401k Plan data: TAX DEFERRED ANNUITY PLAN plan

TAX DEFERRED ANNUITY PLAN 401k Plan overview

Plan Name	TAX DEFERRED ANNUITY PLAN
Plan identification number	002

TAX DEFERRED ANNUITY PLAN Benefits

401k Plan Type	Defined Contribution Pension
Plan Features/Benefits	Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.

401k Sponsoring company profile

GOOD SHEPHERD NURSING HOME has sponsored the creation of one or more 401k plans.

Company Name: GOOD SHEPHERD NURSING HOME

Employer identification number (EIN): 020437234

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TAX DEFERRED ANNUITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2012-01-01 DIANA WILSON
002 2011-01-01 DIANA WILSON
002 2009-01-01 DIANA WILSON

Plan id#	Filing Submission Date	Name of Administrator
002	2012-01-01	DIANA WILSON
002	2011-01-01	DIANA WILSON
002	2009-01-01	DIANA WILSON

Plan Statistics for TAX DEFERRED ANNUITY PLAN

401k plan membership statisitcs for TAX DEFERRED ANNUITY PLAN

Measure Date Value
2012: TAX DEFERRED ANNUITY PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 3
Total of all active and inactive participants 2012-01-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 4
Number of participants with account balances 2012-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: TAX DEFERRED ANNUITY PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 4
Total of all active and inactive participants 2011-01-01 5
Total participants 2011-01-01 5
Number of participants with account balances 2011-01-01 5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: TAX DEFERRED ANNUITY PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 5
Total of all active and inactive participants 2009-01-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 6
Number of participants with account balances 2009-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2012: TAX DEFERRED ANNUITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	3
Total of all active and inactive participants	2012-01-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	4
Number of participants with account balances	2012-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: TAX DEFERRED ANNUITY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	4
Total of all active and inactive participants	2011-01-01	5
Total participants	2011-01-01	5
Number of participants with account balances	2011-01-01	5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: TAX DEFERRED ANNUITY PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	5
Total of all active and inactive participants	2009-01-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	6
Number of participants with account balances	2009-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on TAX DEFERRED ANNUITY PLAN

Measure	Date	Value
2012 : TAX DEFERRED ANNUITY PLAN 2012 401k financial data
Total income from all sources (including contributions)	2012-12-31	$438
Total of all expenses incurred	2012-12-31	$957
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$0
Value of total assets at end of year	2012-12-31	$14,744
Value of total assets at beginning of year	2012-12-31	$15,263
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$957
Total interest from all sources	2012-12-31	$438
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$2,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$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	2012-12-31	No
Value of net income/loss	2012-12-31	$-519
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$14,744
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$15,263
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in pooled separate accounts at end of year	2012-12-31	$3,188
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$3,109
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$438
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$11,556
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$12,154
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$0
Contract administrator fees	2012-12-31	$957
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2012-12-31	No
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
2011 : TAX DEFERRED ANNUITY PLAN 2011 401k financial data
Total income from all sources (including contributions)	2011-12-31	$523
Total of all expenses incurred	2011-12-31	$1,185
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$0
Value of total assets at end of year	2011-12-31	$15,263
Value of total assets at beginning of year	2011-12-31	$15,925
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$1,185
Total interest from all sources	2011-12-31	$523
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$2,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$-662
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$15,263
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$15,925
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in pooled separate accounts at end of year	2011-12-31	$3,109
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$4,116
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$523
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$12,154
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$11,809
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$0
Contract administrator fees	2011-12-31	$1,185
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2011-12-31	No
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
2010 : TAX DEFERRED ANNUITY PLAN 2010 401k financial data
Total income from all sources (including contributions)	2010-12-31	$772
Total of all expenses incurred	2010-12-31	$60
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$0
Value of total assets at end of year	2010-12-31	$15,925
Value of total assets at beginning of year	2010-12-31	$15,213
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$60
Total interest from all sources	2010-12-31	$772
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$2,000,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$712
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$15,925
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$15,213
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in pooled separate accounts at end of year	2010-12-31	$4,116
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$3,739
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$772
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$11,809
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$11,474
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$0
Contract administrator fees	2010-12-31	$60
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2010-12-31	No
Did the plan have assets held for investment	2010-12-31	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	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No

Form 5500 Responses for TAX DEFERRED ANNUITY PLAN

2012: TAX DEFERRED ANNUITY PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: TAX DEFERRED ANNUITY PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: TAX DEFERRED ANNUITY PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

014647-J

Policy instance

Insurance contract or identification number	014647-J
Number of Individuals Covered	4
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

014647-J

Policy instance

Insurance contract or identification number	014647-J
Number of Individuals Covered	5
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

014647-J

Policy instance

Insurance contract or identification number	014647-J
Number of Individuals Covered	6
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

Was this data useful?

If you found the data here useful, PLEASE HELP US. We are a start-up and believe in making information freely available. By linking to us, posting on twitter, facebook and linkedin about us and generally spreading the word, you'll help us to grow. Our vision is to provide high quality data about the activities of all the companies in the world and where possible make it free to use and view. Finding and integrating data from thousands of data sources is time consuming and needs lots of effort. By simply spreading the word about us, you will help us. Please use the share buttons. It will only take a few seconds of your time. Thanks for helping

Information Disclaimer

The information provided on this website is not advice, endorsement or recommendation
The information published is supplied by third parties so we make no warranty on the accuracy, completeness etc. This information is provided "as-is". The information is subject to change as we obtain updates and corrections from the primary information sources.
You are free to use the information for your own personal research on the understanding to do so is at your own risk.

See full terms and conditions

Company Name:	GOOD SHEPHERD NURSING HOME
Employer identification number (EIN):	020437234
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities