401k Plan data: PROVIDENCE MANAGEMENT, LLC 401(K) PLAN plan

PROVIDENCE MANAGEMENT, LLC 401(K) PLAN 401k Plan overview

Plan Name	PROVIDENCE MANAGEMENT, LLC 401(K) PLAN
Plan identification number	001

PROVIDENCE MANAGEMENT, LLC 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 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.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

PROVIDENCE MANAGEMENT, LLC has sponsored the creation of one or more 401k plans.

Company Name: PROVIDENCE MANAGEMENT, LLC

Employer identification number (EIN): 204306429

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PROVIDENCE MANAGEMENT, LLC 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 STEPHEN DOWNING 2023-10-16
001 2021-01-01 ALLISON GARNER 2022-10-17
001 2021-01-01 ALLISON GARNER 2023-05-04
001 2020-01-01 ANNALEE MOORE 2021-03-22
001 2019-01-01 ANNALEE MOORE 2020-09-17
001 2018-01-01 ANNALEE MOORE 2020-03-12
001 2018-01-01 ANNALEE MOORE 2019-10-02
001 2018-01-01 ANNALEE MOORE 2020-07-09
001 2017-04-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-01-01	STEPHEN DOWNING	2023-10-16
001	2021-01-01	ALLISON GARNER	2022-10-17
001	2021-01-01	ALLISON GARNER	2023-05-04
001	2020-01-01	ANNALEE MOORE	2021-03-22
001	2019-01-01	ANNALEE MOORE	2020-09-17
001	2018-01-01	ANNALEE MOORE	2020-03-12
001	2018-01-01	ANNALEE MOORE	2019-10-02
001	2018-01-01	ANNALEE MOORE	2020-07-09
001	2017-04-01

Plan Statistics for PROVIDENCE MANAGEMENT, LLC 401(K) PLAN

401k plan membership statisitcs for PROVIDENCE MANAGEMENT, LLC 401(K) PLAN

Measure Date Value
2022: PROVIDENCE MANAGEMENT, LLC 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 130
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 110
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 30
Total of all active and inactive participants 2022-01-01 140
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 140
Number of participants with account balances 2022-01-01 62
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 2
2021: PROVIDENCE MANAGEMENT, LLC 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 137
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 93
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 37
Total of all active and inactive participants 2021-01-01 130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 130
Number of participants with account balances 2021-01-01 72
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 3
2020: PROVIDENCE MANAGEMENT, LLC 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 124
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 117
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 20
Total of all active and inactive participants 2020-01-01 137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 137
Number of participants with account balances 2020-01-01 66
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 4
2019: PROVIDENCE MANAGEMENT, LLC 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 126
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 124
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 14
Total of all active and inactive participants 2019-01-01 138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 138
Number of participants with account balances 2019-01-01 51
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 3
2018: PROVIDENCE MANAGEMENT, LLC 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 129
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 124
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 2
Total of all active and inactive participants 2018-01-01 126
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 126
Number of participants with account balances 2018-01-01 41
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: PROVIDENCE MANAGEMENT, LLC 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-04-01 0
Total number of active participants reported on line 7a of the Form 5500 2017-04-01 123
Number of retired or separated participants receiving benefits 2017-04-01 0
Number of other retired or separated participants entitled to future benefits 2017-04-01 6
Total of all active and inactive participants 2017-04-01 129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-04-01 0
Total participants 2017-04-01 129
Number of participants with account balances 2017-04-01 39
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-04-01 4

Measure	Date	Value
2022: PROVIDENCE MANAGEMENT, LLC 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	130
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	110
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	30
Total of all active and inactive participants	2022-01-01	140
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	140
Number of participants with account balances	2022-01-01	62
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	2
2021: PROVIDENCE MANAGEMENT, LLC 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	137
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	93
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	37
Total of all active and inactive participants	2021-01-01	130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	130
Number of participants with account balances	2021-01-01	72
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	3
2020: PROVIDENCE MANAGEMENT, LLC 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	124
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	117
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	20
Total of all active and inactive participants	2020-01-01	137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	137
Number of participants with account balances	2020-01-01	66
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	4
2019: PROVIDENCE MANAGEMENT, LLC 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	126
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	124
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	14
Total of all active and inactive participants	2019-01-01	138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	138
Number of participants with account balances	2019-01-01	51
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	3
2018: PROVIDENCE MANAGEMENT, LLC 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	129
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	124
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	2
Total of all active and inactive participants	2018-01-01	126
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	126
Number of participants with account balances	2018-01-01	41
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: PROVIDENCE MANAGEMENT, LLC 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-04-01	0
Total number of active participants reported on line 7a of the Form 5500	2017-04-01	123
Number of retired or separated participants receiving benefits	2017-04-01	0
Number of other retired or separated participants entitled to future benefits	2017-04-01	6
Total of all active and inactive participants	2017-04-01	129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-04-01	0
Total participants	2017-04-01	129
Number of participants with account balances	2017-04-01	39
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-04-01	4

Financial Data on PROVIDENCE MANAGEMENT, LLC 401(K) PLAN

Measure	Date	Value
2022 : PROVIDENCE MANAGEMENT, LLC 401(K) 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	$0
Total income from all sources (including contributions)	2022-12-31	$-5,022
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$71,001
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$64,237
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$36,426
Value of total assets at end of year	2022-12-31	$155,879
Value of total assets at beginning of year	2022-12-31	$231,902
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$6,764
Total interest from all sources	2022-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Administrative expenses professional fees incurred	2022-12-31	$670
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
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	$31,005
Other income not declared elsewhere	2022-12-31	$18
Total non interest bearing cash at end of year	2022-12-31	$308
Total non interest bearing cash at beginning of year	2022-12-31	$308
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	$-76,023
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$155,879
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$231,902
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
Investment advisory and management fees	2022-12-31	$88
Value of interest in pooled separate accounts at end of year	2022-12-31	$154,916
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$231,594
Net investment gain/loss from pooled separate accounts	2022-12-31	$-41,466
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	Yes
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	$5,421
Employer contributions (assets) at end of year	2022-12-31	$655
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$64,237
Contract administrator fees	2022-12-31	$6,006
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	REYNOLDS, BONE & GRIESBECK, PLC
Accountancy firm EIN	2022-12-31	620428728
2021 : PROVIDENCE MANAGEMENT, LLC 401(K) 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	$0
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	$94,490
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$74,001
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$65,753
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$61,037
Value of total assets at end of year	2021-12-31	$231,902
Value of total assets at beginning of year	2021-12-31	$211,413
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$8,248
Total interest from all sources	2021-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Administrative expenses professional fees incurred	2021-12-31	$735
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$15,000
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	$60,399
Total non interest bearing cash at end of year	2021-12-31	$308
Total non interest bearing cash at beginning of year	2021-12-31	$214
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	$20,489
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$231,902
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$211,413
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
Investment advisory and management fees	2021-12-31	$115
Value of interest in pooled separate accounts at end of year	2021-12-31	$231,594
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$211,199
Net investment gain/loss from pooled separate accounts	2021-12-31	$33,453
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
Contributions received in cash from employer	2021-12-31	$638
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$65,753
Contract administrator fees	2021-12-31	$7,398
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	Disclaimer
Accountancy firm name	2021-12-31	REYNOLDS, BONE & GRIESBECK, PLC
Accountancy firm EIN	2021-12-31	620428728
2020 : PROVIDENCE MANAGEMENT, LLC 401(K) 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	$97,301
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$23,295
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$14,142
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$65,767
Value of total assets at end of year	2020-12-31	$211,413
Value of total assets at beginning of year	2020-12-31	$137,407
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$9,153
Total interest from all sources	2020-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Administrative expenses professional fees incurred	2020-12-31	$3,570
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$15,000
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	$57,526
Total non interest bearing cash at end of year	2020-12-31	$214
Total non interest bearing cash at beginning of year	2020-12-31	$11
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	$74,006
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$211,413
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$137,407
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
Investment advisory and management fees	2020-12-31	$80
Value of interest in pooled separate accounts at end of year	2020-12-31	$211,199
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$137,396
Net investment gain/loss from pooled separate accounts	2020-12-31	$31,534
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
Contributions received in cash from employer	2020-12-31	$8,241
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$14,142
Contract administrator fees	2020-12-31	$5,503
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	REYNOLDS, BONE AND GRIESBECK, PLC
Accountancy firm EIN	2020-12-31	620428728
2019 : PROVIDENCE MANAGEMENT, LLC 401(K) 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	$78,170
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$21,666
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$14,220
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$56,323
Value of total assets at end of year	2019-12-31	$137,407
Value of total assets at beginning of year	2019-12-31	$80,903
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$7,446
Total interest from all sources	2019-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Administrative expenses professional fees incurred	2019-12-31	$3,285
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$15,000
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
Contributions received from participants	2019-12-31	$49,921
Total non interest bearing cash at end of year	2019-12-31	$11
Total non interest bearing cash at beginning of year	2019-12-31	$11
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	$56,504
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$137,407
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$80,903
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	$55
Value of interest in pooled separate accounts at end of year	2019-12-31	$137,396
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$80,892
Net investment gain/loss from pooled separate accounts	2019-12-31	$21,847
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
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	$6,402
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$14,220
Contract administrator fees	2019-12-31	$4,106
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	REYNOLDS, BONE & GRIESBECK, PLC
Accountancy firm EIN	2019-12-31	620428728
2018 : PROVIDENCE MANAGEMENT, LLC 401(K) 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	$51,871
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$7,043
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$3,751
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$56,673
Value of total assets at end of year	2018-12-31	$80,903
Value of total assets at beginning of year	2018-12-31	$36,075
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$3,292
Total interest from all sources	2018-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Administrative expenses professional fees incurred	2018-12-31	$264
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$15,000
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	$46,768
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$2,886
Total non interest bearing cash at end of year	2018-12-31	$11
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	$44,828
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$80,903
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$36,075
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	$32
Value of interest in pooled separate accounts at end of year	2018-12-31	$80,892
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$36,075
Net investment gain/loss from pooled separate accounts	2018-12-31	$-4,802
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	$7,019
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$3,751
Contract administrator fees	2018-12-31	$2,996
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	SIMMONS AND ASSOCIATES, CPAS
Accountancy firm EIN	2018-12-31	200504812
2017 : PROVIDENCE MANAGEMENT, LLC 401(K) 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	$37,845
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$1,770
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$466
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$35,972
Value of total assets at end of year	2017-12-31	$36,075
Value of total assets at beginning of year	2017-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$1,304
Total interest from all sources	2017-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
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	No
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	$31,287
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	$36,075
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$36,075
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$0
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	$3
Value of interest in pooled separate accounts at end of year	2017-12-31	$36,075
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$0
Net investment gain/loss from pooled separate accounts	2017-12-31	$1,873
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	$4,685
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$466
Contract administrator fees	2017-12-31	$1,301
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	SIMMONS AND ASSOCIATES, CPAS
Accountancy firm EIN	2017-12-31	200504812

Form 5500 Responses for PROVIDENCE MANAGEMENT, LLC 401(K) PLAN

2022: PROVIDENCE MANAGEMENT, LLC 401(K) 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: PROVIDENCE MANAGEMENT, LLC 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: PROVIDENCE MANAGEMENT, LLC 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: PROVIDENCE MANAGEMENT, LLC 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: PROVIDENCE MANAGEMENT, LLC 401(K) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	Yes
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: PROVIDENCE MANAGEMENT, LLC 401(K) PLAN 2017 form 5500 responses
2017-04-01	Type of plan entity	Single employer plan
2017-04-01	First time form 5500 has been submitted	Yes
2017-04-01	Submission has been amended	No
2017-04-01	This submission is the final filing	No
2017-04-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2017-04-01	Plan is a collectively bargained plan	No
2017-04-01	Plan funding arrangement – Insurance	Yes
2017-04-01	Plan funding arrangement – Trust	Yes
2017-04-01	Plan benefit arrangement – Insurance	Yes
2017-04-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

129180

Policy instance

Insurance contract or identification number	129180
Number of Individuals Covered	83
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $912
Total amount of fees paid to insurance company	USD $91
Commission paid to Insurance Broker	USD $912
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKERAGE COMMISSION
Insurance broker organization code?	3

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

129180

Policy instance

Insurance contract or identification number	129180
Number of Individuals Covered	80
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,143
Total amount of fees paid to insurance company	USD $115
Commission paid to Insurance Broker	USD $1,143
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

129180

Policy instance

Insurance contract or identification number	129180
Number of Individuals Covered	97
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $777
Total amount of fees paid to insurance company	USD $78
Commission paid to Insurance Broker	USD $777
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

129180

Policy instance

Insurance contract or identification number	129180
Number of Individuals Covered	69
Insurance policy start date	2019-05-10
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $533
Total amount of fees paid to insurance company	USD $53
Commission paid to Insurance Broker	USD $533
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

129180

Policy instance

Insurance contract or identification number	129180
Insurance policy start date	2018-05-10
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $305
Total amount of fees paid to insurance company	USD $254
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	254
Additional information about fees paid to insurance broker	TPA COMPENSATION
Insurance broker organization code?	5

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

129180

Policy instance

Insurance contract or identification number	129180
Number of Individuals Covered	43
Insurance policy start date	2017-05-10
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $53
Total amount of fees paid to insurance company	USD $329
Commission paid to Insurance Broker	USD $53
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3
Insurance broker name	ELLIS BENEFITS GROUP, INC.

Potentially related plans

PROVIDENCE MANAGEMENT, INC. DEFINED BENEFIT PENSION PLAN [EIN = 223419023]

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Company Name:	PROVIDENCE MANAGEMENT, LLC
Employer identification number (EIN):	204306429
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities