401k Plan data: ROGUE VALLEY MANOR RETIREMENT PLAN TRUST plan

ROGUE VALLEY MANOR RETIREMENT PLAN TRUST 401k Plan overview

Plan Name	ROGUE VALLEY MANOR RETIREMENT PLAN TRUST
Plan identification number	001

ROGUE VALLEY MANOR RETIREMENT PLAN TRUST Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

ROGUE VALLEY MANOR has sponsored the creation of one or more 401k plans.

Company Name: ROGUE VALLEY MANOR

Employer identification number (EIN): 930453216

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

Additional information about ROGUE VALLEY MANOR

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division

Incorporation Date: 2055-11-02

Company Identification Number: 5597810

Legal Registered Office Address: 1 W MAIN ST

MEDFORD
United States of America (USA)
97501

More information about ROGUE VALLEY MANOR

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ROGUE VALLEY MANOR RETIREMENT PLAN TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2014-10-01
001 2013-10-01 BRIAN MCLEMORE
001 2012-10-01 BRIAN MCLEMORE
001 2011-10-01 BRIAN MCLEMORE
001 2010-10-01 BRIAN MCLEMORE

Plan Statistics for ROGUE VALLEY MANOR RETIREMENT PLAN TRUST

401k plan membership statisitcs for ROGUE VALLEY MANOR RETIREMENT PLAN TRUST

Measure Date Value
2014: ROGUE VALLEY MANOR RETIREMENT PLAN TRUST 2014 401k membership
Total participants, beginning-of-year 2014-10-01 379
Total number of active participants reported on line 7a of the Form 5500 2014-10-01 0
Number of retired or separated participants receiving benefits 2014-10-01 0
Number of other retired or separated participants entitled to future benefits 2014-10-01 0
Total of all active and inactive participants 2014-10-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-10-01 0
Total participants 2014-10-01 0
Number of participants with account balances 2014-10-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-10-01 0
2013: ROGUE VALLEY MANOR RETIREMENT PLAN TRUST 2013 401k membership
Total participants, beginning-of-year 2013-10-01 379
Total number of active participants reported on line 7a of the Form 5500 2013-10-01 320
Number of retired or separated participants receiving benefits 2013-10-01 2
Number of other retired or separated participants entitled to future benefits 2013-10-01 57
Total of all active and inactive participants 2013-10-01 379
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-10-01 0
Total participants 2013-10-01 379
Number of participants with account balances 2013-10-01 377
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-10-01 0
2012: ROGUE VALLEY MANOR RETIREMENT PLAN TRUST 2012 401k membership
Total participants, beginning-of-year 2012-10-01 351
Total number of active participants reported on line 7a of the Form 5500 2012-10-01 329
Number of retired or separated participants receiving benefits 2012-10-01 4
Number of other retired or separated participants entitled to future benefits 2012-10-01 46
Total of all active and inactive participants 2012-10-01 379
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-10-01 0
Total participants 2012-10-01 379
Number of participants with account balances 2012-10-01 373
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-10-01 0
2011: ROGUE VALLEY MANOR RETIREMENT PLAN TRUST 2011 401k membership
Total participants, beginning-of-year 2011-10-01 341
Total number of active participants reported on line 7a of the Form 5500 2011-10-01 315
Number of retired or separated participants receiving benefits 2011-10-01 1
Number of other retired or separated participants entitled to future benefits 2011-10-01 35
Total of all active and inactive participants 2011-10-01 351
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-10-01 0
Total participants 2011-10-01 351
Number of participants with account balances 2011-10-01 351
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-10-01 0
2010: ROGUE VALLEY MANOR RETIREMENT PLAN TRUST 2010 401k membership
Total participants, beginning-of-year 2010-10-01 0
Total number of active participants reported on line 7a of the Form 5500 2010-10-01 297
Number of retired or separated participants receiving benefits 2010-10-01 0
Number of other retired or separated participants entitled to future benefits 2010-10-01 43
Total of all active and inactive participants 2010-10-01 340
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-10-01 1
Total participants 2010-10-01 341
Number of participants with account balances 2010-10-01 337
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-10-01 0

Measure	Date	Value
2014: ROGUE VALLEY MANOR RETIREMENT PLAN TRUST 2014 401k membership
Total participants, beginning-of-year	2014-10-01	379
Total number of active participants reported on line 7a of the Form 5500	2014-10-01	0
Number of retired or separated participants receiving benefits	2014-10-01	0
Number of other retired or separated participants entitled to future benefits	2014-10-01	0
Total of all active and inactive participants	2014-10-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-10-01	0
Total participants	2014-10-01	0
Number of participants with account balances	2014-10-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-10-01	0
2013: ROGUE VALLEY MANOR RETIREMENT PLAN TRUST 2013 401k membership
Total participants, beginning-of-year	2013-10-01	379
Total number of active participants reported on line 7a of the Form 5500	2013-10-01	320
Number of retired or separated participants receiving benefits	2013-10-01	2
Number of other retired or separated participants entitled to future benefits	2013-10-01	57
Total of all active and inactive participants	2013-10-01	379
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-10-01	0
Total participants	2013-10-01	379
Number of participants with account balances	2013-10-01	377
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-10-01	0
2012: ROGUE VALLEY MANOR RETIREMENT PLAN TRUST 2012 401k membership
Total participants, beginning-of-year	2012-10-01	351
Total number of active participants reported on line 7a of the Form 5500	2012-10-01	329
Number of retired or separated participants receiving benefits	2012-10-01	4
Number of other retired or separated participants entitled to future benefits	2012-10-01	46
Total of all active and inactive participants	2012-10-01	379
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-10-01	0
Total participants	2012-10-01	379
Number of participants with account balances	2012-10-01	373
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-10-01	0
2011: ROGUE VALLEY MANOR RETIREMENT PLAN TRUST 2011 401k membership
Total participants, beginning-of-year	2011-10-01	341
Total number of active participants reported on line 7a of the Form 5500	2011-10-01	315
Number of retired or separated participants receiving benefits	2011-10-01	1
Number of other retired or separated participants entitled to future benefits	2011-10-01	35
Total of all active and inactive participants	2011-10-01	351
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-10-01	0
Total participants	2011-10-01	351
Number of participants with account balances	2011-10-01	351
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-10-01	0
2010: ROGUE VALLEY MANOR RETIREMENT PLAN TRUST 2010 401k membership
Total participants, beginning-of-year	2010-10-01	0
Total number of active participants reported on line 7a of the Form 5500	2010-10-01	297
Number of retired or separated participants receiving benefits	2010-10-01	0
Number of other retired or separated participants entitled to future benefits	2010-10-01	43
Total of all active and inactive participants	2010-10-01	340
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-10-01	1
Total participants	2010-10-01	341
Number of participants with account balances	2010-10-01	337
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-10-01	0

Financial Data on ROGUE VALLEY MANOR RETIREMENT PLAN TRUST

Measure	Date	Value
2015 : ROGUE VALLEY MANOR RETIREMENT PLAN TRUST 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-08-31	$0
Total transfer of assets from this plan	2015-08-31	$9,367,893
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-08-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-08-31	$0
Total income from all sources (including contributions)	2015-08-31	$1,270,665
Total loss/gain on sale of assets	2015-08-31	$0
Total of all expenses incurred	2015-08-31	$985,433
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-08-31	$971,075
Expenses. Certain deemed distributions of participant loans	2015-08-31	$10,147
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-08-31	$649,206
Value of total assets at end of year	2015-08-31	$0
Value of total assets at beginning of year	2015-08-31	$9,082,661
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-08-31	$4,211
Total interest from all sources	2015-08-31	$12,486
Total dividends received (eg from common stock, registered investment company shares)	2015-08-31	$682,368
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-08-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-08-31	$682,368
Was this plan covered by a fidelity bond	2015-08-31	Yes
Value of fidelity bond cover	2015-08-31	$500,000
If this is an individual account plan, was there a blackout period	2015-08-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-08-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-08-31	No
Participant contributions at end of year	2015-08-31	$0
Participant contributions at beginning of year	2015-08-31	$364,042
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-08-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-08-31	$0
Other income not declared elsewhere	2015-08-31	$3,055
Administrative expenses (other) incurred	2015-08-31	$188
Total non interest bearing cash at end of year	2015-08-31	$0
Total non interest bearing cash at beginning of year	2015-08-31	$202,858
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-08-31	No
Value of net income/loss	2015-08-31	$285,232
Value of net assets at end of year (total assets less liabilities)	2015-08-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2015-08-31	$9,082,661
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-08-31	No
Were any leases to which the plan was party in default or uncollectible	2015-08-31	No
Investment advisory and management fees	2015-08-31	$4,023
Interest on participant loans	2015-08-31	$12,486
Value of interest in master investment trust accounts at end of year	2015-08-31	$0
Value of interest in master investment trust accounts at beginning of year	2015-08-31	$8,312,737
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-08-31	No
Was there a failure to transmit to the plan any participant contributions	2015-08-31	No
Has the plan failed to provide any benefit when due under the plan	2015-08-31	No
Contributions received in cash from employer	2015-08-31	$649,206
Employer contributions (assets) at end of year	2015-08-31	$0
Employer contributions (assets) at beginning of year	2015-08-31	$203,024
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-08-31	$971,075
Did the plan have assets held for investment	2015-08-31	No
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	2015-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-08-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-08-31	No
Opinion of an independent qualified public accountant for this plan	2015-08-31	Unqualified
Accountancy firm name	2015-08-31	MOSS ADAMS
Accountancy firm EIN	2015-08-31	910189318
2014 : ROGUE VALLEY MANOR RETIREMENT PLAN TRUST 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-09-30	$0
Total transfer of assets to this plan	2014-09-30	$140,048
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-09-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-09-30	$356
Total income from all sources (including contributions)	2014-09-30	$1,702,153
Total loss/gain on sale of assets	2014-09-30	$0
Total of all expenses incurred	2014-09-30	$440,206
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-09-30	$435,111
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-09-30	$849,479
Value of total assets at end of year	2014-09-30	$9,082,661
Value of total assets at beginning of year	2014-09-30	$7,681,022
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-09-30	$5,095
Total interest from all sources	2014-09-30	$13,809
Total dividends received (eg from common stock, registered investment company shares)	2014-09-30	$460,918
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-09-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-09-30	$460,918
Was this plan covered by a fidelity bond	2014-09-30	Yes
Value of fidelity bond cover	2014-09-30	$500,000
If this is an individual account plan, was there a blackout period	2014-09-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-09-30	$0
Were there any nonexempt tranactions with any party-in-interest	2014-09-30	No
Participant contributions at end of year	2014-09-30	$364,042
Participant contributions at beginning of year	2014-09-30	$214,329
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-09-30	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-09-30	$2,894
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-09-30	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-09-30	$356
Other income not declared elsewhere	2014-09-30	$4,545
Administrative expenses (other) incurred	2014-09-30	$310
Total non interest bearing cash at end of year	2014-09-30	$202,858
Total non interest bearing cash at beginning of year	2014-09-30	$4,498
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-09-30	No
Value of net income/loss	2014-09-30	$1,261,947
Value of net assets at end of year (total assets less liabilities)	2014-09-30	$9,082,661
Value of net assets at beginning of year (total assets less liabilities)	2014-09-30	$7,680,666
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-09-30	No
Were any leases to which the plan was party in default or uncollectible	2014-09-30	No
Investment advisory and management fees	2014-09-30	$4,785
Interest on participant loans	2014-09-30	$13,809
Value of interest in master investment trust accounts at end of year	2014-09-30	$8,312,737
Value of interest in master investment trust accounts at beginning of year	2014-09-30	$7,173,510
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-09-30	No
Was there a failure to transmit to the plan any participant contributions	2014-09-30	No
Has the plan failed to provide any benefit when due under the plan	2014-09-30	No
Contributions received in cash from employer	2014-09-30	$849,479
Employer contributions (assets) at end of year	2014-09-30	$203,024
Employer contributions (assets) at beginning of year	2014-09-30	$285,791
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-09-30	$435,111
Did the plan have assets held for investment	2014-09-30	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	2014-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-09-30	No
Opinion of an independent qualified public accountant for this plan	2014-09-30	Unqualified
Accountancy firm name	2014-09-30	MOSS ADAMS
Accountancy firm EIN	2014-09-30	910189318
2013 : ROGUE VALLEY MANOR RETIREMENT PLAN TRUST 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-09-30	$356
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-09-30	$2,172
Total income from all sources (including contributions)	2013-09-30	$1,732,867
Total loss/gain on sale of assets	2013-09-30	$0
Total of all expenses incurred	2013-09-30	$216,284
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-09-30	$211,813
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-09-30	$759,792
Value of total assets at end of year	2013-09-30	$7,681,022
Value of total assets at beginning of year	2013-09-30	$6,166,255
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-09-30	$4,471
Total interest from all sources	2013-09-30	$6,912
Total dividends received (eg from common stock, registered investment company shares)	2013-09-30	$157,123
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-09-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-09-30	$157,123
Administrative expenses professional fees incurred	2013-09-30	$322
Was this plan covered by a fidelity bond	2013-09-30	Yes
Value of fidelity bond cover	2013-09-30	$500,000
If this is an individual account plan, was there a blackout period	2013-09-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-09-30	$0
Were there any nonexempt tranactions with any party-in-interest	2013-09-30	No
Participant contributions at end of year	2013-09-30	$214,329
Participant contributions at beginning of year	2013-09-30	$120,797
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-09-30	$2,894
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-09-30	$19,066
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-09-30	$356
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-09-30	$2,172
Other income not declared elsewhere	2013-09-30	$5,111
Total non interest bearing cash at end of year	2013-09-30	$4,498
Total non interest bearing cash at beginning of year	2013-09-30	$4,912
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-09-30	No
Value of net income/loss	2013-09-30	$1,516,583
Value of net assets at end of year (total assets less liabilities)	2013-09-30	$7,680,666
Value of net assets at beginning of year (total assets less liabilities)	2013-09-30	$6,164,083
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-09-30	No
Were any leases to which the plan was party in default or uncollectible	2013-09-30	No
Investment advisory and management fees	2013-09-30	$4,149
Interest on participant loans	2013-09-30	$6,912
Value of interest in master investment trust accounts at end of year	2013-09-30	$7,173,510
Value of interest in master investment trust accounts at beginning of year	2013-09-30	$5,896,239
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-09-30	Yes
Was there a failure to transmit to the plan any participant contributions	2013-09-30	No
Has the plan failed to provide any benefit when due under the plan	2013-09-30	No
Contributions received in cash from employer	2013-09-30	$759,792
Employer contributions (assets) at end of year	2013-09-30	$285,791
Employer contributions (assets) at beginning of year	2013-09-30	$125,241
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-09-30	$211,813
Did the plan have assets held for investment	2013-09-30	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	2013-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-09-30	No
Opinion of an independent qualified public accountant for this plan	2013-09-30	Unqualified
Accountancy firm name	2013-09-30	MOSS ADAMS
Accountancy firm EIN	2013-09-30	910189318
2012 : ROGUE VALLEY MANOR RETIREMENT PLAN TRUST 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-09-30	$0
Total transfer of assets to this plan	2012-09-30	$43,997
Total transfer of assets from this plan	2012-09-30	$20,745
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-09-30	$2,172
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-09-30	$0
Total income from all sources (including contributions)	2012-09-30	$1,630,378
Total loss/gain on sale of assets	2012-09-30	$0
Total of all expenses incurred	2012-09-30	$496,894
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-09-30	$489,057
Expenses. Certain deemed distributions of participant loans	2012-09-30	$7,520
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-09-30	$730,554
Value of total assets at end of year	2012-09-30	$6,166,255
Value of total assets at beginning of year	2012-09-30	$5,007,347
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-09-30	$317
Total interest from all sources	2012-09-30	$7,254
Total dividends received (eg from common stock, registered investment company shares)	2012-09-30	$175,462
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-09-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-09-30	$175,462
Was this plan covered by a fidelity bond	2012-09-30	Yes
Value of fidelity bond cover	2012-09-30	$500,000
If this is an individual account plan, was there a blackout period	2012-09-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-09-30	$0
Were there any nonexempt tranactions with any party-in-interest	2012-09-30	No
Participant contributions at end of year	2012-09-30	$120,797
Participant contributions at beginning of year	2012-09-30	$152,610
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-09-30	$19,066
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-09-30	$1,981
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-09-30	$2,172
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-09-30	$0
Total non interest bearing cash at end of year	2012-09-30	$4,912
Total non interest bearing cash at beginning of year	2012-09-30	$1,208
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-09-30	No
Value of net income/loss	2012-09-30	$1,133,484
Value of net assets at end of year (total assets less liabilities)	2012-09-30	$6,164,083
Value of net assets at beginning of year (total assets less liabilities)	2012-09-30	$5,007,347
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-09-30	No
Were any leases to which the plan was party in default or uncollectible	2012-09-30	No
Investment advisory and management fees	2012-09-30	$317
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-09-30	$5,896,239
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-09-30	$4,446,572
Interest on participant loans	2012-09-30	$7,254
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-09-30	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-09-30	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-09-30	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-09-30	$717,108
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-09-30	Yes
Was there a failure to transmit to the plan any participant contributions	2012-09-30	No
Has the plan failed to provide any benefit when due under the plan	2012-09-30	No
Contributions received in cash from employer	2012-09-30	$730,554
Employer contributions (assets) at end of year	2012-09-30	$125,241
Employer contributions (assets) at beginning of year	2012-09-30	$404,976
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-09-30	$489,057
Did the plan have assets held for investment	2012-09-30	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	2012-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-09-30	No
Opinion of an independent qualified public accountant for this plan	2012-09-30	Unqualified
Accountancy firm name	2012-09-30	MOSS ADAMS
Accountancy firm EIN	2012-09-30	910189318
2011 : ROGUE VALLEY MANOR RETIREMENT PLAN TRUST 2011 401k financial data
Unrealized appreciation/depreciation of real estate assets	2011-09-30	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2011-09-30	$0
Total unrealized appreciation/depreciation of assets	2011-09-30	$0
Total transfer of assets to this plan	2011-09-30	$4,711,139
Total transfer of assets from this plan	2011-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-09-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-09-30	$0
Expenses. Interest paid	2011-09-30	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2011-09-30	$0
Total income from all sources (including contributions)	2011-09-30	$590,922
Total loss/gain on sale of assets	2011-09-30	$0
Total of all expenses incurred	2011-09-30	$294,714
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-09-30	$260,243
Expenses. Certain deemed distributions of participant loans	2011-09-30	$22,674
Value of total corrective distributions	2011-09-30	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-09-30	$681,302
Value of total assets at end of year	2011-09-30	$5,007,347
Value of total assets at beginning of year	2011-09-30	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-09-30	$11,797
Total income from rents	2011-09-30	$0
Total interest from all sources	2011-09-30	$7,894
Total dividends received (eg from common stock, registered investment company shares)	2011-09-30	$164,538
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-09-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-09-30	$164,538
Administrative expenses professional fees incurred	2011-09-30	$8,191
Was this plan covered by a fidelity bond	2011-09-30	Yes
Value of fidelity bond cover	2011-09-30	$500,000
If this is an individual account plan, was there a blackout period	2011-09-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-09-30	$0
Were there any nonexempt tranactions with any party-in-interest	2011-09-30	No
Contributions received from participants	2011-09-30	$0
Participant contributions at end of year	2011-09-30	$152,610
Participant contributions at beginning of year	2011-09-30	$0
Participant contributions at end of year	2011-09-30	$0
Participant contributions at beginning of year	2011-09-30	$0
Income. Received or receivable in cash from other sources (including rollovers)	2011-09-30	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2011-09-30	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-09-30	$1,981
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-09-30	$0
Other income not declared elsewhere	2011-09-30	$1,080
Administrative expenses (other) incurred	2011-09-30	$155
Total non interest bearing cash at end of year	2011-09-30	$1,208
Total non interest bearing cash at beginning of year	2011-09-30	$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	2011-09-30	No
Income. Non cash contributions	2011-09-30	$0
Value of net income/loss	2011-09-30	$296,208
Value of net assets at end of year (total assets less liabilities)	2011-09-30	$5,007,347
Value of net assets at beginning of year (total assets less liabilities)	2011-09-30	$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-09-30	No
Were any leases to which the plan was party in default or uncollectible	2011-09-30	No
Investment advisory and management fees	2011-09-30	$3,451
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-09-30	$4,446,572
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-09-30	$0
Interest on participant loans	2011-09-30	$7,894
Income. Interest from loans (other than to participants)	2011-09-30	$0
Interest earned on other investments	2011-09-30	$0
Income. Interest from US Government securities	2011-09-30	$0
Income. Interest from corporate debt instruments	2011-09-30	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-09-30	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-09-30	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-09-30	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-09-30	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2011-09-30	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-09-30	$-263,892
Net investment gain/loss from pooled separate accounts	2011-09-30	$0
Net investment gain or loss from common/collective trusts	2011-09-30	$0
Net gain/loss from 103.12 investment entities	2011-09-30	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-09-30	Yes
Was there a failure to transmit to the plan any participant contributions	2011-09-30	No
Has the plan failed to provide any benefit when due under the plan	2011-09-30	No
Contributions received in cash from employer	2011-09-30	$681,302
Employer contributions (assets) at end of year	2011-09-30	$404,976
Employer contributions (assets) at beginning of year	2011-09-30	$0
Income. Dividends from preferred stock	2011-09-30	$0
Income. Dividends from common stock	2011-09-30	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-09-30	$260,243
Contract administrator fees	2011-09-30	$0
Did the plan have assets held for investment	2011-09-30	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	2011-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-09-30	No
Aggregate proceeds on sale of assets	2011-09-30	$0
Aggregate carrying amount (costs) on sale of assets	2011-09-30	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-09-30	No
Opinion of an independent qualified public accountant for this plan	2011-09-30	Unqualified
Accountancy firm name	2011-09-30	MICHALE L. PIELS, CPA'S LLP
Accountancy firm EIN	2011-09-30	931226907

Form 5500 Responses for ROGUE VALLEY MANOR RETIREMENT PLAN TRUST

2014: ROGUE VALLEY MANOR RETIREMENT PLAN TRUST 2014 form 5500 responses
2014-10-01	Type of plan entity	Single employer plan
2014-10-01	Submission has been amended	No
2014-10-01	This submission is the final filing	Yes
2014-10-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2014-10-01	Plan is a collectively bargained plan	No
2014-10-01	Plan funding arrangement – Trust	Yes
2014-10-01	Plan benefit arrangement - Trust	Yes
2013: ROGUE VALLEY MANOR RETIREMENT PLAN TRUST 2013 form 5500 responses
2013-10-01	Type of plan entity	Single employer plan
2013-10-01	Submission has been amended	No
2013-10-01	This submission is the final filing	No
2013-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-10-01	Plan is a collectively bargained plan	No
2013-10-01	Plan funding arrangement – Trust	Yes
2013-10-01	Plan benefit arrangement - Trust	Yes
2012: ROGUE VALLEY MANOR RETIREMENT PLAN TRUST 2012 form 5500 responses
2012-10-01	Type of plan entity	Single employer plan
2012-10-01	Submission has been amended	No
2012-10-01	This submission is the final filing	No
2012-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-10-01	Plan is a collectively bargained plan	No
2012-10-01	Plan funding arrangement – Trust	Yes
2012-10-01	Plan benefit arrangement - Trust	Yes
2011: ROGUE VALLEY MANOR RETIREMENT PLAN TRUST 2011 form 5500 responses
2011-10-01	Type of plan entity	Single employer plan
2011-10-01	Submission has been amended	No
2011-10-01	This submission is the final filing	No
2011-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-10-01	Plan is a collectively bargained plan	No
2011-10-01	Plan funding arrangement – Trust	Yes
2011-10-01	Plan benefit arrangement - Trust	Yes
2010: ROGUE VALLEY MANOR RETIREMENT PLAN TRUST 2010 form 5500 responses
2010-10-01	Type of plan entity	Single employer plan
2010-10-01	First time form 5500 has been submitted	Yes
2010-10-01	Submission has been amended	No
2010-10-01	This submission is the final filing	No
2010-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-10-01	Plan is a collectively bargained plan	No
2010-10-01	Plan funding arrangement – Trust	Yes
2010-10-01	Plan benefit arrangement - Trust	Yes

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Company Name:	ROGUE VALLEY MANOR
Employer identification number (EIN):	930453216
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities

Jurisdiction of Incorporation:	Oregon Secretary of State Corporations Division
Incorporation Date:	2055-11-02
Company Identification Number:	5597810
Legal Registered Office Address:	1 W MAIN ST MEDFORD United States of America (USA) 97501

Plan id#	Filing Submission Date	Name of Administrator
001	2014-10-01
001	2013-10-01	BRIAN MCLEMORE
001	2012-10-01	BRIAN MCLEMORE
001	2011-10-01	BRIAN MCLEMORE
001	2010-10-01	BRIAN MCLEMORE