401k Plan data: ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN plan

ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 401k Plan overview

Plan Name	ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN
Plan identification number	001

ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
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.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

ODD FELLOW & REBEKAH REHABILITATION & HEALTH CARE CENTER, INC. has sponsored the creation of one or more 401k plans.

Company Name: ODD FELLOW & REBEKAH REHABILITATION & HEALTH CARE CENTER, INC.

Employer identification number (EIN): 237259398

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2019-01-01 EUGENE L. URBAN 2019-10-24 EUGENE L. URBAN 2019-10-24
001 2018-01-01
001 2017-01-01 EUGENE L URBAN EUGENE L URBAN 2018-10-11
001 2016-01-01 EUGENE L URBAN EUGENE L URBAN 2017-10-10
001 2015-01-01 EUGENE URBAN EUGENE URBAN 2016-10-11
001 2014-01-01 EUGENE L. URBAN EUGENE L. URBAN 2015-09-29
001 2013-01-01 EUGENE URBAN EUGENE URBAN 2014-10-13
001 2012-01-01 EUGENE URBAN
001 2011-01-01 EUGENE URBAN
001 2010-01-01 EUGENE URBAN 2013-03-05

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2019-01-01	EUGENE L. URBAN	2019-10-24	EUGENE L. URBAN	2019-10-24
001	2018-01-01
001	2017-01-01	EUGENE L URBAN		EUGENE L URBAN	2018-10-11
001	2016-01-01	EUGENE L URBAN		EUGENE L URBAN	2017-10-10
001	2015-01-01	EUGENE URBAN		EUGENE URBAN	2016-10-11
001	2014-01-01	EUGENE L. URBAN		EUGENE L. URBAN	2015-09-29
001	2013-01-01	EUGENE URBAN		EUGENE URBAN	2014-10-13
001	2012-01-01	EUGENE URBAN
001	2011-01-01	EUGENE URBAN
001	2010-01-01	EUGENE URBAN	2013-03-05

Plan Statistics for ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN

401k plan membership statisitcs for ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN

Measure Date Value
2018: ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 204
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 0
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 13
Total of all active and inactive participants 2018-01-01 13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 13
Number of participants with account balances 2018-01-01 13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 212
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 185
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 20
Total of all active and inactive participants 2017-01-01 205
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 205
Number of participants with account balances 2017-01-01 73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 203
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 175
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 18
Total of all active and inactive participants 2016-01-01 193
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 193
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: ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 192
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 186
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 21
Total of all active and inactive participants 2015-01-01 207
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 207
Number of participants with account balances 2015-01-01 70
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 193
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 163
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 18
Total of all active and inactive participants 2014-01-01 181
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 181
Number of participants with account balances 2014-01-01 64
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 167
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 169
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 21
Total of all active and inactive participants 2013-01-01 190
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 190
Number of participants with account balances 2013-01-01 62
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 143
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 130
Number of other retired or separated participants entitled to future benefits 2012-01-01 22
Total of all active and inactive participants 2012-01-01 152
Total participants 2012-01-01 152
Number of participants with account balances 2012-01-01 63
2011: ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 125
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 123
Total of all active and inactive participants 2011-01-01 123
Total participants 2011-01-01 123
Number of participants with account balances 2011-01-01 65

Measure	Date	Value
2018: ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	204
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	0
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	13
Total of all active and inactive participants	2018-01-01	13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	13
Number of participants with account balances	2018-01-01	13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	212
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	185
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	20
Total of all active and inactive participants	2017-01-01	205
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	205
Number of participants with account balances	2017-01-01	73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	203
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	175
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	18
Total of all active and inactive participants	2016-01-01	193
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	193
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: ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	192
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	186
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	21
Total of all active and inactive participants	2015-01-01	207
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	207
Number of participants with account balances	2015-01-01	70
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	193
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	163
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	18
Total of all active and inactive participants	2014-01-01	181
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	181
Number of participants with account balances	2014-01-01	64
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	167
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	169
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	21
Total of all active and inactive participants	2013-01-01	190
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	190
Number of participants with account balances	2013-01-01	62
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	143
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	130
Number of other retired or separated participants entitled to future benefits	2012-01-01	22
Total of all active and inactive participants	2012-01-01	152
Total participants	2012-01-01	152
Number of participants with account balances	2012-01-01	63
2011: ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	125
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	123
Total of all active and inactive participants	2011-01-01	123
Total participants	2011-01-01	123
Number of participants with account balances	2011-01-01	65

Financial Data on ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN

Measure	Date	Value
2018 : ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2018 401k financial data
Total income from all sources (including contributions)	2018-12-31	$-7,373
Total of all expenses incurred	2018-12-31	$2,930,502
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$2,919,258
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$26,040
Value of total assets at end of year	2018-12-31	$301,869
Value of total assets at beginning of year	2018-12-31	$3,239,744
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$11,244
Total interest from all sources	2018-12-31	$94
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$6,841
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2018-12-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$6,841
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$500,000
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	$15,118
Participant contributions at beginning of year	2018-12-31	$17,737
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	$-2,937,875
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$301,869
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$3,239,744
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$301,869
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$3,169,016
Interest on participant loans	2018-12-31	$94
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$52,991
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-40,348
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	$10,922
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$2,919,258
Contract administrator fees	2018-12-31	$11,244
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	FREED MAXICK CPA'S P.C.
Accountancy firm EIN	2018-12-31	454051133
2017 : ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2017 401k financial data
Total income from all sources (including contributions)	2017-12-31	$720,542
Total of all expenses incurred	2017-12-31	$237,663
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$230,101
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$292,696
Value of total assets at end of year	2017-12-31	$3,239,744
Value of total assets at beginning of year	2017-12-31	$2,756,865
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$7,562
Total interest from all sources	2017-12-31	$1,171
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$62,981
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	$62,981
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$500,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$145,009
Participant contributions at end of year	2017-12-31	$17,737
Participant contributions at beginning of year	2017-12-31	$19,450
Participant contributions at beginning of year	2017-12-31	$4,318
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$50,195
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	$482,879
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$3,239,744
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$2,756,865
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$3,169,016
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$2,687,110
Interest on participant loans	2017-12-31	$1,171
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$52,991
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$42,693
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$363,694
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	$97,492
Employer contributions (assets) at beginning of year	2017-12-31	$3,294
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$230,101
Contract administrator fees	2017-12-31	$7,562
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	FREED MAXICK CPA'S P.C.
Accountancy firm EIN	2017-12-31	454051133
2016 : ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2016 401k financial data
Total income from all sources (including contributions)	2016-12-31	$364,120
Total of all expenses incurred	2016-12-31	$249,332
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$242,205
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$228,788
Value of total assets at end of year	2016-12-31	$2,756,865
Value of total assets at beginning of year	2016-12-31	$2,642,077
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$7,127
Total interest from all sources	2016-12-31	$861
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$33,640
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	$33,640
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$135,142
Participant contributions at end of year	2016-12-31	$19,450
Participant contributions at beginning of year	2016-12-31	$11,767
Participant contributions at end of year	2016-12-31	$4,318
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	$114,788
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$2,756,865
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$2,642,077
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$2,687,110
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$2,606,995
Interest on participant loans	2016-12-31	$861
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$42,693
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$23,315
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$100,831
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	No
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	$93,646
Employer contributions (assets) at end of year	2016-12-31	$3,294
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$242,205
Contract administrator fees	2016-12-31	$7,127
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	FREED MAXICK CPA'S P.C.
Accountancy firm EIN	2016-12-31	454051133
2015 : ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2015 401k financial data
Total income from all sources (including contributions)	2015-12-31	$183,386
Total of all expenses incurred	2015-12-31	$67,377
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$61,406
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$223,399
Value of total assets at end of year	2015-12-31	$2,642,077
Value of total assets at beginning of year	2015-12-31	$2,526,068
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$5,971
Total interest from all sources	2015-12-31	$1,063
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$28,409
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	$28,409
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$119,851
Participant contributions at end of year	2015-12-31	$11,767
Participant contributions at beginning of year	2015-12-31	$34,718
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$6,547
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	$116,009
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$2,642,077
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$2,526,068
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$2,606,995
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$2,473,607
Interest on participant loans	2015-12-31	$1,063
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$23,315
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$17,743
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-69,485
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
Contributions received in cash from employer	2015-12-31	$97,001
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$61,406
Contract administrator fees	2015-12-31	$5,971
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	FREED MAXICK CPA'S P.C.
Accountancy firm EIN	2015-12-31	454051133
2014 : ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2014 401k financial data
Total income from all sources (including contributions)	2014-12-31	$387,774
Total of all expenses incurred	2014-12-31	$343,175
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$333,344
Expenses. Certain deemed distributions of participant loans	2014-12-31	$1,097
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$212,495
Value of total assets at end of year	2014-12-31	$2,526,068
Value of total assets at beginning of year	2014-12-31	$2,481,469
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$8,734
Total interest from all sources	2014-12-31	$1,254
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$49,677
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	$49,677
Administrative expenses professional fees incurred	2014-12-31	$0
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$500,000
If this is an individual account plan, was there a blackout period	2014-12-31	Yes
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$125,106
Participant contributions at end of year	2014-12-31	$34,718
Participant contributions at beginning of year	2014-12-31	$21,369
Participant contributions at beginning of year	2014-12-31	$63
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$51,264
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	$44,599
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$2,526,068
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$2,481,469
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$2,473,607
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$1,629,971
Interest on participant loans	2014-12-31	$1,254
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$17,743
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$778,697
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$124,348
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
Contributions received in cash from employer	2014-12-31	$87,389
Employer contributions (assets) at beginning of year	2014-12-31	$105
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$333,344
Contract administrator fees	2014-12-31	$8,734
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	2014-12-31	Yes
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	FREED MAXICK CPA'S P.C.
Accountancy firm EIN	2014-12-31	454051133
2013 : ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2013 401k financial data
Total income from all sources (including contributions)	2013-12-31	$488,014
Total of all expenses incurred	2013-12-31	$57,692
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$57,602
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$182,088
Value of total assets at end of year	2013-12-31	$2,481,469
Value of total assets at beginning of year	2013-12-31	$2,051,147
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$90
Total interest from all sources	2013-12-31	$734
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	No
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$95,605
Participant contributions at end of year	2013-12-31	$21,369
Participant contributions at beginning of year	2013-12-31	$27,040
Participant contributions at end of year	2013-12-31	$63
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$51,264
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	$430,322
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$2,481,469
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$2,051,147
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	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$1,629,971
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$1,291,515
Income. Interest from loans (other than to participants)	2013-12-31	$734
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$778,697
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$732,592
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$305,192
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
Contributions received in cash from employer	2013-12-31	$86,483
Employer contributions (assets) at end of year	2013-12-31	$105
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$57,602
Contract administrator fees	2013-12-31	$90
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 P.C.
Accountancy firm EIN	2013-12-31	454051133
2012 : ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2012 401k financial data
Total income from all sources (including contributions)	2012-12-31	$339,350
Total of all expenses incurred	2012-12-31	$250,156
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$250,066
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$155,495
Value of total assets at end of year	2012-12-31	$2,051,147
Value of total assets at beginning of year	2012-12-31	$1,961,953
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$90
Total interest from all sources	2012-12-31	$595
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	No
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$75,937
Participant contributions at end of year	2012-12-31	$27,040
Participant contributions at beginning of year	2012-12-31	$14,125
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$5,697
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	$89,194
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$2,051,147
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$1,961,953
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Investment advisory and management fees	2012-12-31	$90
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$1,291,515
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$1,134,791
Interest on participant loans	2012-12-31	$595
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$732,592
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$813,037
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$183,260
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
Contributions received in cash from employer	2012-12-31	$73,861
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$250,066
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	2012-12-31	No
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	FREED MAXICK CPAS P.C.
Accountancy firm EIN	2012-12-31	454051133
2011 : ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2011-12-31	$-37,777
Total unrealized appreciation/depreciation of assets	2011-12-31	$-37,777
Total income from all sources (including contributions)	2011-12-31	$120,686
Total of all expenses incurred	2011-12-31	$90,679
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$90,589
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$132,325
Value of total assets at end of year	2011-12-31	$1,961,827
Value of total assets at beginning of year	2011-12-31	$1,931,820
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$90
Total interest from all sources	2011-12-31	$26,138
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	No
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$96,237
Participant contributions at end of year	2011-12-31	$14,067
Participant contributions at beginning of year	2011-12-31	$15,128
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	$30,007
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$1,961,827
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$1,931,820
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Investment advisory and management fees	2011-12-31	$90
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$1,147,001
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$1,089,305
Interest on participant loans	2011-12-31	$504
Interest earned on other investments	2011-12-31	$26,138
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$800,759
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$827,387
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-16,669
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
Contributions received in cash from employer	2011-12-31	$36,088
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$90,589
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	2011-12-31	No
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	FREED MAXICK CPAS, P.C.
Accountancy firm EIN	2011-12-31	454051133

Form 5500 Responses for ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN

2018: ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT 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: ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT 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: ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: ODD FELLOW & REBEKAH RHCC, INC. RETIREMENT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	Yes
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	109
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $24
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	24
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker organization code?	5

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	166
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $23
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	23
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	5
Insurance broker name	ACTUARIAL CONSULTING SERVICES, INC

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	167
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $9
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	9
Insurance broker organization code?	5
Insurance broker name	ACTUARIAL CONSULTING SERVICES, INC

METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )

Policy contract number

941936

Policy instance

Insurance contract or identification number	941936
Number of Individuals Covered	0
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,384
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	27
Insurance broker organization code?	7
Insurance broker name	CADARET GRANT & CO., INC.

METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )

Policy contract number

907700

Policy instance

Insurance contract or identification number	907700
Number of Individuals Covered	0
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	163
Insurance policy start date	2013-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $6
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Amount paid for insurance broker fees	6
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	5
Insurance broker name	ACTUARIAL CONSULTING SERVICES, INC

METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )

Policy contract number

941936

Policy instance

Insurance contract or identification number	941936
Number of Individuals Covered	62
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $14,890
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,556
Insurance broker organization code?	7
Insurance broker name	CADARET GRANT & CO., INC.

METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )

Policy contract number

907700

Policy instance

Insurance contract or identification number	907700
Number of Individuals Covered	5
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )

Policy contract number

907700

Policy instance

Insurance contract or identification number	907700
Number of Individuals Covered	5
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
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 contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )

Policy contract number

941936

Policy instance

Insurance contract or identification number	941936
Number of Individuals Covered	58
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $10,693
Total amount of fees paid to insurance company	USD $0
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 contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,290
Insurance broker organization code?	7
Insurance broker name	MML INVESTORS SERVICES LLC

METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )

Policy contract number

941936

Policy instance

Insurance contract or identification number	941936
Number of Individuals Covered	60
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $9,744
Total amount of fees paid to insurance company	USD $0
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 contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )

Policy contract number

907700

Policy instance

Insurance contract or identification number	907700
Number of Individuals Covered	5
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
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 contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	ODD FELLOW & REBEKAH REHABILITATION & HEALTH CARE CENTER, INC.
Employer identification number (EIN):	237259398
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities