401k Plan data: GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN plan

GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN 401k Plan overview

Plan Name	GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN
Plan identification number	001

GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS 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 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

GRACE COMMUNITY HEALTH CENTER, INC. has sponsored the creation of one or more 401k plans.

Company Name: GRACE COMMUNITY HEALTH CENTER, INC.

Employer identification number (EIN): 261779437

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 MICHAEL STANLEY 2023-10-05
001 2021-01-01 MICHAEL STANLEY 2022-10-12
001 2020-01-01 MICHAEL STANLEY 2021-08-03
001 2019-01-01 MICHAEL STANLEY 2020-07-29
001 2018-01-01 MICHAEL STANLEY 2019-08-13
001 2017-01-01
001 2016-01-01
001 2015-01-01
001 2014-01-01 MICHAEL STANLEY 2015-10-13
001 2013-01-01 MICHAEL STANLEY 2014-07-20
001 2012-01-01 MICHAEL STANLEY 2013-09-29
001 2011-01-01 MICHAEL STANLEY 2012-09-19
001 2010-01-01 DAVID WORTHY 2011-09-23

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-01-01	MICHAEL STANLEY	2023-10-05
001	2021-01-01	MICHAEL STANLEY	2022-10-12
001	2020-01-01	MICHAEL STANLEY	2021-08-03
001	2019-01-01	MICHAEL STANLEY	2020-07-29
001	2018-01-01	MICHAEL STANLEY	2019-08-13
001	2017-01-01
001	2016-01-01
001	2015-01-01
001	2014-01-01	MICHAEL STANLEY	2015-10-13
001	2013-01-01	MICHAEL STANLEY	2014-07-20
001	2012-01-01	MICHAEL STANLEY	2013-09-29
001	2011-01-01	MICHAEL STANLEY	2012-09-19
001	2010-01-01	DAVID WORTHY	2011-09-23

Plan Statistics for GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN

401k plan membership statisitcs for GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN

Measure Date Value
2022: GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 425
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 336
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 113
Total of all active and inactive participants 2022-01-01 449
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 449
Number of participants with account balances 2022-01-01 420
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 359
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 294
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 131
Total of all active and inactive participants 2021-01-01 425
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 425
Number of participants with account balances 2021-01-01 393
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 333
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 270
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 89
Total of all active and inactive participants 2020-01-01 359
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 359
Number of participants with account balances 2020-01-01 314
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 289
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 272
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 61
Total of all active and inactive participants 2019-01-01 333
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 333
Number of participants with account balances 2019-01-01 268
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 271
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 245
Number of other retired or separated participants entitled to future benefits 2018-01-01 51
Total of all active and inactive participants 2018-01-01 296
Total participants 2018-01-01 296
Number of participants with account balances 2018-01-01 192
2017: GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 264
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 207
Number of other retired or separated participants entitled to future benefits 2017-01-01 40
Total of all active and inactive participants 2017-01-01 247
Total participants 2017-01-01 247
Number of participants with account balances 2017-01-01 162
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0

Measure	Date	Value
2022: GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	425
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	336
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	113
Total of all active and inactive participants	2022-01-01	449
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	449
Number of participants with account balances	2022-01-01	420
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	359
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	294
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	131
Total of all active and inactive participants	2021-01-01	425
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	425
Number of participants with account balances	2021-01-01	393
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	333
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	270
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	89
Total of all active and inactive participants	2020-01-01	359
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	359
Number of participants with account balances	2020-01-01	314
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	289
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	272
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	61
Total of all active and inactive participants	2019-01-01	333
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	333
Number of participants with account balances	2019-01-01	268
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	271
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	245
Number of other retired or separated participants entitled to future benefits	2018-01-01	51
Total of all active and inactive participants	2018-01-01	296
Total participants	2018-01-01	296
Number of participants with account balances	2018-01-01	192
2017: GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	264
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	207
Number of other retired or separated participants entitled to future benefits	2017-01-01	40
Total of all active and inactive participants	2017-01-01	247
Total participants	2017-01-01	247
Number of participants with account balances	2017-01-01	162
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0

Financial Data on GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN

Measure	Date	Value
2022 : GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN 2022 401k financial data
Total income from all sources (including contributions)	2022-12-31	$142,142
Total of all expenses incurred	2022-12-31	$651,675
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$646,469
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$1,940,284
Value of total assets at end of year	2022-12-31	$9,436,898
Value of total assets at beginning of year	2022-12-31	$9,946,431
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$5,206
Total interest from all sources	2022-12-31	$6,178
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$400,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$1,199,125
Participant contributions at end of year	2022-12-31	$658
Participant contributions at beginning of year	2022-12-31	$32
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$6,778
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-509,533
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$9,436,898
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$9,946,431
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$9,030,152
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$9,697,296
Interest earned on other investments	2022-12-31	$6,178
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$406,088
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$249,071
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-1,804,320
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$734,381
Employer contributions (assets) at beginning of year	2022-12-31	$32
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$646,469
Contract administrator fees	2022-12-31	$5,206
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	FORVIS LLP
Accountancy firm EIN	2022-12-31	440160260
2021 : GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN 2021 401k financial data
Total income from all sources (including contributions)	2021-12-31	$2,781,316
Total of all expenses incurred	2021-12-31	$680,389
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$678,499
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$1,612,856
Value of total assets at end of year	2021-12-31	$9,946,431
Value of total assets at beginning of year	2021-12-31	$7,845,504
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$1,890
Total interest from all sources	2021-12-31	$2,238
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$400,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$916,372
Participant contributions at end of year	2021-12-31	$32
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$149,088
Administrative expenses (other) incurred	2021-12-31	$1,890
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$2,100,927
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$9,946,431
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$7,845,504
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$9,697,296
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$7,709,515
Interest earned on other investments	2021-12-31	$2,238
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$249,071
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$135,989
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$1,166,222
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$547,396
Employer contributions (assets) at end of year	2021-12-31	$32
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$678,499
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	DEAN DORTON ALLEN FORD PLLC
Accountancy firm EIN	2021-12-31	273858252
2020 : GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN 2020 401k financial data
Total income from all sources (including contributions)	2020-12-31	$2,753,780
Total of all expenses incurred	2020-12-31	$528,782
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$526,622
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$1,598,789
Value of total assets at end of year	2020-12-31	$7,845,504
Value of total assets at beginning of year	2020-12-31	$5,620,506
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$2,160
Total interest from all sources	2020-12-31	$1,870
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$400,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$884,112
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$209,114
Administrative expenses (other) incurred	2020-12-31	$2,160
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$2,224,998
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$7,845,504
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$5,620,506
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$7,709,515
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$5,620,451
Interest earned on other investments	2020-12-31	$1,870
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$135,989
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$1,153,121
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$505,563
Employer contributions (assets) at beginning of year	2020-12-31	$55
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$526,622
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	DEAN DORTON ALLEN FORD PLLC
Accountancy firm EIN	2020-12-31	273858252
2019 : GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN 2019 401k financial data
Total income from all sources (including contributions)	2019-12-31	$1,975,630
Total of all expenses incurred	2019-12-31	$246,325
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$244,830
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$1,106,439
Value of total assets at end of year	2019-12-31	$5,620,506
Value of total assets at beginning of year	2019-12-31	$3,891,201
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$1,495
Total interest from all sources	2019-12-31	$52
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$13,151
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$13,151
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$400,000
If this is an individual account plan, was there a blackout period	2019-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$705,720
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$1,754
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Income. Non cash contributions	2019-12-31	$0
Value of net income/loss	2019-12-31	$1,729,305
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$5,620,506
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$3,891,201
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$5,620,451
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$3,890,439
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$762
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$762
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$52
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$855,988
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$398,965
Employer contributions (assets) at end of year	2019-12-31	$55
Employer contributions (assets) at beginning of year	2019-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$244,830
Contract administrator fees	2019-12-31	$1,495
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	2019-12-31	Yes
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	DEAN DORTON ALLEN FORD PLLC
Accountancy firm EIN	2019-12-31	273858252
2018 : GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN 2018 401k financial data
Total income from all sources (including contributions)	2018-12-31	$779,019
Total of all expenses incurred	2018-12-31	$173,012
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$171,124
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$996,581
Value of total assets at end of year	2018-12-31	$3,891,201
Value of total assets at beginning of year	2018-12-31	$3,285,194
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$1,888
Total interest from all sources	2018-12-31	$46
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$330,000
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	$622,189
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$30,421
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	$606,007
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$3,891,201
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$3,285,194
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	$3,890,439
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$3,284,134
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-12-31	$762
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-12-31	$1,060
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-12-31	$1,060
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-31	$46
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-217,608
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	$343,971
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$171,124
Contract administrator fees	2018-12-31	$1,888
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	DEAN DORTON ALLEN FORD PLLC
Accountancy firm EIN	2018-12-31	273858252
2017 : GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN 2017 401k financial data
Total income from all sources (including contributions)	2017-12-31	$1,836,474
Total of all expenses incurred	2017-12-31	$142,061
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$140,241
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$1,425,230
Value of total assets at end of year	2017-12-31	$3,285,194
Value of total assets at beginning of year	2017-12-31	$1,590,781
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$1,820
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$89,223
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	$89,223
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$330,000
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	$557,588
Participant contributions at beginning of year	2017-12-31	$1,659
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$558,173
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	$1,694,413
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$3,285,194
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$1,590,781
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	$3,284,134
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$1,586,967
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-12-31	$1,060
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-12-31	$142
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-12-31	$142
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$322,021
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	$309,469
Employer contributions (assets) at beginning of year	2017-12-31	$2,013
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$140,241
Contract administrator fees	2017-12-31	$1,820
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	DEAN DORTON ALLEN FORD PLLC
Accountancy firm EIN	2017-12-31	273858252

Form 5500 Responses for GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN

2022: GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: GRACE COMMUNITY HEALTH CENTER, INC. 401(K) RETIRMENT SAVINGS PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

B21-80017

Policy instance

Insurance contract or identification number	B21-80017
Number of Individuals Covered	420
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $948
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	948
Additional information about fees paid to insurance broker	ADMINISTRATIVE CHARGES
Insurance broker organization code?	4

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

B21-80017

Policy instance

Insurance contract or identification number	B21-80017
Number of Individuals Covered	393
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $361
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	361
Additional information about fees paid to insurance broker	ADMINISTRATIVE CHARGES
Insurance broker organization code?	4

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

B21-80017

Policy instance

Insurance contract or identification number	B21-80017
Number of Individuals Covered	314
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $254
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	254
Additional information about fees paid to insurance broker	ADMINISTRATIVE CHARGES
Insurance broker organization code?	4

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Company Name:	GRACE COMMUNITY HEALTH CENTER, INC.
Employer identification number (EIN):	261779437
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities