401k Plan data: COASTLINE EMPLOYEES 403B PLAN plan

COASTLINE EMPLOYEES 403B PLAN 401k Plan overview

Plan Name	COASTLINE EMPLOYEES 403B PLAN
Plan identification number	004

COASTLINE EMPLOYEES 403B 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 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

COASTLINE ELDERLY SERVICES INC. has sponsored the creation of one or more 401k plans.

Company Name: COASTLINE ELDERLY SERVICES INC.

Employer identification number (EIN): 042622121

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COASTLINE EMPLOYEES 403B PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
004 2021-07-01
004 2020-07-01
004 2019-07-01
004 2018-07-01
004 2017-07-01
004 2016-07-01 JUSTIN LEES PAULA SHINER 2018-04-16
004 2016-07-01 PAULA SHINER 2017-12-06
004 2015-07-01 JUSTIN LEES 2017-01-18 PAULA SHINER 2017-02-23
004 2014-07-01 JUSTIN LEES 2016-04-06 PAULA SHINER 2016-04-06
004 2014-05-01 JUSTIN LEES 2015-04-15 PAULA SHINER 2015-04-15
004 2014-05-01 JUSTIN LEES 2015-04-14 PAULA SHINER 2015-04-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
004	2021-07-01
004	2020-07-01
004	2019-07-01
004	2018-07-01
004	2017-07-01
004	2016-07-01	JUSTIN LEES		PAULA SHINER	2018-04-16
004	2016-07-01			PAULA SHINER	2017-12-06
004	2015-07-01	JUSTIN LEES	2017-01-18	PAULA SHINER	2017-02-23
004	2014-07-01	JUSTIN LEES	2016-04-06	PAULA SHINER	2016-04-06
004	2014-05-01	JUSTIN LEES	2015-04-15	PAULA SHINER	2015-04-15
004	2014-05-01	JUSTIN LEES	2015-04-14	PAULA SHINER	2015-04-14

Plan Statistics for COASTLINE EMPLOYEES 403B PLAN

401k plan membership statisitcs for COASTLINE EMPLOYEES 403B PLAN

Measure Date Value
2021: COASTLINE EMPLOYEES 403B PLAN 2021 401k membership
Total participants, beginning-of-year 2021-07-01 174
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 166
Number of retired or separated participants receiving benefits 2021-07-01 2
Number of other retired or separated participants entitled to future benefits 2021-07-01 30
Total of all active and inactive participants 2021-07-01 198
Total participants 2021-07-01 198
Number of participants with account balances 2021-07-01 151
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-07-01 0
2020: COASTLINE EMPLOYEES 403B PLAN 2020 401k membership
Total participants, beginning-of-year 2020-07-01 171
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 146
Number of retired or separated participants receiving benefits 2020-07-01 0
Number of other retired or separated participants entitled to future benefits 2020-07-01 28
Total of all active and inactive participants 2020-07-01 174
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-07-01 0
Total participants 2020-07-01 174
Number of participants with account balances 2020-07-01 143
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-07-01 0
2019: COASTLINE EMPLOYEES 403B PLAN 2019 401k membership
Total participants, beginning-of-year 2019-07-01 147
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 152
Number of other retired or separated participants entitled to future benefits 2019-07-01 19
Total of all active and inactive participants 2019-07-01 171
Total participants 2019-07-01 171
Number of participants with account balances 2019-07-01 129
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-07-01 0
2018: COASTLINE EMPLOYEES 403B PLAN 2018 401k membership
Total participants, beginning-of-year 2018-07-01 167
Total number of active participants reported on line 7a of the Form 5500 2018-07-01 126
Number of other retired or separated participants entitled to future benefits 2018-07-01 21
Total of all active and inactive participants 2018-07-01 147
Total participants 2018-07-01 147
Number of participants with account balances 2018-07-01 125
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-07-01 0
2017: COASTLINE EMPLOYEES 403B PLAN 2017 401k membership
Total participants, beginning-of-year 2017-07-01 159
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 148
Number of retired or separated participants receiving benefits 2017-07-01 0
Number of other retired or separated participants entitled to future benefits 2017-07-01 19
Total of all active and inactive participants 2017-07-01 167
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-07-01 0
Total participants 2017-07-01 167
Number of participants with account balances 2017-07-01 117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-07-01 2
2016: COASTLINE EMPLOYEES 403B PLAN 2016 401k membership
Total participants, beginning-of-year 2016-07-01 142
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 122
Number of retired or separated participants receiving benefits 2016-07-01 0
Number of other retired or separated participants entitled to future benefits 2016-07-01 16
Total of all active and inactive participants 2016-07-01 138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-07-01 0
Total participants 2016-07-01 138
Number of participants with account balances 2016-07-01 125
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-07-01 0

Measure	Date	Value
2021: COASTLINE EMPLOYEES 403B PLAN 2021 401k membership
Total participants, beginning-of-year	2021-07-01	174
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	166
Number of retired or separated participants receiving benefits	2021-07-01	2
Number of other retired or separated participants entitled to future benefits	2021-07-01	30
Total of all active and inactive participants	2021-07-01	198
Total participants	2021-07-01	198
Number of participants with account balances	2021-07-01	151
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-07-01	0
2020: COASTLINE EMPLOYEES 403B PLAN 2020 401k membership
Total participants, beginning-of-year	2020-07-01	171
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	146
Number of retired or separated participants receiving benefits	2020-07-01	0
Number of other retired or separated participants entitled to future benefits	2020-07-01	28
Total of all active and inactive participants	2020-07-01	174
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-07-01	0
Total participants	2020-07-01	174
Number of participants with account balances	2020-07-01	143
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-07-01	0
2019: COASTLINE EMPLOYEES 403B PLAN 2019 401k membership
Total participants, beginning-of-year	2019-07-01	147
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	152
Number of other retired or separated participants entitled to future benefits	2019-07-01	19
Total of all active and inactive participants	2019-07-01	171
Total participants	2019-07-01	171
Number of participants with account balances	2019-07-01	129
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-07-01	0
2018: COASTLINE EMPLOYEES 403B PLAN 2018 401k membership
Total participants, beginning-of-year	2018-07-01	167
Total number of active participants reported on line 7a of the Form 5500	2018-07-01	126
Number of other retired or separated participants entitled to future benefits	2018-07-01	21
Total of all active and inactive participants	2018-07-01	147
Total participants	2018-07-01	147
Number of participants with account balances	2018-07-01	125
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-07-01	0
2017: COASTLINE EMPLOYEES 403B PLAN 2017 401k membership
Total participants, beginning-of-year	2017-07-01	159
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	148
Number of retired or separated participants receiving benefits	2017-07-01	0
Number of other retired or separated participants entitled to future benefits	2017-07-01	19
Total of all active and inactive participants	2017-07-01	167
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-07-01	0
Total participants	2017-07-01	167
Number of participants with account balances	2017-07-01	117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-07-01	2
2016: COASTLINE EMPLOYEES 403B PLAN 2016 401k membership
Total participants, beginning-of-year	2016-07-01	142
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	122
Number of retired or separated participants receiving benefits	2016-07-01	0
Number of other retired or separated participants entitled to future benefits	2016-07-01	16
Total of all active and inactive participants	2016-07-01	138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-07-01	0
Total participants	2016-07-01	138
Number of participants with account balances	2016-07-01	125
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-07-01	0

Financial Data on COASTLINE EMPLOYEES 403B PLAN

Measure	Date	Value
2022 : COASTLINE EMPLOYEES 403B PLAN 2022 401k financial data
Total transfer of assets to this plan	2022-06-30	$0
Total income from all sources (including contributions)	2022-06-30	$-158,675
Total of all expenses incurred	2022-06-30	$761,583
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-06-30	$725,838
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-06-30	$539,361
Value of total assets at end of year	2022-06-30	$4,287,944
Value of total assets at beginning of year	2022-06-30	$5,208,202
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-06-30	$35,745
Total interest from all sources	2022-06-30	$13,048
Total dividends received (eg from common stock, registered investment company shares)	2022-06-30	$324,064
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-06-30	$324,064
Was this plan covered by a fidelity bond	2022-06-30	Yes
Value of fidelity bond cover	2022-06-30	$500,000
If this is an individual account plan, was there a blackout period	2022-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2022-06-30	No
Contributions received from participants	2022-06-30	$241,652
Participant contributions at end of year	2022-06-30	$138,026
Participant contributions at beginning of year	2022-06-30	$122,018
Income. Received or receivable in cash from other sources (including rollovers)	2022-06-30	$20,912
Administrative expenses (other) incurred	2022-06-30	$35,745
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-06-30	No
Value of net income/loss	2022-06-30	$-920,258
Value of net assets at end of year (total assets less liabilities)	2022-06-30	$4,287,944
Value of net assets at beginning of year (total assets less liabilities)	2022-06-30	$5,208,202
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-06-30	No
Were any leases to which the plan was party in default or uncollectible	2022-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-06-30	$3,416,761
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-06-30	$4,298,688
Interest on participant loans	2022-06-30	$5,610
Interest earned on other investments	2022-06-30	$7,438
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-06-30	$670,132
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-06-30	$708,502
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-06-30	$-1,035,148
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-06-30	No
Was there a failure to transmit to the plan any participant contributions	2022-06-30	No
Has the plan failed to provide any benefit when due under the plan	2022-06-30	No
Contributions received in cash from employer	2022-06-30	$276,797
Employer contributions (assets) at end of year	2022-06-30	$63,025
Employer contributions (assets) at beginning of year	2022-06-30	$78,994
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-06-30	$725,838
Did the plan have assets held for investment	2022-06-30	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	2022-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-06-30	No
Opinion of an independent qualified public accountant for this plan	2022-06-30	Unqualified
Accountancy firm name	2022-06-30	DANIEL DENNIS & COMPANY, LLP
Accountancy firm EIN	2022-06-30	042734675
2021 : COASTLINE EMPLOYEES 403B PLAN 2021 401k financial data
Total income from all sources (including contributions)	2021-06-30	$1,660,568
Total of all expenses incurred	2021-06-30	$632,380
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-06-30	$615,815
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-06-30	$507,812
Value of total assets at end of year	2021-06-30	$5,208,202
Value of total assets at beginning of year	2021-06-30	$4,180,014
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-06-30	$16,565
Total interest from all sources	2021-06-30	$6,766
Total dividends received (eg from common stock, registered investment company shares)	2021-06-30	$177,695
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-06-30	$177,695
Was this plan covered by a fidelity bond	2021-06-30	Yes
Value of fidelity bond cover	2021-06-30	$400,000
If this is an individual account plan, was there a blackout period	2021-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2021-06-30	No
Contributions received from participants	2021-06-30	$232,649
Participant contributions at end of year	2021-06-30	$122,018
Participant contributions at beginning of year	2021-06-30	$152,641
Administrative expenses (other) incurred	2021-06-30	$16,565
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-06-30	No
Value of net income/loss	2021-06-30	$1,028,188
Value of net assets at end of year (total assets less liabilities)	2021-06-30	$5,208,202
Value of net assets at beginning of year (total assets less liabilities)	2021-06-30	$4,180,014
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-06-30	No
Were any leases to which the plan was party in default or uncollectible	2021-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-06-30	$4,298,688
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-06-30	$3,290,975
Interest on participant loans	2021-06-30	$6,766
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-06-30	$708,502
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-06-30	$662,060
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-06-30	$968,295
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-06-30	No
Was there a failure to transmit to the plan any participant contributions	2021-06-30	No
Has the plan failed to provide any benefit when due under the plan	2021-06-30	No
Contributions received in cash from employer	2021-06-30	$275,163
Employer contributions (assets) at end of year	2021-06-30	$78,994
Employer contributions (assets) at beginning of year	2021-06-30	$74,338
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-06-30	$615,815
Did the plan have assets held for investment	2021-06-30	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	2021-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-06-30	No
Opinion of an independent qualified public accountant for this plan	2021-06-30	Disclaimer
Accountancy firm name	2021-06-30	DANIEL DENNIS & COMPANY, LLP
Accountancy firm EIN	2021-06-30	042734675
2020 : COASTLINE EMPLOYEES 403B PLAN 2020 401k financial data
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-06-30	$257
Total income from all sources (including contributions)	2020-06-30	$642,086
Total of all expenses incurred	2020-06-30	$227,468
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-06-30	$211,744
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-06-30	$464,467
Value of total assets at end of year	2020-06-30	$4,180,014
Value of total assets at beginning of year	2020-06-30	$3,765,653
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-06-30	$15,724
Total interest from all sources	2020-06-30	$7,107
Total dividends received (eg from common stock, registered investment company shares)	2020-06-30	$143,170
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-06-30	$143,170
Was this plan covered by a fidelity bond	2020-06-30	Yes
Value of fidelity bond cover	2020-06-30	$400,000
If this is an individual account plan, was there a blackout period	2020-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2020-06-30	No
Contributions received from participants	2020-06-30	$222,195
Participant contributions at end of year	2020-06-30	$152,641
Participant contributions at beginning of year	2020-06-30	$133,822
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-06-30	$257
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-06-30	No
Value of net income/loss	2020-06-30	$414,618
Value of net assets at end of year (total assets less liabilities)	2020-06-30	$4,180,014
Value of net assets at beginning of year (total assets less liabilities)	2020-06-30	$3,765,396
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-06-30	No
Were any leases to which the plan was party in default or uncollectible	2020-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-06-30	$3,290,975
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-06-30	$2,975,343
Interest on participant loans	2020-06-30	$7,107
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-06-30	$662,060
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-06-30	$590,577
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-06-30	$27,342
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-06-30	No
Was there a failure to transmit to the plan any participant contributions	2020-06-30	No
Has the plan failed to provide any benefit when due under the plan	2020-06-30	No
Contributions received in cash from employer	2020-06-30	$242,272
Employer contributions (assets) at end of year	2020-06-30	$74,338
Employer contributions (assets) at beginning of year	2020-06-30	$65,911
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-06-30	$211,744
Contract administrator fees	2020-06-30	$15,724
Did the plan have assets held for investment	2020-06-30	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	2020-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2020-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2020-06-30	Disclaimer
Accountancy firm name	2020-06-30	DANIEL DENNIS & COMPANY LLP
Accountancy firm EIN	2020-06-30	042734675
2019 : COASTLINE EMPLOYEES 403B PLAN 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-06-30	$257
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-06-30	$257
Total income from all sources (including contributions)	2019-06-30	$873,108
Total of all expenses incurred	2019-06-30	$220,502
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-06-30	$205,460
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-06-30	$678,380
Value of total assets at end of year	2019-06-30	$3,765,653
Value of total assets at beginning of year	2019-06-30	$3,113,047
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-06-30	$15,042
Total interest from all sources	2019-06-30	$5,818
Total dividends received (eg from common stock, registered investment company shares)	2019-06-30	$151,873
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-06-30	$151,873
Was this plan covered by a fidelity bond	2019-06-30	Yes
Value of fidelity bond cover	2019-06-30	$400,000
If this is an individual account plan, was there a blackout period	2019-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2019-06-30	No
Contributions received from participants	2019-06-30	$209,360
Participant contributions at end of year	2019-06-30	$133,822
Participant contributions at beginning of year	2019-06-30	$73,062
Income. Received or receivable in cash from other sources (including rollovers)	2019-06-30	$246,667
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-06-30	$257
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-06-30	$257
Other income not declared elsewhere	2019-06-30	$504
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-06-30	No
Value of net income/loss	2019-06-30	$652,606
Value of net assets at end of year (total assets less liabilities)	2019-06-30	$3,765,396
Value of net assets at beginning of year (total assets less liabilities)	2019-06-30	$3,112,790
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-06-30	No
Were any leases to which the plan was party in default or uncollectible	2019-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-06-30	$2,975,343
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-06-30	$2,413,612
Interest on participant loans	2019-06-30	$5,818
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-06-30	$590,577
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-06-30	$571,248
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-06-30	$36,533
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-06-30	No
Was there a failure to transmit to the plan any participant contributions	2019-06-30	No
Has the plan failed to provide any benefit when due under the plan	2019-06-30	No
Contributions received in cash from employer	2019-06-30	$222,353
Employer contributions (assets) at end of year	2019-06-30	$65,911
Employer contributions (assets) at beginning of year	2019-06-30	$55,125
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-06-30	$205,460
Contract administrator fees	2019-06-30	$15,042
Did the plan have assets held for investment	2019-06-30	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	2019-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2019-06-30	Disclaimer
Accountancy firm name	2019-06-30	DANIEL DENNIS & COMPANY LLP
Accountancy firm EIN	2019-06-30	042734675
2018 : COASTLINE EMPLOYEES 403B PLAN 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-06-30	$257
Total income from all sources (including contributions)	2018-06-30	$694,343
Total of all expenses incurred	2018-06-30	$420,899
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-06-30	$416,526
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-06-30	$481,048
Value of total assets at end of year	2018-06-30	$3,113,047
Value of total assets at beginning of year	2018-06-30	$2,839,346
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-06-30	$4,373
Total interest from all sources	2018-06-30	$2,720
Total dividends received (eg from common stock, registered investment company shares)	2018-06-30	$12,041
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-06-30	$12,041
Administrative expenses professional fees incurred	2018-06-30	$4,373
Was this plan covered by a fidelity bond	2018-06-30	Yes
Value of fidelity bond cover	2018-06-30	$320,000
If this is an individual account plan, was there a blackout period	2018-06-30	Yes
Were there any nonexempt tranactions with any party-in-interest	2018-06-30	No
Contributions received from participants	2018-06-30	$192,927
Participant contributions at end of year	2018-06-30	$73,062
Participant contributions at beginning of year	2018-06-30	$67,194
Income. Received or receivable in cash from other sources (including rollovers)	2018-06-30	$87,739
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2018-06-30	$257
Other income not declared elsewhere	2018-06-30	$1,253
Total non interest bearing cash at beginning of year	2018-06-30	$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	2018-06-30	No
Value of net income/loss	2018-06-30	$273,444
Value of net assets at end of year (total assets less liabilities)	2018-06-30	$3,112,790
Value of net assets at beginning of year (total assets less liabilities)	2018-06-30	$2,839,346
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-06-30	No
Were any leases to which the plan was party in default or uncollectible	2018-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-06-30	$2,413,612
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-06-30	$1,993,774
Interest on participant loans	2018-06-30	$2,720
Interest earned on other investments	2018-06-30	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-06-30	$571,248
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-06-30	$719,317
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-06-30	$197,281
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-06-30	No
Was there a failure to transmit to the plan any participant contributions	2018-06-30	No
Has the plan failed to provide any benefit when due under the plan	2018-06-30	No
Contributions received in cash from employer	2018-06-30	$200,382
Employer contributions (assets) at end of year	2018-06-30	$55,125
Employer contributions (assets) at beginning of year	2018-06-30	$59,061
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-06-30	$416,526
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	2018-06-30	Yes
Did the plan have assets held for investment	2018-06-30	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	2018-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2018-06-30	Disclaimer
Accountancy firm name	2018-06-30	DANIEL DENNIS & COMPANY LLP
Accountancy firm EIN	2018-06-30	042734675
2017 : COASTLINE EMPLOYEES 403B PLAN 2017 401k financial data
Unrealized appreciation/depreciation of real estate assets	2017-06-30	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2017-06-30	$0
Total unrealized appreciation/depreciation of assets	2017-06-30	$0
Total transfer of assets to this plan	2017-06-30	$0
Total transfer of assets from this plan	2017-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-06-30	$0
Expenses. Interest paid	2017-06-30	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2017-06-30	$0
Total income from all sources (including contributions)	2017-06-30	$674,527
Total loss/gain on sale of assets	2017-06-30	$0
Total of all expenses incurred	2017-06-30	$198,467
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-06-30	$197,667
Expenses. Certain deemed distributions of participant loans	2017-06-30	$0
Value of total corrective distributions	2017-06-30	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-06-30	$426,727
Value of total assets at end of year	2017-06-30	$2,839,346
Value of total assets at beginning of year	2017-06-30	$2,363,286
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-06-30	$800
Total income from rents	2017-06-30	$0
Total interest from all sources	2017-06-30	$10,051
Total dividends received (eg from common stock, registered investment company shares)	2017-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-06-30	$0
Assets. Real estate other than employer real property at end of year	2017-06-30	$0
Assets. Real estate other than employer real property at beginning of year	2017-06-30	$0
Administrative expenses professional fees incurred	2017-06-30	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2017-06-30	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2017-06-30	$0
Was this plan covered by a fidelity bond	2017-06-30	Yes
Value of fidelity bond cover	2017-06-30	$300,000
If this is an individual account plan, was there a blackout period	2017-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2017-06-30	No
Contributions received from participants	2017-06-30	$154,268
Participant contributions at end of year	2017-06-30	$67,194
Participant contributions at beginning of year	2017-06-30	$50,823
Participant contributions at end of year	2017-06-30	$0
Participant contributions at beginning of year	2017-06-30	$5,174
Assets. Other investments not covered elsewhere at end of year	2017-06-30	$0
Assets. Other investments not covered elsewhere at beginning of year	2017-06-30	$0
Income. Received or receivable in cash from other sources (including rollovers)	2017-06-30	$75,250
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2017-06-30	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2017-06-30	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2017-06-30	$0
Assets. Loans (other than to participants) at end of year	2017-06-30	$0
Assets. Loans (other than to participants) at beginning of year	2017-06-30	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2017-06-30	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2017-06-30	$0
Other income not declared elsewhere	2017-06-30	$0
Administrative expenses (other) incurred	2017-06-30	$0
Liabilities. Value of operating payables at end of year	2017-06-30	$0
Liabilities. Value of operating payables at beginning of year	2017-06-30	$0
Total non interest bearing cash at end of year	2017-06-30	$0
Total non interest bearing cash at beginning of year	2017-06-30	$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	2017-06-30	No
Income. Non cash contributions	2017-06-30	$0
Value of net income/loss	2017-06-30	$476,060
Value of net assets at end of year (total assets less liabilities)	2017-06-30	$2,839,346
Value of net assets at beginning of year (total assets less liabilities)	2017-06-30	$2,363,286
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-06-30	No
Were any leases to which the plan was party in default or uncollectible	2017-06-30	No
Assets. partnership/joint venture interests at end of year	2017-06-30	$0
Assets. partnership/joint venture interests at beginning of year	2017-06-30	$0
Investment advisory and management fees	2017-06-30	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-06-30	$1,993,774
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-06-30	$1,513,496
Value of interest in pooled separate accounts at end of year	2017-06-30	$0
Value of interest in pooled separate accounts at beginning of year	2017-06-30	$0
Interest on participant loans	2017-06-30	$2,430
Income. Interest from loans (other than to participants)	2017-06-30	$0
Interest earned on other investments	2017-06-30	$7,621
Income. Interest from US Government securities	2017-06-30	$0
Income. Interest from corporate debt instruments	2017-06-30	$0
Value of interest in master investment trust accounts at end of year	2017-06-30	$0
Value of interest in master investment trust accounts at beginning of year	2017-06-30	$0
Value of interest in common/collective trusts at end of year	2017-06-30	$0
Value of interest in common/collective trusts at beginning of year	2017-06-30	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-06-30	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-06-30	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-06-30	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-06-30	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-06-30	$719,317
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-06-30	$733,878
Expenses. Payments to insurance carriers foe the provision of benefits	2017-06-30	$0
Asset value of US Government securities at end of year	2017-06-30	$0
Asset value of US Government securities at beginning of year	2017-06-30	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-06-30	$237,749
Net investment gain/loss from pooled separate accounts	2017-06-30	$0
Net investment gain or loss from common/collective trusts	2017-06-30	$0
Net gain/loss from 103.12 investment entities	2017-06-30	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-06-30	No
Was there a failure to transmit to the plan any participant contributions	2017-06-30	No
Has the plan failed to provide any benefit when due under the plan	2017-06-30	No
Assets. Invements in employer securities at end of year	2017-06-30	$0
Assets. Invements in employer securities at beginning of year	2017-06-30	$0
Assets. Value of employer real property at end of year	2017-06-30	$0
Assets. Value of employer real property at beginning of year	2017-06-30	$0
Contributions received in cash from employer	2017-06-30	$197,209
Employer contributions (assets) at end of year	2017-06-30	$59,061
Employer contributions (assets) at beginning of year	2017-06-30	$59,915
Income. Dividends from preferred stock	2017-06-30	$0
Income. Dividends from common stock	2017-06-30	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-06-30	$197,667
Asset. Corporate debt instrument preferred debt at end of year	2017-06-30	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2017-06-30	$0
Asset. Corporate debt instrument debt (other) at end of year	2017-06-30	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2017-06-30	$0
Contract administrator fees	2017-06-30	$800
Assets. Corporate common stocks other than exployer securities at end of year	2017-06-30	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2017-06-30	$0
Liabilities. Value of benefit claims payable at end of year	2017-06-30	$0
Liabilities. Value of benefit claims payable at beginning of year	2017-06-30	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2017-06-30	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2017-06-30	$0
Did the plan have assets held for investment	2017-06-30	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	2017-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-06-30	No
Aggregate proceeds on sale of assets	2017-06-30	$0
Aggregate carrying amount (costs) on sale of assets	2017-06-30	$0
Liabilities. Value of acquisition indebtedness at end of year	2017-06-30	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2017-06-30	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2017-06-30	Disclaimer
Accountancy firm name	2017-06-30	DANIEL DENNIS & COMPANY LLP
Accountancy firm EIN	2017-06-30	042734675

Form 5500 Responses for COASTLINE EMPLOYEES 403B PLAN

2021: COASTLINE EMPLOYEES 403B PLAN 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan funding arrangement – Trust	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement - Trust	Yes
2020: COASTLINE EMPLOYEES 403B PLAN 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan funding arrangement – Trust	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement - Trust	Yes
2019: COASTLINE EMPLOYEES 403B PLAN 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan funding arrangement – Trust	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement - Trust	Yes
2018: COASTLINE EMPLOYEES 403B PLAN 2018 form 5500 responses
2018-07-01	Type of plan entity	Single employer plan
2018-07-01	Plan funding arrangement – Insurance	Yes
2018-07-01	Plan funding arrangement – Trust	Yes
2018-07-01	Plan benefit arrangement – Insurance	Yes
2018-07-01	Plan benefit arrangement - Trust	Yes
2017: COASTLINE EMPLOYEES 403B PLAN 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	Submission has been amended	No
2017-07-01	This submission is the final filing	No
2017-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-07-01	Plan is a collectively bargained plan	No
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan funding arrangement – Trust	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement - Trust	Yes
2016: COASTLINE EMPLOYEES 403B PLAN 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Submission has been amended	Yes
2016-07-01	This submission is the final filing	No
2016-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-07-01	Plan is a collectively bargained plan	No
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

503403-01

Policy instance

Insurance contract or identification number	503403-01
Number of Individuals Covered	44
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes

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

Policy contract number

503403-01

Policy instance

Insurance contract or identification number	503403-01
Number of Individuals Covered	45
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes

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

Policy contract number

503403-01

Policy instance

Insurance contract or identification number	503403-01
Number of Individuals Covered	47
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes

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

Policy contract number

503403-01

Policy instance

Insurance contract or identification number	503403-01
Number of Individuals Covered	49
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Are there contracts with allocated funds for group deferred annuity?	Yes

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

Policy contract number

G76244

Policy instance

Insurance contract or identification number	G76244
Number of Individuals Covered	0
Insurance policy start date	2017-07-01
Insurance policy end date	2018-01-16
Total amount of commissions paid to insurance broker	USD $5,653
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

503403-01

Policy instance

Insurance contract or identification number	503403-01
Number of Individuals Covered	50
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	COASTLINE ELDERLY SERVICES INC.
Employer identification number (EIN):	042622121
NAIC Classification:	624100
NAIC Description:	Individual and Family Services