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BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 401k Plan overview

Plan NameBROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN
Plan identification number 001

BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • 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.

401k Sponsoring company profile

BROAD ACRES NURSING HOME ASSOCIATION has sponsored the creation of one or more 401k plans.

Company Name:BROAD ACRES NURSING HOME ASSOCIATION
Employer identification number (EIN):251255591
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Additional information about BROAD ACRES NURSING HOME ASSOCIATION

Jurisdiction of Incorporation: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF STATE
Incorporation Date:
Company Identification Number: 601254

More information about BROAD ACRES NURSING HOME ASSOCIATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01
0012021-01-01
0012020-01-01
0012019-01-01
0012019-01-01
0012018-01-01
0012017-01-01
0012016-01-01
0012015-01-01
0012015-01-01AMBER WORDEN2016-10-17 AMBER WORDEN2016-10-17
0012014-01-01MAUREEN MESSICK
0012013-01-01MAUREEN MESSICK
0012012-01-01MAUREEN MESSICK
0012011-01-01MAUREEN MESSICK
0012010-01-01MAUREEN MESSICK MAUREEN MESSICK2011-10-14
0012009-01-01MAUREEN MESSICK
0012009-01-01MAUREEN MESSICK

Plan Statistics for BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN

401k plan membership statisitcs for BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN

Measure Date Value
2022: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01135
Total number of active participants reported on line 7a of the Form 55002022-01-01121
Number of retired or separated participants receiving benefits2022-01-011
Number of other retired or separated participants entitled to future benefits2022-01-016
Total of all active and inactive participants2022-01-01128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01128
Number of participants with account balances2022-01-0134
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01158
Total number of active participants reported on line 7a of the Form 55002021-01-01129
Number of retired or separated participants receiving benefits2021-01-011
Number of other retired or separated participants entitled to future benefits2021-01-015
Total of all active and inactive participants2021-01-01135
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01135
Number of participants with account balances2021-01-0129
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01158
Total number of active participants reported on line 7a of the Form 55002020-01-01143
Number of retired or separated participants receiving benefits2020-01-013
Number of other retired or separated participants entitled to future benefits2020-01-0112
Total of all active and inactive participants2020-01-01158
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01158
Number of participants with account balances2020-01-0136
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01138
Total number of active participants reported on line 7a of the Form 55002019-01-01127
Number of retired or separated participants receiving benefits2019-01-018
Number of other retired or separated participants entitled to future benefits2019-01-012
Total of all active and inactive participants2019-01-01137
Total participants2019-01-01137
Number of participants with account balances2019-01-0141
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01125
Total number of active participants reported on line 7a of the Form 55002018-01-01130
Number of retired or separated participants receiving benefits2018-01-018
Total of all active and inactive participants2018-01-01138
Total participants2018-01-01138
Number of participants with account balances2018-01-0145
2017: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01132
Total number of active participants reported on line 7a of the Form 55002017-01-01125
Number of retired or separated participants receiving benefits2017-01-018
Total of all active and inactive participants2017-01-01133
Total participants2017-01-01133
Number of participants with account balances2017-01-0134
2016: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01162
Total number of active participants reported on line 7a of the Form 55002016-01-01128
Number of retired or separated participants receiving benefits2016-01-017
Total of all active and inactive participants2016-01-01135
Total participants2016-01-01135
Number of participants with account balances2016-01-0142
2015: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01202
Total number of active participants reported on line 7a of the Form 55002015-01-01125
Number of retired or separated participants receiving benefits2015-01-017
Total of all active and inactive participants2015-01-01132
Total participants2015-01-01132
2014: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01154
Total number of active participants reported on line 7a of the Form 55002014-01-01136
Number of retired or separated participants receiving benefits2014-01-0112
Total of all active and inactive participants2014-01-01148
Total participants2014-01-01148
Number of participants with account balances2014-01-0139
2013: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01132
Total number of active participants reported on line 7a of the Form 55002013-01-01141
Number of retired or separated participants receiving benefits2013-01-0113
Total of all active and inactive participants2013-01-01154
Total participants2013-01-01154
Number of participants with account balances2013-01-0142
2012: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01135
Total number of active participants reported on line 7a of the Form 55002012-01-01123
Number of retired or separated participants receiving benefits2012-01-019
Total of all active and inactive participants2012-01-01132
Total participants2012-01-01132
Number of participants with account balances2012-01-0141
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-012
2011: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01149
Total number of active participants reported on line 7a of the Form 55002011-01-01125
Number of retired or separated participants receiving benefits2011-01-0110
Total of all active and inactive participants2011-01-01135
Total participants2011-01-01135
Number of participants with account balances2011-01-0140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-012
2010: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01144
Total number of active participants reported on line 7a of the Form 55002010-01-01149
Total of all active and inactive participants2010-01-01149
Total participants2010-01-01149
Number of participants with account balances2010-01-0153
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-0113
2009: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01152
Total number of active participants reported on line 7a of the Form 55002009-01-01132
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-0112
Total of all active and inactive participants2009-01-01144
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-01144
Number of participants with account balances2009-01-0147
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-013

Financial Data on BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN

Measure Date Value
2022 : BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$5,340
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$6,939
Total income from all sources (including contributions)2022-12-31$-87,929
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$30,981
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$25,990
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$125,287
Value of total assets at end of year2022-12-31$1,249,679
Value of total assets at beginning of year2022-12-31$1,370,188
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$4,991
Total interest from all sources2022-12-31$3,341
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$17,164
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$17,164
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$125,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$93,295
Participant contributions at end of year2022-12-31$3,450
Participant contributions at beginning of year2022-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$13,882
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$1,878
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$1,556
Other income not declared elsewhere2022-12-31$1,448
Liabilities. Value of operating payables at end of year2022-12-31$3,462
Liabilities. Value of operating payables at beginning of year2022-12-31$5,383
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-118,910
Value of net assets at end of year (total assets less liabilities)2022-12-31$1,244,339
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$1,363,249
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$978,570
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$1,251,152
Interest earned on other investments2022-12-31$3,341
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$266,948
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$119,007
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-235,169
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$18,110
Employer contributions (assets) at end of year2022-12-31$711
Employer contributions (assets) at beginning of year2022-12-31$29
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$25,990
Contract administrator fees2022-12-31$4,991
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31MAYER HOFFMAN MCCANN P.C.
Accountancy firm EIN2022-12-31431947695
2021 : BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$6,939
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$15,092
Total income from all sources (including contributions)2021-12-31$257,933
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$950,595
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$944,568
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$72,855
Value of total assets at end of year2021-12-31$1,370,188
Value of total assets at beginning of year2021-12-31$2,071,003
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$6,027
Total interest from all sources2021-12-31$1,107
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$57,265
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$57,265
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$205,592
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$61,302
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$2,479
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-12-31$1,556
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-12-31$565
Liabilities. Value of operating payables at end of year2021-12-31$5,383
Liabilities. Value of operating payables at beginning of year2021-12-31$14,527
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$-692,662
Value of net assets at end of year (total assets less liabilities)2021-12-31$1,363,249
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$2,055,911
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$1,251,152
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$0
Value of interest in pooled separate accounts at end of year2021-12-31$0
Value of interest in pooled separate accounts at beginning of year2021-12-31$1,696,171
Interest earned on other investments2021-12-31$1,107
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$119,007
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$371,342
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$126,706
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$11,553
Employer contributions (assets) at end of year2021-12-31$29
Employer contributions (assets) at beginning of year2021-12-31$1,011
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$944,568
Contract administrator fees2021-12-31$6,027
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31MAYER HOFFMAN MCCANN P.C.
Accountancy firm EIN2021-12-31431947695
2020 : BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$14,527
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$14,527
Total income from all sources (including contributions)2020-12-31$201,103
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$51,908
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$51,380
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$70,518
Value of total assets at end of year2020-12-31$2,071,038
Value of total assets at beginning of year2020-12-31$1,921,843
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$528
Total interest from all sources2020-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$9,779
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$9,779
Administrative expenses professional fees incurred2020-12-31$528
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$191,836
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$57,740
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$2,479
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$2,479
Liabilities. Value of operating payables at end of year2020-12-31$14,527
Liabilities. Value of operating payables at beginning of year2020-12-31$14,527
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$149,195
Value of net assets at end of year (total assets less liabilities)2020-12-31$2,056,511
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$1,907,316
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest in pooled separate accounts at end of year2020-12-31$1,696,172
Value of interest in pooled separate accounts at beginning of year2020-12-31$1,706,890
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$371,341
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$211,463
Net investment gain/loss from pooled separate accounts2020-12-31$120,806
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$12,778
Employer contributions (assets) at end of year2020-12-31$1,046
Employer contributions (assets) at beginning of year2020-12-31$1,011
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$51,380
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31MAYER HOFFMAN MCCANN P.C.
Accountancy firm EIN2020-12-31431947695
2019 : BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$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$15,826
Total income from all sources (including contributions)2019-12-31$84,243
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$134,994
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$134,532
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$81,836
Value of total assets at end of year2019-12-31$1,605,253
Value of total assets at beginning of year2019-12-31$1,671,830
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$462
Total interest from all sources2019-12-31$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 year2019-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2019-12-31$5,970
Administrative expenses professional fees incurred2019-12-31$462
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$250,000
If this is an individual account plan, was there a blackout period2019-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$134,532
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$67,300
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$2,479
Liabilities. Value of operating payables at end of year2019-12-31$0
Liabilities. Value of operating payables at beginning of year2019-12-31$15,826
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$-50,751
Value of net assets at end of year (total assets less liabilities)2019-12-31$1,605,253
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$1,656,004
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in pooled separate accounts at end of year2019-12-31$1,406,206
Value of interest in pooled separate accounts at beginning of year2019-12-31$1,474,723
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$199,047
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$193,653
Net investment gain/loss from pooled separate accounts2019-12-31$2,407
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$14,536
Employer contributions (assets) at end of year2019-12-31$0
Employer contributions (assets) at beginning of year2019-12-31$975
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$134,532
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31MAYER HOFFMAN MCCANN P.C.
Accountancy firm EIN2019-12-31431947695
2018 : BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$15,826
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$14,741
Total income from all sources (including contributions)2018-12-31$12,688
Total of all expenses incurred2018-12-31$19,663
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$19,040
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$101,529
Value of total assets at end of year2018-12-31$1,671,830
Value of total assets at beginning of year2018-12-31$1,677,720
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$623
Total interest from all sources2018-12-31$93
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$5,454
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2018-12-31$5,454
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$250,000
If this is an individual account plan, was there a blackout period2018-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$19,040
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$83,983
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-12-31$2,479
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-12-31$2,872
Liabilities. Value of operating payables at end of year2018-12-31$15,826
Liabilities. Value of operating payables at beginning of year2018-12-31$14,741
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-6,975
Value of net assets at end of year (total assets less liabilities)2018-12-31$1,656,004
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$1,662,979
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Value of interest in pooled separate accounts at end of year2018-12-31$1,474,723
Value of interest in pooled separate accounts at beginning of year2018-12-31$1,497,628
Interest on participant loans2018-12-31$93
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$193,653
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$176,533
Net investment gain/loss from pooled separate accounts2018-12-31$-94,388
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$17,546
Employer contributions (assets) at end of year2018-12-31$975
Employer contributions (assets) at beginning of year2018-12-31$687
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$19,040
Contract administrator fees2018-12-31$623
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31BAKERTILLYVIRCHOWKRAUSE,LLP
Accountancy firm EIN2018-12-31390859910
2017 : BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2017 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$14,741
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$8,387
Total income from all sources (including contributions)2017-12-31$318,212
Total of all expenses incurred2017-12-31$607
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$105,271
Value of total assets at end of year2017-12-31$1,677,720
Value of total assets at beginning of year2017-12-31$1,353,761
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$607
Total interest from all sources2017-12-31$93
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$4,953
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2017-12-31$4,953
Was this plan covered by a fidelity bond2017-12-31No
If this is an individual account plan, was there a blackout period2017-12-31No
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$86,104
Participant contributions at beginning of year2017-12-31$3,515
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-12-31$2,872
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-12-31$3,974
Liabilities. Value of operating payables at end of year2017-12-31$14,741
Liabilities. Value of operating payables at beginning of year2017-12-31$8,387
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$317,605
Value of net assets at end of year (total assets less liabilities)2017-12-31$1,662,979
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$1,345,374
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Value of interest in pooled separate accounts at end of year2017-12-31$1,497,628
Value of interest in pooled separate accounts at beginning of year2017-12-31$1,187,231
Interest on participant loans2017-12-31$93
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-12-31$176,533
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-12-31$157,699
Net investment gain/loss from pooled separate accounts2017-12-31$207,895
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$19,167
Employer contributions (assets) at end of year2017-12-31$687
Employer contributions (assets) at beginning of year2017-12-31$1,342
Contract administrator fees2017-12-31$607
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31Yes
Opinion of an independent qualified public accountant for this plan2017-12-31Disclaimer
Accountancy firm name2017-12-31BAKERTILLYVIRCHOWKRAUSE, LLP
Accountancy firm EIN2017-12-31390859910
2016 : BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2016 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$8,387
Total income from all sources (including contributions)2016-12-31$183,044
Total of all expenses incurred2016-12-31$21,209
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$20,603
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$99,997
Value of total assets at end of year2016-12-31$1,353,761
Value of total assets at beginning of year2016-12-31$1,183,539
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$606
Total interest from all sources2016-12-31$158
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$4,367
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$4,367
Was this plan covered by a fidelity bond2016-12-31No
If this is an individual account plan, was there a blackout period2016-12-31No
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$81,004
Participant contributions at end of year2016-12-31$3,515
Participant contributions at beginning of year2016-12-31$3,271
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$3,974
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$5,011
Liabilities. Value of operating payables at end of year2016-12-31$8,387
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$161,835
Value of net assets at end of year (total assets less liabilities)2016-12-31$1,345,374
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$1,183,539
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Value of interest in pooled separate accounts at end of year2016-12-31$1,187,231
Value of interest in pooled separate accounts at beginning of year2016-12-31$1,035,273
Interest on participant loans2016-12-31$158
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$157,699
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$139,336
Net investment gain/loss from pooled separate accounts2016-12-31$78,522
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$18,993
Employer contributions (assets) at end of year2016-12-31$1,342
Employer contributions (assets) at beginning of year2016-12-31$648
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$20,603
Contract administrator fees2016-12-31$606
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-12-31No
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31BAKERTILLYVIRCHOWKRAUSE, LLP
Accountancy firm EIN2016-12-31390859910
2014 : BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2014 401k financial data
Total income from all sources (including contributions)2014-12-31$148,869
Total of all expenses incurred2014-12-31$90,061
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$89,575
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$86,630
Value of total assets at end of year2014-12-31$1,110,407
Value of total assets at beginning of year2014-12-31$1,051,599
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$486
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Was this plan covered by a fidelity bond2014-12-31No
If this is an individual account plan, was there a blackout period2014-12-31No
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$72,334
Participant contributions at end of year2014-12-31$2,763
Participant contributions at beginning of year2014-12-31$2,509
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$58,808
Value of net assets at end of year (total assets less liabilities)2014-12-31$1,110,407
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$1,051,599
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Value of interest in pooled separate accounts at end of year2014-12-31$917,384
Value of interest in pooled separate accounts at beginning of year2014-12-31$870,485
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-12-31$182,599
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-12-31$174,829
Net investment gain/loss from pooled separate accounts2014-12-31$62,239
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$14,296
Employer contributions (assets) at end of year2014-12-31$7,661
Employer contributions (assets) at beginning of year2014-12-31$3,776
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$89,575
Contract administrator fees2014-12-31$486
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32014-12-31No
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31REILLY, PENNER & BENTON LLP
Accountancy firm EIN2014-12-31390747409
2013 : BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2013 401k financial data
Total income from all sources (including contributions)2013-12-31$223,984
Total of all expenses incurred2013-12-31$29,282
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$28,790
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$81,133
Value of total assets at end of year2013-12-31$1,051,599
Value of total assets at beginning of year2013-12-31$856,897
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$492
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Was this plan covered by a fidelity bond2013-12-31No
If this is an individual account plan, was there a blackout period2013-12-31No
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$66,380
Participant contributions at end of year2013-12-31$2,509
Participant contributions at beginning of year2013-12-31$5,781
Income. Received or receivable in cash from other sources (including rollovers)2013-12-31$1,876
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$194,702
Value of net assets at end of year (total assets less liabilities)2013-12-31$1,051,599
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$856,897
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Value of interest in pooled separate accounts at end of year2013-12-31$870,485
Value of interest in pooled separate accounts at beginning of year2013-12-31$693,479
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-12-31$174,829
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-12-31$153,988
Net investment gain/loss from pooled separate accounts2013-12-31$142,851
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$12,877
Employer contributions (assets) at end of year2013-12-31$3,776
Employer contributions (assets) at beginning of year2013-12-31$3,649
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$28,790
Contract administrator fees2013-12-31$492
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32013-12-31No
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31Yes
Opinion of an independent qualified public accountant for this plan2013-12-31Disclaimer
Accountancy firm name2013-12-31REILLY, PENNER & BENTON LLP
Accountancy firm EIN2013-12-31390747409
2012 : BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2012 401k financial data
Total income from all sources (including contributions)2012-12-31$149,865
Total of all expenses incurred2012-12-31$14,575
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$14,083
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$74,842
Value of total assets at end of year2012-12-31$856,897
Value of total assets at beginning of year2012-12-31$721,607
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$492
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Was this plan covered by a fidelity bond2012-12-31No
If this is an individual account plan, was there a blackout period2012-12-31No
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$62,332
Participant contributions at end of year2012-12-31$5,781
Participant contributions at beginning of year2012-12-31$2,134
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$135,290
Value of net assets at end of year (total assets less liabilities)2012-12-31$856,897
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$721,607
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Value of interest in pooled separate accounts at end of year2012-12-31$693,479
Value of interest in pooled separate accounts at beginning of year2012-12-31$618,256
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-12-31$153,988
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-12-31$97,925
Net investment gain/loss from pooled separate accounts2012-12-31$75,023
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$12,510
Employer contributions (assets) at end of year2012-12-31$3,649
Employer contributions (assets) at beginning of year2012-12-31$3,292
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$14,083
Contract administrator fees2012-12-31$492
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-12-31No
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31Yes
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31REILLY, PENNER & BENTON LLP
Accountancy firm EIN2012-12-31390747409
2011 : BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2011 401k financial data
Total income from all sources (including contributions)2011-12-31$63,535
Total of all expenses incurred2011-12-31$154,403
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$153,935
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$70,475
Value of total assets at end of year2011-12-31$721,607
Value of total assets at beginning of year2011-12-31$812,475
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$468
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Was this plan covered by a fidelity bond2011-12-31No
If this is an individual account plan, was there a blackout period2011-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$59,253
Participant contributions at end of year2011-12-31$2,134
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$-90,868
Value of net assets at end of year (total assets less liabilities)2011-12-31$721,607
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$812,475
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of interest in pooled separate accounts at end of year2011-12-31$618,256
Value of interest in pooled separate accounts at beginning of year2011-12-31$747,025
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-12-31$97,925
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-12-31$62,742
Net investment gain/loss from pooled separate accounts2011-12-31$-6,940
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$11,222
Employer contributions (assets) at end of year2011-12-31$3,292
Employer contributions (assets) at beginning of year2011-12-31$2,708
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$153,935
Contract administrator fees2011-12-31$468
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-12-31No
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31REILLY, PENNER & BENTON LLP
Accountancy firm EIN2011-12-31390747409
2010 : BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2010 401k financial data
Total income from all sources (including contributions)2010-12-31$153,988
Total of all expenses incurred2010-12-31$82,540
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$82,000
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$71,938
Value of total assets at end of year2010-12-31$812,475
Value of total assets at beginning of year2010-12-31$741,027
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$540
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Was this plan covered by a fidelity bond2010-12-31No
If this is an individual account plan, was there a blackout period2010-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$60,428
Participant contributions at beginning of year2010-12-31$2,673
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$71,448
Value of net assets at end of year (total assets less liabilities)2010-12-31$812,475
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$741,027
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest in pooled separate accounts at end of year2010-12-31$747,025
Value of interest in pooled separate accounts at beginning of year2010-12-31$683,310
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$62,742
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$51,804
Net investment gain/loss from pooled separate accounts2010-12-31$82,050
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$11,510
Employer contributions (assets) at end of year2010-12-31$2,708
Employer contributions (assets) at beginning of year2010-12-31$3,240
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$82,000
Contract administrator fees2010-12-31$540
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-12-31No
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31REILLY, PENNER & BENTON LLP
Accountancy firm EIN2010-12-31390747409
2009 : BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN

2022: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedYes
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: BROAD ACRES NURSING HOME ASSOCIATION 403(B) PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedYes
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered116
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $95
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees95
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 3
Insurance contract or identification number613953
Number of Individuals Covered129
Insurance policy start date2021-05-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $29
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees29
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberBROA00PA00RN
Policy instance 2
Insurance contract or identification numberBROA00PA00RN
Number of Individuals Covered0
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $144
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $144
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberBROA00PA00RF
Policy instance 1
Insurance contract or identification numberBROA00PA00RF
Number of Individuals Covered0
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,008
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,008
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberBROA00PA00RN
Policy instance 2
Insurance contract or identification numberBROA00PA00RN
Number of Individuals Covered10
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $513
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $513
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberBROA00PA00RF
Policy instance 1
Insurance contract or identification numberBROA00PA00RF
Number of Individuals Covered25
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $2,995
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,995
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberBROA00PA00RN
Policy instance 2
Insurance contract or identification numberBROA00PA00RN
Number of Individuals Covered10
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $766
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $766
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberBROA00PA00RF
Policy instance 1
Insurance contract or identification numberBROA00PA00RF
Number of Individuals Covered32
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $3,336
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,336
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number0000BROA00PA00R
Policy instance 1
Insurance contract or identification number0000BROA00PA00R
Number of Individuals Covered32
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $3,336
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,336
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number0000BROA00PAOO
Policy instance 1
Insurance contract or identification number0000BROA00PAOO
Number of Individuals Covered40
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $4,180
Total amount of fees paid to insurance companyUSD $0
Contracts With Unallocated Funds Deposit Administration1
Commission paid to Insurance BrokerUSD $4,180
Amount paid for insurance broker fees0
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number0000BROA00PAOO
Policy instance 1
Insurance contract or identification number0000BROA00PAOO
Total amount of commissions paid to insurance brokerUSD $4,088
Total amount of fees paid to insurance companyUSD $0
Contracts With Unallocated Funds Deposit Administration1

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