401k Plan data: SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN plan

SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 401k Plan overview

Plan Name	SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN
Plan identification number	001

SOUTH COVE MANOR NURSING HOME,INC. 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.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

SOUTH COVE MANOR NURSING AND REHABILITATION CENTER, INC. has sponsored the creation of one or more 401k plans.

Company Name: SOUTH COVE MANOR NURSING AND REHABILITATION CENTER, INC.

Employer identification number (EIN): 800687948

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01 LI CHEN
001 2016-01-01 LI CHEN
001 2015-01-01 LI CHEN
001 2014-01-01 LI CHEN

Plan Statistics for SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN

401k plan membership statisitcs for SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN

Measure Date Value
2022: SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 197
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 170
Number of retired or separated participants receiving benefits 2022-01-01 3
Number of other retired or separated participants entitled to future benefits 2022-01-01 30
Total of all active and inactive participants 2022-01-01 203
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 203
Number of participants with account balances 2022-01-01 126
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 1
2021: SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 215
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 178
Number of retired or separated participants receiving benefits 2021-01-01 1
Number of other retired or separated participants entitled to future benefits 2021-01-01 28
Total of all active and inactive participants 2021-01-01 207
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 207
Number of participants with account balances 2021-01-01 119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 3
2020: SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 215
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 185
Number of retired or separated participants receiving benefits 2020-01-01 2
Number of other retired or separated participants entitled to future benefits 2020-01-01 31
Total of all active and inactive participants 2020-01-01 218
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 218
Number of participants with account balances 2020-01-01 119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 2
2019: SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 204
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 186
Number of retired or separated participants receiving benefits 2019-01-01 3
Number of other retired or separated participants entitled to future benefits 2019-01-01 25
Total of all active and inactive participants 2019-01-01 214
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 214
Number of participants with account balances 2019-01-01 112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 3
2018: SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 207
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 186
Number of retired or separated participants receiving benefits 2018-01-01 1
Number of other retired or separated participants entitled to future benefits 2018-01-01 22
Total of all active and inactive participants 2018-01-01 209
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 209
Number of participants with account balances 2018-01-01 97
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 1
2017: SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 218
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 194
Number of retired or separated participants receiving benefits 2017-01-01 1
Number of other retired or separated participants entitled to future benefits 2017-01-01 19
Total of all active and inactive participants 2017-01-01 214
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 214
Number of participants with account balances 2017-01-01 102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 1
2016: SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 193
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 199
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 18
Total of all active and inactive participants 2016-01-01 217
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 217
Number of participants with account balances 2016-01-01 94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 4
2015: SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 144
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 175
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 18
Total of all active and inactive participants 2015-01-01 193
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 193
Number of participants with account balances 2015-01-01 79
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 3
2014: SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 144
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 132
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 11
Total of all active and inactive participants 2014-01-01 143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 143
Number of participants with account balances 2014-01-01 72
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 1

Measure	Date	Value
2022: SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	197
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	170
Number of retired or separated participants receiving benefits	2022-01-01	3
Number of other retired or separated participants entitled to future benefits	2022-01-01	30
Total of all active and inactive participants	2022-01-01	203
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	203
Number of participants with account balances	2022-01-01	126
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	1
2021: SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	215
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	178
Number of retired or separated participants receiving benefits	2021-01-01	1
Number of other retired or separated participants entitled to future benefits	2021-01-01	28
Total of all active and inactive participants	2021-01-01	207
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	207
Number of participants with account balances	2021-01-01	119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	3
2020: SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	215
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	185
Number of retired or separated participants receiving benefits	2020-01-01	2
Number of other retired or separated participants entitled to future benefits	2020-01-01	31
Total of all active and inactive participants	2020-01-01	218
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	218
Number of participants with account balances	2020-01-01	119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	2
2019: SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	204
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	186
Number of retired or separated participants receiving benefits	2019-01-01	3
Number of other retired or separated participants entitled to future benefits	2019-01-01	25
Total of all active and inactive participants	2019-01-01	214
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	214
Number of participants with account balances	2019-01-01	112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	3
2018: SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	207
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	186
Number of retired or separated participants receiving benefits	2018-01-01	1
Number of other retired or separated participants entitled to future benefits	2018-01-01	22
Total of all active and inactive participants	2018-01-01	209
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	209
Number of participants with account balances	2018-01-01	97
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	1
2017: SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	218
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	194
Number of retired or separated participants receiving benefits	2017-01-01	1
Number of other retired or separated participants entitled to future benefits	2017-01-01	19
Total of all active and inactive participants	2017-01-01	214
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	214
Number of participants with account balances	2017-01-01	102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	1
2016: SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	193
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	199
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	18
Total of all active and inactive participants	2016-01-01	217
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	217
Number of participants with account balances	2016-01-01	94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	4
2015: SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	144
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	175
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	18
Total of all active and inactive participants	2015-01-01	193
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	193
Number of participants with account balances	2015-01-01	79
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	3
2014: SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	144
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	132
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	11
Total of all active and inactive participants	2014-01-01	143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	143
Number of participants with account balances	2014-01-01	72
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	1

Financial Data on SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN

Measure	Date	Value
2022 : SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-965,989
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$175,445
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$175,097
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$677,015
Value of total assets at end of year	2022-12-31	$8,920,667
Value of total assets at beginning of year	2022-12-31	$10,062,101
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$348
Total interest from all sources	2022-12-31	$662
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$2,800
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$2,800
Administrative expenses professional fees incurred	2022-12-31	$348
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$513,052
Participant contributions at end of year	2022-12-31	$7,353
Participant contributions at beginning of year	2022-12-31	$12,872
Participant contributions at end of year	2022-12-31	$20,238
Participant contributions at beginning of year	2022-12-31	$20,738
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$24,503
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2022-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2022-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-1,141,434
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$8,920,667
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$10,062,101
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in pooled separate accounts at end of year	2022-12-31	$8,576,217
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$9,625,139
Interest on participant loans	2022-12-31	$662
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2022-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$311,171
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$397,618
Net investment gain/loss from pooled separate accounts	2022-12-31	$-1,646,466
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$139,460
Employer contributions (assets) at end of year	2022-12-31	$5,688
Employer contributions (assets) at beginning of year	2022-12-31	$5,734
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$175,097
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	MARCUM LLP
Accountancy firm EIN	2022-12-31	111986323
2021 : SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$24,870
Total income from all sources (including contributions)	2021-12-31	$1,714,941
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$632,934
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$632,934
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$600,358
Value of total assets at end of year	2021-12-31	$10,035,629
Value of total assets at beginning of year	2021-12-31	$8,978,492
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$0
Total interest from all sources	2021-12-31	$1,100
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$1,747
Administrative expenses professional fees incurred	2021-12-31	$5,758
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$474,526
Participant contributions at end of year	2021-12-31	$12,872
Participant contributions at beginning of year	2021-12-31	$22,881
Participant contributions at end of year	2021-12-31	$20,738
Participant contributions at beginning of year	2021-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2021-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2021-12-31	$24,870
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$1,082,007
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$10,035,629
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$8,953,622
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in pooled separate accounts at end of year	2021-12-31	$9,625,139
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$8,793,571
Interest on participant loans	2021-12-31	$1,096
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2021-12-31	$4
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$397,618
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$159,928
Net investment gain/loss from pooled separate accounts	2021-12-31	$1,113,483
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$125,832
Employer contributions (assets) at end of year	2021-12-31	$0
Employer contributions (assets) at beginning of year	2021-12-31	$2,112
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$632,934
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	MARCUM LLP
Accountancy firm EIN	2021-12-31	111986323
2020 : SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$24,870
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$1,836,913
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$165,608
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$162,002
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$644,721
Value of total assets at end of year	2020-12-31	$8,978,492
Value of total assets at beginning of year	2020-12-31	$7,282,317
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$3,606
Total interest from all sources	2020-12-31	$1,551
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$498,220
Participant contributions at end of year	2020-12-31	$22,881
Participant contributions at beginning of year	2020-12-31	$27,507
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$8,278
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2020-12-31	$24,870
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-12-31	$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	2020-12-31	No
Value of net income/loss	2020-12-31	$1,671,305
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$8,953,622
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$7,282,317
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in pooled separate accounts at end of year	2020-12-31	$8,793,571
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$7,117,682
Interest on participant loans	2020-12-31	$1,535
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-12-31	$16
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$159,928
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$137,128
Net investment gain/loss from pooled separate accounts	2020-12-31	$1,190,641
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$138,223
Employer contributions (assets) at end of year	2020-12-31	$2,112
Employer contributions (assets) at beginning of year	2020-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$162,002
Contract administrator fees	2020-12-31	$3,606
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2020-12-31	410746749
2019 : SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$1,738,092
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$271,706
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$271,204
Value of total corrective distributions	2019-12-31	$502
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$538,250
Value of total assets at end of year	2019-12-31	$7,282,317
Value of total assets at beginning of year	2019-12-31	$5,815,931
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$0
Total interest from all sources	2019-12-31	$2,442
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$399,106
Participant contributions at end of year	2019-12-31	$27,507
Participant contributions at beginning of year	2019-12-31	$51,795
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$29,378
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$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	2019-12-31	No
Value of net income/loss	2019-12-31	$1,466,386
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$7,282,317
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$5,815,931
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in pooled separate accounts at end of year	2019-12-31	$7,117,682
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$5,763,845
Interest on participant loans	2019-12-31	$2,379
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$63
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$137,128
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$291
Net investment gain/loss from pooled separate accounts	2019-12-31	$1,197,400
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$109,766
Employer contributions (assets) at end of year	2019-12-31	$0
Employer contributions (assets) at beginning of year	2019-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$271,204
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2019-12-31	410746749
2018 : SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$87,202
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$483,422
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$483,422
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$432,329
Value of total assets at end of year	2018-12-31	$5,815,931
Value of total assets at beginning of year	2018-12-31	$6,212,151
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$0
Total interest from all sources	2018-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$500,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$335,277
Participant contributions at end of year	2018-12-31	$51,795
Participant contributions at beginning of year	2018-12-31	$30,419
Participant contributions at end of year	2018-12-31	$0
Participant contributions at beginning of year	2018-12-31	$13,291
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$-396,220
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$5,815,931
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$6,212,151
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in pooled separate accounts at end of year	2018-12-31	$5,763,845
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$6,148,371
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$291
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$15,976
Net investment gain/loss from pooled separate accounts	2018-12-31	$-345,127
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$97,052
Employer contributions (assets) at end of year	2018-12-31	$0
Employer contributions (assets) at beginning of year	2018-12-31	$4,094
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$483,422
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2018-12-31	410746749
2017 : SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$1,258,887
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$400,278
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$384,990
Expenses. Certain deemed distributions of participant loans	2017-12-31	$13,702
Value of total corrective distributions	2017-12-31	$1,586
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$459,252
Value of total assets at end of year	2017-12-31	$6,212,151
Value of total assets at beginning of year	2017-12-31	$5,353,542
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$0
Total interest from all sources	2017-12-31	$2,114
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$500,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$340,743
Participant contributions at end of year	2017-12-31	$30,419
Participant contributions at beginning of year	2017-12-31	$59,897
Participant contributions at end of year	2017-12-31	$13,291
Participant contributions at beginning of year	2017-12-31	$10,953
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$12,842
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$858,609
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$6,212,151
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$5,353,542
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in pooled separate accounts at end of year	2017-12-31	$6,148,371
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$5,278,882
Income. Interest from loans (other than to participants)	2017-12-31	$2,114
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$15,976
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$0
Net investment gain/loss from pooled separate accounts	2017-12-31	$797,521
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$105,667
Employer contributions (assets) at end of year	2017-12-31	$4,094
Employer contributions (assets) at beginning of year	2017-12-31	$3,810
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$384,990
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2017-12-31	410746749
2016 : SOUTH COVE MANOR NURSING HOME,INC. 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	$720,000
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$251,107
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$249,695
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$402,015
Value of total assets at end of year	2016-12-31	$5,353,542
Value of total assets at beginning of year	2016-12-31	$4,884,649
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$1,412
Total interest from all sources	2016-12-31	$3,485
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
Administrative expenses professional fees incurred	2016-12-31	$1,062
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$308,316
Participant contributions at end of year	2016-12-31	$59,897
Participant contributions at beginning of year	2016-12-31	$71,485
Participant contributions at end of year	2016-12-31	$3,810
Participant contributions at beginning of year	2016-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-12-31	$10,953
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-12-31	$0
Total non interest bearing cash at end of year	2016-12-31	$0
Total non interest bearing cash at beginning of year	2016-12-31	$1,062
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	$468,893
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$5,353,542
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$4,884,649
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	$4,620,847
Value of interest in pooled separate accounts at end of year	2016-12-31	$5,278,882
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$0
Interest on participant loans	2016-12-31	$3,483
Income. Interest from US Government securities	2016-12-31	$2
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	$191,255
Net investment gain/loss from pooled separate accounts	2016-12-31	$314,500
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$93,699
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$249,695
Contract administrator fees	2016-12-31	$350
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	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2016-12-31	410746749
2015 : SOUTH COVE MANOR NURSING HOME,INC. 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	$426,648
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$120,941
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$120,056
Value of total corrective distributions	2015-12-31	$885
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$491,546
Value of total assets at end of year	2015-12-31	$4,884,649
Value of total assets at beginning of year	2015-12-31	$4,578,942
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$0
Total interest from all sources	2015-12-31	$2,770
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	$500,000
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	$277,617
Participant contributions at end of year	2015-12-31	$71,485
Participant contributions at beginning of year	2015-12-31	$75,075
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$130,547
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$0
Total non interest bearing cash at end of year	2015-12-31	$1,062
Total non interest bearing cash at beginning of year	2015-12-31	$1,062
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	$305,707
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$4,884,649
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$4,578,942
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$4,620,847
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$4,305,796
Value of interest in pooled separate accounts at end of year	2015-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$0
Interest on participant loans	2015-12-31	$3,548
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$-778
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$191,255
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$197,009
Net investment gain/loss from pooled separate accounts	2015-12-31	$-67,668
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	$83,382
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$120,056
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	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2015-12-31	410746749
2014 : SOUTH COVE MANOR NURSING HOME,INC. 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	$537,787
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$666,464
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$666,464
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$341,833
Value of total assets at end of year	2014-12-31	$4,578,942
Value of total assets at beginning of year	2014-12-31	$4,707,619
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$0
Total interest from all sources	2014-12-31	$2,584
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	$500,000
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	$258,660
Participant contributions at end of year	2014-12-31	$75,075
Participant contributions at beginning of year	2014-12-31	$10,950
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$0
Other income not declared elsewhere	2014-12-31	$2,244
Total non interest bearing cash at end of year	2014-12-31	$1,062
Total non interest bearing cash at beginning of year	2014-12-31	$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	2014-12-31	No
Value of net income/loss	2014-12-31	$-128,677
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$4,578,942
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$4,707,619
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	$4,305,796
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$4,305,057
Value of interest in pooled separate accounts at end of year	2014-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$0
Income. Interest from loans (other than to participants)	2014-12-31	$1,817
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$767
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$197,009
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$391,612
Net investment gain/loss from pooled separate accounts	2014-12-31	$191,126
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	$83,173
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$666,464
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	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2014-12-31	410746749

Form 5500 Responses for SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN

2022: SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	Yes
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: SOUTH COVE MANOR NURSING HOME,INC. 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: SOUTH COVE MANOR NURSING HOME,INC. 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: SOUTH COVE MANOR NURSING HOME,INC. 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

815776

Policy instance

Insurance contract or identification number	815776
Number of Individuals Covered	126
Insurance policy start date	2022-01-01
Insurance policy end date	2022-07-18
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

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

Policy contract number

815776

Policy instance

Insurance contract or identification number	815776
Number of Individuals Covered	119
Insurance policy start date	2021-01-01
Insurance policy end date	2021-07-18
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

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

Policy contract number

815776

Policy instance

Insurance contract or identification number	815776
Number of Individuals Covered	119
Insurance policy start date	2020-01-01
Insurance policy end date	2020-07-18
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $3,664
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	3664
Additional information about fees paid to insurance broker	TPA PARTNERSHIP PROGRAM
Insurance broker organization code?	5

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

Policy contract number

815776

Policy instance

Insurance contract or identification number	815776
Number of Individuals Covered	112
Insurance policy start date	2019-01-01
Insurance policy end date	2019-07-18
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $4,638
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Amount paid for insurance broker fees	3197
Additional information about fees paid to insurance broker	TPA PARTNERSHIP PROGRAM
Insurance broker organization code?	5

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

Policy contract number

815776

Policy instance

Insurance contract or identification number	815776
Number of Individuals Covered	97
Insurance policy start date	2018-01-01
Insurance policy end date	2018-07-18
Total amount of commissions paid to insurance broker	USD $18,392
Total amount of fees paid to insurance company	USD $3,068
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $18,392
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3

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

Policy contract number

815776

Policy instance

Insurance contract or identification number	815776
Number of Individuals Covered	102
Insurance policy start date	2017-01-01
Insurance policy end date	2017-07-18
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $12,393
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Amount paid for insurance broker fees	8099
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3
Insurance broker name	MSI FINANCIAL SERVICES, INC

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

15921

Policy instance

Insurance contract or identification number	15921
Number of Individuals Covered	1081549
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $17,891
Total amount of fees paid to insurance company	USD $3,450
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?	Yes
Commission paid to Insurance Broker	USD $15,494
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3
Insurance broker name	PENRET SERVICES INC

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

15921

Policy instance

Insurance contract or identification number	15921
Number of Individuals Covered	99
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $14,674
Total amount of fees paid to insurance company	USD $2,469
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,674
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3
Insurance broker name	PENRET SERVICES INC

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Company Name:	SOUTH COVE MANOR NURSING AND REHABILITATION CENTER, INC.
Employer identification number (EIN):	800687948
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities