401k Plan data: CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN plan

CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 401k Plan overview

Plan Name	CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN
Plan identification number	001

CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock 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.

401k Sponsoring company profile

ROCHESTER FRIENDLY HOME has sponsored the creation of one or more 401k plans.

Company Name: ROCHESTER FRIENDLY HOME

Employer identification number (EIN): 161597251

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01 CHRISTINE JOHNSON
001 2016-01-01 MICHAEL PERRY
001 2015-01-01 MICHAEL PERRY
001 2014-01-01 MICHAEL PERRY
001 2013-01-01 MICHAEL PERRY
001 2012-01-01 MICHAEL PERRY

Plan Statistics for CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN

401k plan membership statisitcs for CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN

Measure Date Value
2022: CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 228
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 181
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 91
Total of all active and inactive participants 2022-01-01 272
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 1
Total participants 2022-01-01 273
Number of participants with account balances 2022-01-01 254
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 45
2021: CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 185
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 158
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 76
Total of all active and inactive participants 2021-01-01 234
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 234
Number of participants with account balances 2021-01-01 228
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 58
2020: CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 197
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 146
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 39
Total of all active and inactive participants 2020-01-01 185
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 185
Number of participants with account balances 2020-01-01 157
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 23
2019: CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 191
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 188
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 9
Total of all active and inactive participants 2019-01-01 197
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 197
Number of participants with account balances 2019-01-01 101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 5
2018: CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 191
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 181
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 10
Total of all active and inactive participants 2018-01-01 191
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 191
Number of participants with account balances 2018-01-01 104
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 14
2017: CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 197
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 183
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 8
Total of all active and inactive participants 2017-01-01 191
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 191
Number of participants with account balances 2017-01-01 113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 5
2016: CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 196
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 195
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 2
Total of all active and inactive participants 2016-01-01 197
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 197
Number of participants with account balances 2016-01-01 72
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 197
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 193
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 3
Total of all active and inactive participants 2015-01-01 196
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 196
Number of participants with account balances 2015-01-01 76
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 291
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 194
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 3
Total of all active and inactive participants 2014-01-01 197
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 197
Number of participants with account balances 2014-01-01 16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 188
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 289
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 2
Total of all active and inactive participants 2013-01-01 291
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 291
Number of participants with account balances 2013-01-01 15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 162
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 188
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 0
Total of all active and inactive participants 2012-01-01 188
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 188
Number of participants with account balances 2012-01-01 15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0

Measure	Date	Value
2022: CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	228
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	181
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	91
Total of all active and inactive participants	2022-01-01	272
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	1
Total participants	2022-01-01	273
Number of participants with account balances	2022-01-01	254
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	45
2021: CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	185
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	158
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	76
Total of all active and inactive participants	2021-01-01	234
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	234
Number of participants with account balances	2021-01-01	228
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	58
2020: CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	197
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	146
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	39
Total of all active and inactive participants	2020-01-01	185
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	185
Number of participants with account balances	2020-01-01	157
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	23
2019: CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	191
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	188
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	9
Total of all active and inactive participants	2019-01-01	197
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	197
Number of participants with account balances	2019-01-01	101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	5
2018: CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	191
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	181
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	10
Total of all active and inactive participants	2018-01-01	191
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	191
Number of participants with account balances	2018-01-01	104
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	14
2017: CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	197
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	183
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	8
Total of all active and inactive participants	2017-01-01	191
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	191
Number of participants with account balances	2017-01-01	113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	5
2016: CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	196
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	195
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	2
Total of all active and inactive participants	2016-01-01	197
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	197
Number of participants with account balances	2016-01-01	72
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	197
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	193
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	3
Total of all active and inactive participants	2015-01-01	196
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	196
Number of participants with account balances	2015-01-01	76
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	291
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	194
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	3
Total of all active and inactive participants	2014-01-01	197
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	197
Number of participants with account balances	2014-01-01	16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	188
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	289
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	2
Total of all active and inactive participants	2013-01-01	291
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	291
Number of participants with account balances	2013-01-01	15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	162
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	188
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	0
Total of all active and inactive participants	2012-01-01	188
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	188
Number of participants with account balances	2012-01-01	15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0

Financial Data on CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN

Measure	Date	Value
2022 : CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$125
Total income from all sources (including contributions)	2022-12-31	$321,364
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$67,065
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$63,861
Expenses. Certain deemed distributions of participant loans	2022-12-31	$1,000
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$481,223
Value of total assets at end of year	2022-12-31	$1,826,358
Value of total assets at beginning of year	2022-12-31	$1,572,184
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$2,204
Total interest from all sources	2022-12-31	$502
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$30,543
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$30,543
Administrative expenses professional fees incurred	2022-12-31	$2,204
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$600,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$173,295
Participant contributions at end of year	2022-12-31	$19,262
Participant contributions at beginning of year	2022-12-31	$10,547
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$103,467
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2022-12-31	$125
Other income not declared elsewhere	2022-12-31	$2,077
Total non interest bearing cash at end of year	2022-12-31	$16,417
Total non interest bearing cash at beginning of year	2022-12-31	$14,415
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$254,299
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$1,826,358
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$1,572,059
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$1,585,580
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$1,372,368
Interest on participant loans	2022-12-31	$502
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-12-31	$21,654
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-12-31	$2,479
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-12-31	$2,479
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$183,445
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$172,375
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-192,981
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$204,461
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$63,861
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	BONADIO & CO., LLP
Accountancy firm EIN	2022-12-31	161131146
2021 : CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$125
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$361,731
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$153,241
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$148,111
Expenses. Certain deemed distributions of participant loans	2021-12-31	$3,200
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$351,237
Value of total assets at end of year	2021-12-31	$1,572,184
Value of total assets at beginning of year	2021-12-31	$1,363,569
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$1,930
Total interest from all sources	2021-12-31	$457
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$32,453
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$32,453
Administrative expenses professional fees incurred	2021-12-31	$1,930
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$600,000
If this is an individual account plan, was there a blackout period	2021-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$170,242
Participant contributions at end of year	2021-12-31	$10,547
Participant contributions at beginning of year	2021-12-31	$15,049
Participant contributions at beginning of year	2021-12-31	$12,032
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$2,088
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2021-12-31	$125
Other income not declared elsewhere	2021-12-31	$1,974
Total non interest bearing cash at end of year	2021-12-31	$14,415
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	$208,490
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$1,572,059
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$1,363,569
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 registered invesment companies (eg mutual funds) at end of year	2021-12-31	$1,372,368
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$1,003,783
Interest on participant loans	2021-12-31	$457
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2021-12-31	$2,479
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2021-12-31	$799
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2021-12-31	$799
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$172,375
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$195,627
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$-24,390
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$178,907
Employer contributions (assets) at beginning of year	2021-12-31	$136,279
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$148,111
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	2021-12-31	Yes
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	BONADIO & CO., LLP
Accountancy firm EIN	2021-12-31	161131146
2020 : CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$572,370
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$296,556
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$293,454
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$376,675
Value of total assets at end of year	2020-12-31	$1,363,569
Value of total assets at beginning of year	2020-12-31	$1,087,755
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$3,102
Total interest from all sources	2020-12-31	$491
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$4,536
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$4,536
Administrative expenses professional fees incurred	2020-12-31	$3,102
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$600,000
If this is an individual account plan, was there a blackout period	2020-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$190,815
Participant contributions at end of year	2020-12-31	$15,049
Participant contributions at end of year	2020-12-31	$12,032
Assets. Other investments not covered elsewhere at beginning of year	2020-12-31	$42,839
Other income not declared elsewhere	2020-12-31	$2,068
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	$275,814
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$1,363,569
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$1,087,755
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 registered invesment companies (eg mutual funds) at end of year	2020-12-31	$1,003,783
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$967,003
Interest on participant loans	2020-12-31	$491
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-12-31	$799
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$195,627
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$188,600
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$185,860
Employer contributions (assets) at end of year	2020-12-31	$136,279
Employer contributions (assets) at beginning of year	2020-12-31	$77,913
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$293,454
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	2020-12-31	Yes
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	BONADIO & CO., LLP
Accountancy firm EIN	2020-12-31	161131146
2019 : CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$423,281
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$130,620
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$126,218
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$273,782
Value of total assets at end of year	2019-12-31	$1,087,755
Value of total assets at beginning of year	2019-12-31	$795,094
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$4,402
Total interest from all sources	2019-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$39,066
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$39,066
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$600,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$154,962
Assets. Other investments not covered elsewhere at end of year	2019-12-31	$42,839
Assets. Other investments not covered elsewhere at beginning of year	2019-12-31	$39,749
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	$292,661
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$1,087,755
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$795,094
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Investment advisory and management fees	2019-12-31	$2,633
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$967,003
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$673,584
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$110,433
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	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$118,820
Employer contributions (assets) at end of year	2019-12-31	$77,913
Employer contributions (assets) at beginning of year	2019-12-31	$81,761
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$126,218
Contract administrator fees	2019-12-31	$1,769
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	BONADIO & CO., LLP
Accountancy firm EIN	2019-12-31	161131146
2018 : CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$280,382
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$337,244
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$333,106
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$315,798
Value of total assets at end of year	2018-12-31	$795,094
Value of total assets at beginning of year	2018-12-31	$851,956
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$4,138
Total interest from all sources	2018-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$43,712
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$43,712
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$600,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$190,962
Assets. Other investments not covered elsewhere at end of year	2018-12-31	$39,749
Assets. Other investments not covered elsewhere at beginning of year	2018-12-31	$19,832
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	$-56,862
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$795,094
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$851,956
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
Investment advisory and management fees	2018-12-31	$2,369
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$673,584
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$735,559
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-79,128
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	$124,836
Employer contributions (assets) at end of year	2018-12-31	$81,761
Employer contributions (assets) at beginning of year	2018-12-31	$96,565
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$333,106
Contract administrator fees	2018-12-31	$1,769
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	BONADIO & CO., LLP
Accountancy firm EIN	2018-12-31	161131146
2017 : CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$387,594
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$19,885
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$17,120
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$302,330
Value of total assets at end of year	2017-12-31	$851,956
Value of total assets at beginning of year	2017-12-31	$484,247
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$2,765
Total interest from all sources	2017-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$29,214
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$29,214
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$600,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$171,060
Participant contributions at end of year	2017-12-31	$0
Participant contributions at beginning of year	2017-12-31	$2,452
Assets. Other investments not covered elsewhere at end of year	2017-12-31	$19,832
Assets. Other investments not covered elsewhere at beginning of year	2017-12-31	$0
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	$73
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	$367,709
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$851,956
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$484,247
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
Investment advisory and management fees	2017-12-31	$1,842
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$735,559
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$377,536
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-12-31	$14,283
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-12-31	$14,283
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$56,050
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	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$131,270
Employer contributions (assets) at end of year	2017-12-31	$96,565
Employer contributions (assets) at beginning of year	2017-12-31	$89,903
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$17,120
Contract administrator fees	2017-12-31	$923
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	BONADIO & CO., LLP
Accountancy firm EIN	2017-12-31	161131146
2016 : CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$232,461
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$18,454
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$16,446
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$212,534
Value of total assets at end of year	2016-12-31	$484,247
Value of total assets at beginning of year	2016-12-31	$270,240
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$2,008
Total interest from all sources	2016-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$11,029
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$11,029
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$600,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$122,631
Participant contributions at end of year	2016-12-31	$2,452
Participant contributions at beginning of year	2016-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-12-31	$73
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-12-31	$0
Other income not declared elsewhere	2016-12-31	$73
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	$214,007
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$484,247
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$270,240
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
Investment advisory and management fees	2016-12-31	$688
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$377,536
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$265,593
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2016-12-31	$14,283
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-12-31	$4,647
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-12-31	$4,647
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$8,825
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
Contributions received in cash from employer	2016-12-31	$89,903
Employer contributions (assets) at end of year	2016-12-31	$89,903
Employer contributions (assets) at beginning of year	2016-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$16,446
Contract administrator fees	2016-12-31	$1,320
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	EFPR GROUP, CPAS, PLLC
Accountancy firm EIN	2016-12-31	474526160
2015 : CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$69,988
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$6,511
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$5,725
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$72,278
Value of total assets at end of year	2015-12-31	$270,240
Value of total assets at beginning of year	2015-12-31	$206,763
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$786
Total interest from all sources	2015-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$13,034
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$13,034
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$600,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$72,278
Participant contributions at end of year	2015-12-31	$0
Participant contributions at beginning of year	2015-12-31	$1,103
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	$63,477
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$270,240
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$206,763
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
Investment advisory and management fees	2015-12-31	$324
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$265,593
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$204,924
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$4,647
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$736
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$736
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-15,324
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$5,725
Contract administrator fees	2015-12-31	$462
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	EFPR GROUP, CPAS, PLLC
Accountancy firm EIN	2015-12-31	474526160
2014 : CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2014 401k financial data
Total income from all sources (including contributions)	2014-12-31	$42,809
Total of all expenses incurred	2014-12-31	$5,281
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$5,281
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$35,053
Value of total assets at end of year	2014-12-31	$206,763
Value of total assets at beginning of year	2014-12-31	$169,235
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$10,405
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$10,405
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$600,000
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	$35,053
Participant contributions at end of year	2014-12-31	$1,103
Total non interest bearing cash at beginning of year	2014-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$37,528
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$206,763
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$169,235
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	$204,924
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$169,235
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$736
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$-2,649
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$5,281
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	EFP ROTENBERG, LLP
Accountancy firm EIN	2014-12-31	264298079
2013 : CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2013 401k financial data
Total income from all sources (including contributions)	2013-12-31	$47,355
Total of all expenses incurred	2013-12-31	$12,865
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$12,837
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$29,332
Value of total assets at end of year	2013-12-31	$169,235
Value of total assets at beginning of year	2013-12-31	$134,745
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$28
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	$600,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
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	$29,332
Participant contributions at beginning of year	2013-12-31	$1,311
Total non interest bearing cash at end of year	2013-12-31	$0
Total non interest bearing cash at beginning of year	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	$34,490
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$169,235
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$134,745
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
Investment advisory and management fees	2013-12-31	$28
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$169,235
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$124,932
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$8,502
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$8,502
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$18,023
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	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$12,837
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	FREED MAXICK CPA'S PC
Accountancy firm EIN	2013-12-31	454051133
2012 : CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2012 401k financial data
Unrealized appreciation/depreciation of real estate assets	2012-12-31	$2,775
Total unrealized appreciation/depreciation of assets	2012-12-31	$2,775
Total income from all sources (including contributions)	2012-12-31	$134,745
Total loss/gain on sale of assets	2012-12-31	$169
Total of all expenses incurred	2012-12-31	$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$128,778
Value of total assets at end of year	2012-12-31	$134,745
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$3,023
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$3,023
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$600,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$31,766
Participant contributions at end of year	2012-12-31	$1,311
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$97,012
Total non interest bearing cash at end of year	2012-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$134,745
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$134,745
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$124,932
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$8,502
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$0
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
Aggregate proceeds on sale of assets	2012-12-31	$169
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	FREED MAXICK CPA'S PC
Accountancy firm EIN	2012-12-31	454051133

Form 5500 Responses for CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN

2022: CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: CLOVERWOOD SENIOR LIVING INC. 403(B) 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: CLOVERWOOD SENIOR LIVING INC. 403(B) 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: CLOVERWOOD SENIOR LIVING INC. 403(B) 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: CLOVERWOOD SENIOR LIVING INC. 403(B) 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: CLOVERWOOD SENIOR LIVING INC. 403(B) 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: CLOVERWOOD SENIOR LIVING INC. 403(B) 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 – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: CLOVERWOOD SENIOR LIVING INC. 403(B) 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 – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: CLOVERWOOD SENIOR LIVING INC. 403(B) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	First time form 5500 has been submitted	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )

Policy contract number

GA-63915

Policy instance

Insurance contract or identification number	GA-63915
Number of Individuals Covered	46
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )

Policy contract number

GA-63915

Policy instance

Insurance contract or identification number	GA-63915
Number of Individuals Covered	49
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )

Policy contract number

GA-63915

Policy instance

Insurance contract or identification number	GA-63915
Number of Individuals Covered	5
Insurance policy start date	2020-03-01
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
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	ROCHESTER FRIENDLY HOME
Employer identification number (EIN):	161597251
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities