401k Plan data: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN plan

WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 401k Plan overview

Plan Name	WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN
Plan identification number	001

WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
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.
Stock bonus
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
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

VJJ HOLDIG CO LLC has sponsored the creation of one or more 401k plans.

Company Name: VJJ HOLDIG CO LLC

Employer identification number (EIN): 113480393

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01 MELISSA MODICA 2022-10-12 MELISSA MODICA 2022-10-12
001 2020-01-01 MELISSA MODICA 2021-10-07
001 2019-01-01 KEN GAUL 2020-10-12
001 2018-01-01 KENNETH GAUL 2019-10-12
001 2017-01-01
001 2016-01-01
001 2015-01-01
001 2014-01-01 SHELDON BENSON SHELDON BENSON 2015-10-15
001 2013-01-01 KENNETH GAUL KENNETH GAUL 2014-10-27
001 2012-01-01 KENNETH GAUL KENNETH GAUL 2013-10-15
001 2011-01-01 JOSEPH ZWOLAK JOSEPH ZWOLAK 2012-10-15
001 2010-01-01 JOSEPH ZWOLAK JOSEPH ZWOLAK 2011-10-27
001 2009-01-01 JOSEPH ZWOLAK JOSEPH ZWOLAK 2010-10-12

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01
001	2021-01-01	MELISSA MODICA	2022-10-12	MELISSA MODICA	2022-10-12
001	2020-01-01	MELISSA MODICA	2021-10-07
001	2019-01-01	KEN GAUL	2020-10-12
001	2018-01-01	KENNETH GAUL	2019-10-12
001	2017-01-01
001	2016-01-01
001	2015-01-01
001	2014-01-01	SHELDON BENSON		SHELDON BENSON	2015-10-15
001	2013-01-01	KENNETH GAUL		KENNETH GAUL	2014-10-27
001	2012-01-01	KENNETH GAUL		KENNETH GAUL	2013-10-15
001	2011-01-01	JOSEPH ZWOLAK		JOSEPH ZWOLAK	2012-10-15
001	2010-01-01	JOSEPH ZWOLAK		JOSEPH ZWOLAK	2011-10-27
001	2009-01-01	JOSEPH ZWOLAK		JOSEPH ZWOLAK	2010-10-12

Plan Statistics for WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN

401k plan membership statisitcs for WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN

Measure Date Value
2021: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 113
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 33
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 26
Total of all active and inactive participants 2021-01-01 59
Total participants 2021-01-01 59
Number of participants with account balances 2021-01-01 33
2020: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 156
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 55
Number of other retired or separated participants entitled to future benefits 2020-01-01 61
Total of all active and inactive participants 2020-01-01 116
Total participants 2020-01-01 116
Number of participants with account balances 2020-01-01 76
2019: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 248
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 116
Number of other retired or separated participants entitled to future benefits 2019-01-01 27
Total of all active and inactive participants 2019-01-01 143
Total participants 2019-01-01 143
Number of participants with account balances 2019-01-01 82
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 254
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 119
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 123
Total of all active and inactive participants 2018-01-01 242
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 242
Number of participants with account balances 2018-01-01 184
2017: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 261
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 96
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 153
Total of all active and inactive participants 2017-01-01 249
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 249
Number of participants with account balances 2017-01-01 211
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 287
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 100
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 154
Total of all active and inactive participants 2016-01-01 254
Total participants 2016-01-01 254
Number of participants with account balances 2016-01-01 222
2015: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 263
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 121
Number of other retired or separated participants entitled to future benefits 2015-01-01 104
Total of all active and inactive participants 2015-01-01 225
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 1
Total participants 2015-01-01 226
Number of participants with account balances 2015-01-01 225
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 273
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 103
Number of retired or separated participants receiving benefits 2014-01-01 5
Number of other retired or separated participants entitled to future benefits 2014-01-01 163
Total of all active and inactive participants 2014-01-01 271
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 271
Number of participants with account balances 2014-01-01 254
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 1
2013: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 245
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 110
Number of other retired or separated participants entitled to future benefits 2013-01-01 144
Total of all active and inactive participants 2013-01-01 254
Total participants 2013-01-01 254
Number of participants with account balances 2013-01-01 232
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 258
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 142
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 88
Total of all active and inactive participants 2012-01-01 230
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 230
Number of participants with account balances 2012-01-01 230
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 255
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 146
Number of retired or separated participants receiving benefits 2011-01-01 102
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 248
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 248
Number of participants with account balances 2011-01-01 248
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 231
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 172
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 77
Total of all active and inactive participants 2010-01-01 249
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 249
Number of participants with account balances 2010-01-01 249
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 203
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 155
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 62
Total of all active and inactive participants 2009-01-01 217
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 217
Number of participants with account balances 2009-01-01 217
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2021: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	113
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	33
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	26
Total of all active and inactive participants	2021-01-01	59
Total participants	2021-01-01	59
Number of participants with account balances	2021-01-01	33
2020: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	156
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	55
Number of other retired or separated participants entitled to future benefits	2020-01-01	61
Total of all active and inactive participants	2020-01-01	116
Total participants	2020-01-01	116
Number of participants with account balances	2020-01-01	76
2019: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	248
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	116
Number of other retired or separated participants entitled to future benefits	2019-01-01	27
Total of all active and inactive participants	2019-01-01	143
Total participants	2019-01-01	143
Number of participants with account balances	2019-01-01	82
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	254
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	119
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	123
Total of all active and inactive participants	2018-01-01	242
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	242
Number of participants with account balances	2018-01-01	184
2017: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	261
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	96
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	153
Total of all active and inactive participants	2017-01-01	249
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	249
Number of participants with account balances	2017-01-01	211
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	287
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	100
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	154
Total of all active and inactive participants	2016-01-01	254
Total participants	2016-01-01	254
Number of participants with account balances	2016-01-01	222
2015: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	263
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	121
Number of other retired or separated participants entitled to future benefits	2015-01-01	104
Total of all active and inactive participants	2015-01-01	225
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	1
Total participants	2015-01-01	226
Number of participants with account balances	2015-01-01	225
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	273
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	103
Number of retired or separated participants receiving benefits	2014-01-01	5
Number of other retired or separated participants entitled to future benefits	2014-01-01	163
Total of all active and inactive participants	2014-01-01	271
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	271
Number of participants with account balances	2014-01-01	254
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	1
2013: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	245
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	110
Number of other retired or separated participants entitled to future benefits	2013-01-01	144
Total of all active and inactive participants	2013-01-01	254
Total participants	2013-01-01	254
Number of participants with account balances	2013-01-01	232
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	258
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	142
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	88
Total of all active and inactive participants	2012-01-01	230
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	230
Number of participants with account balances	2012-01-01	230
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	255
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	146
Number of retired or separated participants receiving benefits	2011-01-01	102
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	248
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	248
Number of participants with account balances	2011-01-01	248
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	231
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	172
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	77
Total of all active and inactive participants	2010-01-01	249
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	249
Number of participants with account balances	2010-01-01	249
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	203
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	155
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	62
Total of all active and inactive participants	2009-01-01	217
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	217
Number of participants with account balances	2009-01-01	217
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN

Measure	Date	Value
2021 : WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2021 401k financial data
Total transfer of assets from this plan	2021-12-31	$693,727
Total income from all sources (including contributions)	2021-12-31	$114,575
Total of all expenses incurred	2021-12-31	$145,908
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$141,100
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$11,282
Value of total assets at end of year	2021-12-31	$555,939
Value of total assets at beginning of year	2021-12-31	$1,280,999
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$4,808
Total interest from all sources	2021-12-31	$246
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$260,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$11,282
Participant contributions at end of year	2021-12-31	$0
Participant contributions at beginning of year	2021-12-31	$15,086
Participant contributions at end of year	2021-12-31	$234
Participant contributions at beginning of year	2021-12-31	$910
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2021-12-31	$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	2021-12-31	No
Value of net income/loss	2021-12-31	$-31,333
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$555,939
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$1,280,999
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in pooled separate accounts at end of year	2021-12-31	$548,088
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$948,695
Interest on participant loans	2021-12-31	$246
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$7,617
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$316,308
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$101,444
Net investment gain/loss from pooled separate accounts	2021-12-31	$1,603
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Employer contributions (assets) at beginning of year	2021-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$141,100
Contract administrator fees	2021-12-31	$4,808
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	HMM CPAS LLP
Accountancy firm EIN	2021-12-31	465416249
2020 : WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2020 401k financial data
Total income from all sources (including contributions)	2020-12-31	$182,792
Total of all expenses incurred	2020-12-31	$103,379
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$97,504
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$46,039
Value of total assets at end of year	2020-12-31	$1,280,999
Value of total assets at beginning of year	2020-12-31	$1,201,586
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$5,875
Total interest from all sources	2020-12-31	$1,049
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$260,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$46,039
Participant contributions at end of year	2020-12-31	$15,086
Participant contributions at beginning of year	2020-12-31	$24,832
Participant contributions at end of year	2020-12-31	$910
Participant contributions at beginning of year	2020-12-31	$3,971
Other income not declared elsewhere	2020-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$79,413
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$1,280,999
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$1,201,586
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in pooled separate accounts at end of year	2020-12-31	$948,695
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$871,930
Income. Interest from loans (other than to participants)	2020-12-31	$1,049
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$316,308
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$300,853
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$130,912
Net investment gain/loss from pooled separate accounts	2020-12-31	$4,792
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Employer contributions (assets) at end of year	2020-12-31	$0
Employer contributions (assets) at beginning of year	2020-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$97,504
Contract administrator fees	2020-12-31	$5,875
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	HMM CPAS LLP
Accountancy firm EIN	2020-12-31	465416249
2019 : WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2019 401k financial data
Total income from all sources (including contributions)	2019-12-31	$430,294
Total income from all sources (including contributions)	2019-12-31	$430,294
Total of all expenses incurred	2019-12-31	$1,779,576
Total of all expenses incurred	2019-12-31	$1,779,576
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$1,741,816
Value of total corrective distributions	2019-12-31	$24,483
Value of total corrective distributions	2019-12-31	$24,483
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$120,393
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$120,393
Value of total assets at end of year	2019-12-31	$1,201,586
Value of total assets at end of year	2019-12-31	$1,201,586
Value of total assets at beginning of year	2019-12-31	$2,550,868
Value of total assets at beginning of year	2019-12-31	$2,550,868
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$13,277
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$13,277
Total interest from all sources	2019-12-31	$1,072
Total interest from all sources	2019-12-31	$1,072
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$260,000
Value of fidelity bond cover	2019-12-31	$260,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$120,393
Contributions received from participants	2019-12-31	$120,393
Participant contributions at end of year	2019-12-31	$24,832
Participant contributions at end of year	2019-12-31	$24,832
Participant contributions at beginning of year	2019-12-31	$23,341
Participant contributions at beginning of year	2019-12-31	$23,341
Participant contributions at end of year	2019-12-31	$3,971
Participant contributions at end of year	2019-12-31	$3,971
Participant contributions at beginning of year	2019-12-31	$3,565
Participant contributions at beginning of year	2019-12-31	$3,565
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$-1,349,282
Value of net income/loss	2019-12-31	$-1,349,282
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$1,201,586
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$1,201,586
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$2,550,868
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$2,550,868
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in pooled separate accounts at end of year	2019-12-31	$871,930
Value of interest in pooled separate accounts at end of year	2019-12-31	$871,930
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$2,195,756
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$2,195,756
Interest on participant loans	2019-12-31	$1,072
Interest on participant loans	2019-12-31	$1,072
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$300,853
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$300,853
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$328,206
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$328,206
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$303,547
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$303,547
Net investment gain/loss from pooled separate accounts	2019-12-31	$5,282
Net investment gain/loss from pooled separate accounts	2019-12-31	$5,282
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2019-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$1,741,816
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$1,741,816
Contract administrator fees	2019-12-31	$13,277
Contract administrator fees	2019-12-31	$13,277
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	HMM CPAS LLP
Accountancy firm name	2019-12-31	HMM CPAS LLP
Accountancy firm EIN	2019-12-31	465416249
Accountancy firm EIN	2019-12-31	465416249
2018 : WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2018 401k financial data
Total income from all sources (including contributions)	2018-12-31	$39,773
Total of all expenses incurred	2018-12-31	$451,099
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$384,597
Value of total corrective distributions	2018-12-31	$46,680
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$170,237
Value of total assets at end of year	2018-12-31	$2,550,868
Value of total assets at beginning of year	2018-12-31	$2,962,194
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$19,822
Total interest from all sources	2018-12-31	$1,446
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$260,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$140,007
Participant contributions at end of year	2018-12-31	$23,341
Participant contributions at beginning of year	2018-12-31	$48,458
Participant contributions at end of year	2018-12-31	$3,565
Participant contributions at beginning of year	2018-12-31	$211
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$30,230
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2018-12-31	$0
Other income not declared elsewhere	2018-12-31	$79
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$-411,326
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$2,550,868
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$2,962,194
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$0
Value of interest in pooled separate accounts at end of year	2018-12-31	$2,195,756
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$2,373,613
Interest on participant loans	2018-12-31	$1,446
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$328,206
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$539,912
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-141,345
Net investment gain/loss from pooled separate accounts	2018-12-31	$9,356
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$0
Employer contributions (assets) at beginning of year	2018-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$384,597
Contract administrator fees	2018-12-31	$19,822
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	HMM CPAS LLP
Accountancy firm EIN	2018-12-31	465416249
2017 : WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2017 401k financial data
Total income from all sources (including contributions)	2017-12-31	$618,906
Total of all expenses incurred	2017-12-31	$363,028
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$307,812
Value of total corrective distributions	2017-12-31	$43,657
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$258,365
Value of total assets at end of year	2017-12-31	$2,962,194
Value of total assets at beginning of year	2017-12-31	$2,706,316
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$11,559
Total interest from all sources	2017-12-31	$1,831
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$260,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$134,650
Participant contributions at end of year	2017-12-31	$48,458
Participant contributions at beginning of year	2017-12-31	$66,756
Participant contributions at end of year	2017-12-31	$211
Participant contributions at beginning of year	2017-12-31	$211
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$123,715
Value of other receiveables (less allowance for doubtful accounts) at end of year	2017-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2017-12-31	$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	2017-12-31	No
Value of net income/loss	2017-12-31	$255,878
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$2,962,194
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$2,706,316
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$0
Value of interest in pooled separate accounts at end of year	2017-12-31	$2,373,613
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$2,073,270
Interest on participant loans	2017-12-31	$1,831
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$539,912
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$393,452
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$351,027
Net investment gain/loss from pooled separate accounts	2017-12-31	$7,683
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Employer contributions (assets) at end of year	2017-12-31	$0
Employer contributions (assets) at beginning of year	2017-12-31	$172,627
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$307,812
Contract administrator fees	2017-12-31	$11,559
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	HMM CPAS LLP
Accountancy firm EIN	2017-12-31	465416249
2016 : WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2016 401k financial data
Total income from all sources (including contributions)	2016-12-31	$550,823
Total of all expenses incurred	2016-12-31	$302,134
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$253,909
Value of total corrective distributions	2016-12-31	$39,248
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$404,430
Value of total assets at end of year	2016-12-31	$2,706,316
Value of total assets at beginning of year	2016-12-31	$2,457,627
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$8,977
Total interest from all sources	2016-12-31	$2,269
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$260,000
If this is an individual account plan, was there a blackout period	2016-12-31	Yes
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$152,750
Participant contributions at end of year	2016-12-31	$66,756
Participant contributions at beginning of year	2016-12-31	$58,575
Participant contributions at end of year	2016-12-31	$211
Participant contributions at beginning of year	2016-12-31	$211
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$251,680
Other income not declared elsewhere	2016-12-31	$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	2016-12-31	No
Value of net income/loss	2016-12-31	$248,689
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$2,706,316
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$2,457,627
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$2,073,270
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$2,037,514
Interest on participant loans	2016-12-31	$2,269
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$393,452
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$188,700
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$138,256
Net investment gain/loss from pooled separate accounts	2016-12-31	$5,868
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Employer contributions (assets) at end of year	2016-12-31	$172,627
Employer contributions (assets) at beginning of year	2016-12-31	$172,627
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$253,909
Contract administrator fees	2016-12-31	$8,977
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	2016-12-31	Yes
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	HMM CPAS LLP
Accountancy firm EIN	2016-12-31	465416249
2015 : WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2015 401k financial data
Total income from all sources (including contributions)	2015-12-31	$90,077
Total of all expenses incurred	2015-12-31	$282,590
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$280,315
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$241,914
Value of total assets at end of year	2015-12-31	$2,457,627
Value of total assets at beginning of year	2015-12-31	$2,650,140
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$2,275
Total interest from all sources	2015-12-31	$32,367
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$260,000
If this is an individual account plan, was there a blackout period	2015-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$155,267
Participant contributions at end of year	2015-12-31	$58,575
Participant contributions at beginning of year	2015-12-31	$41,744
Participant contributions at end of year	2015-12-31	$211
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$86,647
Other income not declared elsewhere	2015-12-31	$3,752
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-192,513
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$2,457,627
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$2,650,140
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$2,037,514
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$2,054,337
Interest on participant loans	2015-12-31	$1,225
Interest earned on other investments	2015-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$31,142
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$188,700
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$381,432
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-188,863
Net investment gain/loss from pooled separate accounts	2015-12-31	$907
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Employer contributions (assets) at end of year	2015-12-31	$172,627
Employer contributions (assets) at beginning of year	2015-12-31	$172,627
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$280,315
Contract administrator fees	2015-12-31	$2,275
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	2015-12-31	Yes
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	HMM CPAS LLP
Accountancy firm EIN	2015-12-31	465416249
2014 : WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2014 401k financial data
Total income from all sources (including contributions)	2014-12-31	$323,414
Total of all expenses incurred	2014-12-31	$466,563
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$450,748
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$140,572
Value of total assets at end of year	2014-12-31	$2,650,140
Value of total assets at beginning of year	2014-12-31	$2,793,289
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$15,815
Total interest from all sources	2014-12-31	$1,677
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$260,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$140,572
Participant contributions at end of year	2014-12-31	$41,744
Participant contributions at beginning of year	2014-12-31	$38,276
Participant contributions at beginning of year	2014-12-31	$3,538
Other income not declared elsewhere	2014-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-143,149
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$2,650,140
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$2,793,289
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$2,054,337
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$2,215,220
Interest on participant loans	2014-12-31	$1,677
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$381,432
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$363,628
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$176,554
Net investment gain/loss from pooled separate accounts	2014-12-31	$4,611
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Employer contributions (assets) at end of year	2014-12-31	$172,627
Employer contributions (assets) at beginning of year	2014-12-31	$172,627
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$450,748
Contract administrator fees	2014-12-31	$15,815
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	HMM, CPAS LLP
Accountancy firm EIN	2014-12-31	465416249
2013 : WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2013 401k financial data
Total income from all sources (including contributions)	2013-12-31	$606,053
Total of all expenses incurred	2013-12-31	$605,481
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$593,623
Expenses. Certain deemed distributions of participant loans	2013-12-31	$1,635
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$181,288
Value of total assets at end of year	2013-12-31	$2,793,289
Value of total assets at beginning of year	2013-12-31	$2,792,717
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$10,223
Total interest from all sources	2013-12-31	$2,049
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$260,000
If this is an individual account plan, was there a blackout period	2013-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$181,288
Participant contributions at end of year	2013-12-31	$38,276
Participant contributions at beginning of year	2013-12-31	$50,760
Participant contributions at end of year	2013-12-31	$3,538
Participant contributions at beginning of year	2013-12-31	$3,943
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$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	2013-12-31	No
Value of net income/loss	2013-12-31	$572
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$2,793,289
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$2,792,717
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$2,215,220
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$2,565,387
Value of interest in pooled separate accounts at end of year	2013-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$0
Interest on participant loans	2013-12-31	$2,049
Value of interest in master investment trust accounts at end of year	2013-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2013-12-31	$0
Value of interest in common/collective trusts at end of year	2013-12-31	$0
Value of interest in common/collective trusts at beginning of year	2013-12-31	$0
Assets. Value of investments in 103.12 investment entities at end of year	2013-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2013-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$363,628
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$421,491
Net investment gain/loss from pooled separate accounts	2013-12-31	$1,225
Net investment gain or loss from common/collective trusts	2013-12-31	$0
Net gain/loss from 103.12 investment entities	2013-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$0
Employer contributions (assets) at end of year	2013-12-31	$172,627
Employer contributions (assets) at beginning of year	2013-12-31	$172,627
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$593,623
Contract administrator fees	2013-12-31	$10,223
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	2013-12-31	Yes
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	HORAN, MARTELLO & MORRONE
Accountancy firm EIN	2013-12-31	112528271
2012 : WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2012 401k financial data
Total income from all sources (including contributions)	2012-12-31	$549,979
Total of all expenses incurred	2012-12-31	$258,338
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$239,851
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$356,199
Value of total assets at end of year	2012-12-31	$2,792,717
Value of total assets at beginning of year	2012-12-31	$2,501,076
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$18,487
Total interest from all sources	2012-12-31	$-3,864
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Administrative expenses professional fees incurred	2012-12-31	$17,637
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$260,000
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	$181,986
Participant contributions at end of year	2012-12-31	$50,760
Participant contributions at beginning of year	2012-12-31	$47,181
Participant contributions at end of year	2012-12-31	$3,943
Participant contributions at beginning of year	2012-12-31	$63,356
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$1,586
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	$291,641
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$2,792,717
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$2,501,076
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
Investment advisory and management fees	2012-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$2,565,387
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$2,211,894
Interest on participant loans	2012-12-31	$2,014
Income. Interest from loans (other than to participants)	2012-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$-5,878
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$197,644
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$172,627
Employer contributions (assets) at end of year	2012-12-31	$172,627
Employer contributions (assets) at beginning of year	2012-12-31	$178,645
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$239,851
Contract administrator fees	2012-12-31	$850
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	HORAN, MARTELLO & MORRONE
Accountancy firm EIN	2012-12-31	112528271
2011 : WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2011 401k financial data
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$297,082
Total of all expenses incurred	2011-12-31	$67,618
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$58,522
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$402,952
Value of total assets at end of year	2011-12-31	$2,501,076
Value of total assets at beginning of year	2011-12-31	$2,271,612
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$9,096
Total interest from all sources	2011-12-31	$-210
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$260,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$219,380
Participant contributions at end of year	2011-12-31	$47,181
Participant contributions at beginning of year	2011-12-31	$59,460
Participant contributions at end of year	2011-12-31	$63,356
Participant contributions at beginning of year	2011-12-31	$8,350
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$4,927
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	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	$229,464
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$2,501,076
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$2,271,612
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
Investment advisory and management fees	2011-12-31	$9,096
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$2,211,894
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$2,022,620
Interest on participant loans	2011-12-31	$2,442
Income. Interest from US Government securities	2011-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$-2,652
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-105,660
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$178,645
Employer contributions (assets) at end of year	2011-12-31	$178,645
Employer contributions (assets) at beginning of year	2011-12-31	$181,182
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$58,522
Contract administrator fees	2011-12-31	$0
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	HORAN, MARTELLO & MORRONE
Accountancy firm EIN	2011-12-31	112528271
2010 : WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$732,898
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$103,018
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$94,604
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$495,412
Value of total assets at end of year	2010-12-31	$2,271,612
Value of total assets at beginning of year	2010-12-31	$1,641,732
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$8,414
Total interest from all sources	2010-12-31	$7,097
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$260,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$212,249
Participant contributions at end of year	2010-12-31	$59,460
Participant contributions at beginning of year	2010-12-31	$34,848
Participant contributions at end of year	2010-12-31	$8,350
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$101,981
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
Income. Non cash contributions	2010-12-31	$0
Value of net income/loss	2010-12-31	$629,880
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$2,271,612
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$1,641,732
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 registered invesment companies (eg mutual funds) at end of year	2010-12-31	$2,022,620
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$1,438,139
Interest on participant loans	2010-12-31	$2,067
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$5,030
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$230,389
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$181,182
Employer contributions (assets) at end of year	2010-12-31	$181,182
Employer contributions (assets) at beginning of year	2010-12-31	$168,745
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$94,604
Contract administrator fees	2010-12-31	$8,414
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	HORAN, MARTELLO & MORRONE
Accountancy firm EIN	2010-12-31	112528271
2009 : WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN

2021: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	Yes
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: WOODHAVEN NURSING HOME EMPLOYEES 401(K) 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 – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: WOODHAVEN NURSING HOME EMPLOYEES 401(K) PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: WOODHAVEN NURSING HOME EMPLOYEES 401(K) 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 – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )

Policy contract number

691261

Policy instance

Insurance contract or identification number	691261
Number of Individuals Covered	35
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $834
Total amount of fees paid to insurance company	USD $0
Commission paid to Insurance Broker	USD $834
Insurance broker organization code?	3

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )

Policy contract number

691261

Policy instance

Insurance contract or identification number	691261
Number of Individuals Covered	74
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Insurance broker organization code?	3

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )

Policy contract number

691261

Policy instance

Insurance contract or identification number	691261
Number of Individuals Covered	80
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,437
Total amount of fees paid to insurance company	USD $0
Commission paid to Insurance Broker	USD $2,437
Insurance broker organization code?	3

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )

Policy contract number

691261

Policy instance

Insurance contract or identification number	691261
Number of Individuals Covered	186
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,768
Total amount of fees paid to insurance company	USD $0
Commission paid to Insurance Broker	USD $3,768
Insurance broker organization code?	3

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )

Policy contract number

691261

Policy instance

Insurance contract or identification number	691261
Number of Individuals Covered	214
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,310
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,310
Insurance broker organization code?	3
Insurance broker name	JAMES ALTEBRANDO

FIRST GREAT WEST LIFE INSURANCE & ANNUITY CO (National Association of Insurance Commissioners NAIC id number: 60214 )

Policy contract number

386551-01

Policy instance

Insurance contract or identification number	386551-01
Number of Individuals Covered	41
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $4,240
Total amount of fees paid to insurance company	USD $0
Commission paid to Insurance Broker	USD $4,240
Insurance broker organization code?	3
Insurance broker name	JAMES ALTEBRANDO

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )

Policy contract number

691261

Policy instance

Insurance contract or identification number	691261
Number of Individuals Covered	131
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $18,384
Total amount of fees paid to insurance company	USD $0
Commission paid to Insurance Broker	USD $18,384
Insurance broker organization code?	3
Insurance broker name	JAMES ALTEBRANDO

FIRST GREAT WEST LIFE INSURANCE & ANNUITY CO (National Association of Insurance Commissioners NAIC id number: 60214 )

Policy contract number

386551-01

Policy instance

Insurance contract or identification number	386551-01
Number of Individuals Covered	60
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $954
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
Commission paid to Insurance Broker	USD $567
Insurance broker organization code?	3
Insurance broker name	JAMES ALTEBRANDO

FIRST GREAT WEST LIFE INSURANCE & ANNUITY CO (National Association of Insurance Commissioners NAIC id number: 60214 )

Policy contract number

386551-01

Policy instance

Insurance contract or identification number	386551-01
Number of Individuals Covered	63
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $148
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
Commission paid to Insurance Broker	USD $148
Insurance broker organization code?	3
Insurance broker name	JOHN PETRAGLIA

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Company Name:	VJJ HOLDIG CO LLC
Employer identification number (EIN):	113480393
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities