401k Plan data: MORAVIAN HALL SQUARE RETIREMENT COMMUNITY ANNUITY PROGRAM plan

MORAVIAN HALL SQUARE RETIREMENT COMMUNITY ANNUITY PROGRAM 401k Plan overview

Plan Name	MORAVIAN HALL SQUARE RETIREMENT COMMUNITY ANNUITY PROGRAM
Plan identification number	001

MORAVIAN HALL SQUARE RETIREMENT COMMUNITY ANNUITY PROGRAM 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)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
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.

401k Sponsoring company profile

MORNINGSTAR SENIOR LIVING, INC. has sponsored the creation of one or more 401k plans.

Company Name: MORNINGSTAR SENIOR LIVING, INC.

Employer identification number (EIN): 222717623

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MORAVIAN HALL SQUARE RETIREMENT COMMUNITY ANNUITY PROGRAM

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2012-01-01 CHRISTOPHER HUNT 2013-01-04
001 2011-01-01 CHRISTOPHER HUNT
001 2010-01-01 CHRISTOPHER HUNT
001 2009-01-01 CHRISTOPHER HUNT

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2012-01-01	CHRISTOPHER HUNT	2013-01-04
001	2011-01-01	CHRISTOPHER HUNT
001	2010-01-01	CHRISTOPHER HUNT
001	2009-01-01	CHRISTOPHER HUNT

Plan Statistics for MORAVIAN HALL SQUARE RETIREMENT COMMUNITY ANNUITY PROGRAM

401k plan membership statisitcs for MORAVIAN HALL SQUARE RETIREMENT COMMUNITY ANNUITY PROGRAM

Measure Date Value
2011: MORAVIAN HALL SQUARE RETIREMENT COMMUNITY ANNUITY PROGRAM 2011 401k membership
Total participants, beginning-of-year 2011-01-01 366
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 15
Number of retired or separated participants receiving benefits 2011-01-01 1
Number of other retired or separated participants entitled to future benefits 2011-01-01 21
Total of all active and inactive participants 2011-01-01 37
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 37
Number of participants with account balances 2011-01-01 37
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: MORAVIAN HALL SQUARE RETIREMENT COMMUNITY ANNUITY PROGRAM 2010 401k membership
Total participants, beginning-of-year 2010-01-01 374
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 330
Number of retired or separated participants receiving benefits 2010-01-01 2
Number of other retired or separated participants entitled to future benefits 2010-01-01 33
Total of all active and inactive participants 2010-01-01 365
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 1
Total participants 2010-01-01 366
Number of participants with account balances 2010-01-01 76
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: MORAVIAN HALL SQUARE RETIREMENT COMMUNITY ANNUITY PROGRAM 2009 401k membership
Total participants, beginning-of-year 2009-01-01 380
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 341
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 33
Total of all active and inactive participants 2009-01-01 374
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 374
Number of participants with account balances 2009-01-01 77
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2011: MORAVIAN HALL SQUARE RETIREMENT COMMUNITY ANNUITY PROGRAM 2011 401k membership
Total participants, beginning-of-year	2011-01-01	366
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	15
Number of retired or separated participants receiving benefits	2011-01-01	1
Number of other retired or separated participants entitled to future benefits	2011-01-01	21
Total of all active and inactive participants	2011-01-01	37
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	37
Number of participants with account balances	2011-01-01	37
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: MORAVIAN HALL SQUARE RETIREMENT COMMUNITY ANNUITY PROGRAM 2010 401k membership
Total participants, beginning-of-year	2010-01-01	374
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	330
Number of retired or separated participants receiving benefits	2010-01-01	2
Number of other retired or separated participants entitled to future benefits	2010-01-01	33
Total of all active and inactive participants	2010-01-01	365
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	1
Total participants	2010-01-01	366
Number of participants with account balances	2010-01-01	76
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: MORAVIAN HALL SQUARE RETIREMENT COMMUNITY ANNUITY PROGRAM 2009 401k membership
Total participants, beginning-of-year	2009-01-01	380
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	341
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	33
Total of all active and inactive participants	2009-01-01	374
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	374
Number of participants with account balances	2009-01-01	77
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on MORAVIAN HALL SQUARE RETIREMENT COMMUNITY ANNUITY PROGRAM

Measure	Date	Value
2011 : MORAVIAN HALL SQUARE RETIREMENT COMMUNITY ANNUITY PROGRAM 2011 401k financial data
Total income from all sources (including contributions)	2011-12-31	$64,913
Total of all expenses incurred	2011-12-31	$1,125,884
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$1,123,315
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$47,215
Value of total assets at end of year	2011-12-31	$635,616
Value of total assets at beginning of year	2011-12-31	$1,696,587
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$2,569
Total interest from all sources	2011-12-31	$19,511
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$3,789
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2011-12-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$3,789
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$350,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$47,215
Participant contributions at end of year	2011-12-31	$3,647
Participant contributions at beginning of year	2011-12-31	$3,515
Participant contributions at end of year	2011-12-31	$0
Participant contributions at beginning of year	2011-12-31	$645
Administrative expenses (other) incurred	2011-12-31	$2,569
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$-1,060,971
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$635,616
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$1,696,587
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$97,839
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$477,237
Value of interest in pooled separate accounts at end of year	2011-12-31	$81,393
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$484,114
Interest on participant loans	2011-12-31	$67
Interest earned on other investments	2011-12-31	$19,426
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$58,245
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$58,245
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$18
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$452,737
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$672,831
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-7,945
Net investment gain/loss from pooled separate accounts	2011-12-31	$2,343
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$1,123,315
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	PARENTEBEARD LLC
Accountancy firm EIN	2011-12-31	232932984
2010 : MORAVIAN HALL SQUARE RETIREMENT COMMUNITY ANNUITY PROGRAM 2010 401k financial data
Total income from all sources (including contributions)	2010-12-31	$256,398
Total of all expenses incurred	2010-12-31	$135,137
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$133,115
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$122,388
Value of total assets at end of year	2010-12-31	$1,696,587
Value of total assets at beginning of year	2010-12-31	$1,575,326
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$2,022
Total interest from all sources	2010-12-31	$21,994
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$9,129
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2010-12-31	$9,129
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$350,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$122,388
Participant contributions at end of year	2010-12-31	$3,515
Participant contributions at beginning of year	2010-12-31	$5,177
Participant contributions at end of year	2010-12-31	$645
Participant contributions at beginning of year	2010-12-31	$200
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$0
Administrative expenses (other) incurred	2010-12-31	$2,022
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$121,261
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$1,696,587
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$1,575,326
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$477,237
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$328,009
Value of interest in pooled separate accounts at end of year	2010-12-31	$484,114
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$503,525
Interest on participant loans	2010-12-31	$144
Interest earned on other investments	2010-12-31	$21,821
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$58,245
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$45,817
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$45,817
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$29
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$672,831
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$692,598
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$40,221
Net investment gain/loss from pooled separate accounts	2010-12-31	$62,666
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$133,115
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	PARENTEBEARD LLC
Accountancy firm EIN	2010-12-31	232932984
2009 : MORAVIAN HALL SQUARE RETIREMENT COMMUNITY ANNUITY PROGRAM 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for MORAVIAN HALL SQUARE RETIREMENT COMMUNITY ANNUITY PROGRAM

2011: MORAVIAN HALL SQUARE RETIREMENT COMMUNITY ANNUITY PROGRAM 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: MORAVIAN HALL SQUARE RETIREMENT COMMUNITY ANNUITY PROGRAM 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: MORAVIAN HALL SQUARE RETIREMENT COMMUNITY ANNUITY PROGRAM 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	First time form 5500 has been submitted	Yes
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

194249+001

Policy instance

Insurance contract or identification number	194249+001
Number of Individuals Covered	32
Total amount of commissions paid to insurance broker	USD $192
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

194249+001

Policy instance

Insurance contract or identification number	194249+001
Number of Individuals Covered	54
Total amount of commissions paid to insurance broker	USD $540
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $475
Amount paid for insurance broker fees	475
Insurance broker organization code?	4
Insurance broker name	RAYMOND JAMES FINANCIAL SERVICES

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Company Name:	MORNINGSTAR SENIOR LIVING, INC.
Employer identification number (EIN):	222717623
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities