01-01	Plan benefit arrangement - Trust	Yes
2007: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2007 form 5500 responses
2007-01-01	Type of plan entity	Single employer plan
2007-01-01	Submission has been amended	No
2007-01-01	This submission is the final filing	No
2007-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2007-01-01	Plan is a collectively bargained plan	No
2007-01-01	Plan funding arrangement – Insurance	Yes
2007-01-01	Plan funding arrangement – Trust	Yes
2007-01-01	Plan benefit arrangement – Insurance	Yes
2007-01-01	Plan benefit arrangement - Trust	Yes
2006: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2006 form 5500 responses
2006-01-01	Type of plan entity	Single employer plan
2006-01-01	Submission has been amended	Yes
2006-01-01	This submission is the final filing	No
2006-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2006-01-01	Plan is a collectively bargained plan	No
2006-01-01	Plan funding arrangement – Insurance	Yes
2006-01-01	Plan funding arrangement – Trust	Yes
2006-01-01	Plan benefit arrangement – Insurance	Yes
2006-01-01	Plan benefit arrangement - Trust	Yes
2005: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2005 form 5500 responses
2005-01-01	Type of plan entity	Single employer plan
2005-01-01	Submission has been amended	Yes
2005-01-01	This submission is the final filing	No
2005-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2005-01-01	Plan is a collectively bargained plan	No
2005-01-01	Plan funding arrangement – Insurance	Yes
2005-01-01	Plan funding arrangement – Trust	Yes
2005-01-01	Plan benefit arrangement – Insurance	Yes
2005-01-01	Plan benefit arrangement - Trust	Yes
2004: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2004 form 5500 responses
2004-01-01	Type of plan entity	Single employer plan
2004-01-01	Submission has been amended	Yes
2004-01-01	This submission is the final filing	No
2004-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2004-01-01	Plan is a collectively bargained plan	No
2004-01-01	Plan funding arrangement – Insurance	Yes
2004-01-01	Plan funding arrangement – Trust	Yes
2004-01-01	Plan benefit arrangement – Insurance	Yes
2004-01-01	Plan benefit arrangement - Trust	Yes
2003: TRI COMMUNITY NURSING CENTER 401(K) PLAN 2003 form 5500 responses
2003-02-01	Type of plan entity	Single employer plan
2003-02-01	First time form 5500 has been submitted	Yes
2003-02-01	Submission has been amended	Yes
2003-02-01	This submission is the final filing	No
2003-02-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2003-02-01	Plan is a collectively bargained plan	No
2003-02-01	Plan funding arrangement – Insurance	Yes
2003-02-01	Plan funding arrangement – Trust	Yes
2003-02-01	Plan benefit arrangement – Insurance	Yes
2003-02-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

335868-01

Policy instance

Insurance contract or identification number	335868-01
Number of Individuals Covered	0
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

335868-01

Policy instance

Insurance contract or identification number	335868-01
Number of Individuals Covered	0
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	FMS OF AMERICA

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

335868-01

Policy instance

Insurance contract or identification number	335868-01
Number of Individuals Covered	91
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	FMS OF AMERICA

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

705435

Policy instance

Insurance contract or identification number	705435
Number of Individuals Covered	133
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $224
Total amount of fees paid to insurance company	USD $655
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 $224
Amount paid for insurance broker fees	655
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	3
Insurance broker name	NORTHWESTERN MUTUAL INVESTMENT SERV

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

705435

Policy instance

Insurance contract or identification number	705435
Number of Individuals Covered	130
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $930
Total amount of fees paid to insurance company	USD $626
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

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

705435

Policy instance

Insurance contract or identification number	705435
Number of Individuals Covered	157
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,036
Total amount of fees paid to insurance company	USD $544
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

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

7-05435

Policy instance

Insurance contract or identification number	7-05435
Number of Individuals Covered	120
Insurance policy start date	2008-01-01
Insurance policy end date	2008-12-31
Total amount of commissions paid to insurance broker	USD $916
Total amount of fees paid to insurance company	USD $386
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 $916
Amount paid for insurance broker fees	386
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	3
Insurance broker name	NORTHWESTERN MUTUAL INVESTMENT SERV

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

7-05435

Policy instance

Insurance contract or identification number	7-05435
Number of Individuals Covered	158
Insurance policy start date	2007-01-01
Insurance policy end date	2007-12-31
Total amount of commissions paid to insurance broker	USD $1,382
Total amount of fees paid to insurance company	USD $257
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 $1,382
Amount paid for insurance broker fees	257
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	3
Insurance broker name	NORTHWESTERN MUTUAL INVESTMENT SERV

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

7-05435

Policy instance

Insurance contract or identification number	7-05435
Number of Individuals Covered	153
Insurance policy start date	2006-01-01
Insurance policy end date	2006-12-31
Total amount of commissions paid to insurance broker	USD $681
Total amount of fees paid to insurance company	USD $148
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 $681
Amount paid for insurance broker fees	148
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	3
Insurance broker name	NORTHWESTERN MUTUAL INVESTMENT SERV

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

7-05435

Policy instance

Insurance contract or identification number	7-05435
Number of Individuals Covered	154
Insurance policy start date	2005-01-01
Insurance policy end date	2005-12-31
Total amount of commissions paid to insurance broker	USD $431
Total amount of fees paid to insurance company	USD $82
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 $279
Amount paid for insurance broker fees	82
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3
Insurance broker name	NORTHWESTERN MUTUAL

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

7-05435

Policy instance

Insurance contract or identification number	7-05435
Number of Individuals Covered	154
Insurance policy start date	2004-01-01
Insurance policy end date	2004-12-31
Total amount of commissions paid to insurance broker	USD $443
Total amount of fees paid to insurance company	USD $23
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Commission paid to Insurance Broker	USD $443
Amount paid for insurance broker fees	23
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3
Insurance broker name	A G EDWARDS

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

7-05435

Policy instance

Insurance contract or identification number	7-05435
Number of Individuals Covered	140
Insurance policy start date	2003-02-01
Insurance policy end date	2003-12-31
Total amount of commissions paid to insurance broker	USD $165
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
Commission paid to Insurance Broker	USD $165
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3
Insurance broker name	A G EDWARDS

Potentially related plans

TRI COMMUNITY WATER SYSTEM [EIN = 630464018]

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Company Name:	PEACE INC. DBA TRI COMMUNITY NURSING CENTER
Employer identification number (EIN):	581847649
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities