401k Plan data: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN plan

CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 401k Plan overview

Plan Name	CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN
Plan identification number	001

CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) 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.
Participant-directed brokerage accounts provided as an investment option under the plan.
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

CAROLINA LIFESTYLES SENIOR CARE, INC. has sponsored the creation of one or more 401k plans.

Company Name: CAROLINA LIFESTYLES SENIOR CARE, INC.

Employer identification number (EIN): 262722845

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 PATTY AIKEN 2024-02-20 PATTY AIKEN 2024-02-20
001 2021-01-01
001 2021-01-01
001 2021-01-01 PATTY AIKEN
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01 PATTY AIKEN PATTY AIKEN 2018-12-11
001 2017-01-01 PATTY AIKEN PATTY AIKEN 2018-10-15
001 2016-01-01 PATTY AIKEN PATTY AIKEN 2017-12-27
001 2016-01-01 PATTY R. AIKEN 2017-10-05
001 2015-01-01 PATTY R. AIKEN PATTY R. AIKEN 2016-10-17
001 2015-01-01 PATTY R. AIKEN PATTY R. AIKEN 2016-10-19
001 2014-01-01 PATTY R. AIKEN PATTY R. AIKEN 2015-08-19
001 2013-01-01 PATTY R. AIKEN PATTY R. AIKEN 2014-11-03
001 2012-01-01 PATTY R. AIKEN PATTY R. AIKEN 2013-10-04
001 2012-01-01 PATTY R. AIKEN PATTY R. AIKEN 2014-11-03
001 2011-01-01 PATTY AIKEN PATTY AIKEN 2012-09-24
001 2009-01-01 PATTY AIKEN PATTY AIKEN 2010-06-10

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	PATTY AIKEN	2024-02-20	PATTY AIKEN	2024-02-20
001	2021-01-01
001	2021-01-01
001	2021-01-01	PATTY AIKEN
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2017-01-01	PATTY AIKEN		PATTY AIKEN	2018-12-11
001	2017-01-01	PATTY AIKEN		PATTY AIKEN	2018-10-15
001	2016-01-01	PATTY AIKEN		PATTY AIKEN	2017-12-27
001	2016-01-01			PATTY R. AIKEN	2017-10-05
001	2015-01-01	PATTY R. AIKEN		PATTY R. AIKEN	2016-10-17
001	2015-01-01	PATTY R. AIKEN		PATTY R. AIKEN	2016-10-19
001	2014-01-01	PATTY R. AIKEN		PATTY R. AIKEN	2015-08-19
001	2013-01-01	PATTY R. AIKEN		PATTY R. AIKEN	2014-11-03
001	2012-01-01	PATTY R. AIKEN		PATTY R. AIKEN	2013-10-04
001	2012-01-01	PATTY R. AIKEN		PATTY R. AIKEN	2014-11-03
001	2011-01-01	PATTY AIKEN		PATTY AIKEN	2012-09-24
001	2009-01-01	PATTY AIKEN		PATTY AIKEN	2010-06-10

Plan Statistics for CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN

401k plan membership statisitcs for CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN

Measure Date Value
2021: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 114
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 78
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 7
Total of all active and inactive participants 2021-01-01 85
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 85
Number of participants with account balances 2021-01-01 26
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 1
2020: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 117
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 88
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 7
Total of all active and inactive participants 2020-01-01 95
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 95
Number of participants with account balances 2020-01-01 30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 1
2019: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 124
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 103
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 9
Total of all active and inactive participants 2019-01-01 112
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 112
Number of participants with account balances 2019-01-01 33
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 3
2018: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 162
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 112
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 3
Total of all active and inactive participants 2018-01-01 115
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 115
Number of participants with account balances 2018-01-01 29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 129
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 142
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 4
Total of all active and inactive participants 2017-01-01 146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 146
Number of participants with account balances 2017-01-01 32
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 2
2016: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 120
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 108
Number of retired or separated participants receiving benefits 2016-01-01 1
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 109
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 109
Number of participants with account balances 2016-01-01 17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 2
2015: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 104
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 92
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 92
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 92
Number of participants with account balances 2015-01-01 15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 1
2014: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 102
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 92
Number of retired or separated participants receiving benefits 2014-01-01 3
Number of other retired or separated participants entitled to future benefits 2014-01-01 1
Total of all active and inactive participants 2014-01-01 96
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 96
Number of participants with account balances 2014-01-01 21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 2
2013: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 107
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 89
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 3
Total of all active and inactive participants 2013-01-01 92
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 92
Number of participants with account balances 2013-01-01 16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 109
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 115
Number of retired or separated participants receiving benefits 2012-01-01 1
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 116
Number of participants with account balances 2012-01-01 15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 118
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 98
Number of retired or separated participants receiving benefits 2011-01-01 2
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 100
Number of participants with account balances 2011-01-01 14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 87
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 103
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 1
Total of all active and inactive participants 2009-01-01 104
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 104
Number of participants with account balances 2009-01-01 13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2021: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	114
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	78
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	7
Total of all active and inactive participants	2021-01-01	85
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	85
Number of participants with account balances	2021-01-01	26
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	1
2020: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	117
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	88
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	7
Total of all active and inactive participants	2020-01-01	95
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	95
Number of participants with account balances	2020-01-01	30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	1
2019: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	124
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	103
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	9
Total of all active and inactive participants	2019-01-01	112
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	112
Number of participants with account balances	2019-01-01	33
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	3
2018: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	162
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	112
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	3
Total of all active and inactive participants	2018-01-01	115
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	115
Number of participants with account balances	2018-01-01	29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	129
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	142
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	4
Total of all active and inactive participants	2017-01-01	146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	146
Number of participants with account balances	2017-01-01	32
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	2
2016: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	120
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	108
Number of retired or separated participants receiving benefits	2016-01-01	1
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	109
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	109
Number of participants with account balances	2016-01-01	17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	2
2015: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	104
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	92
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	92
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	92
Number of participants with account balances	2015-01-01	15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	1
2014: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	102
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	92
Number of retired or separated participants receiving benefits	2014-01-01	3
Number of other retired or separated participants entitled to future benefits	2014-01-01	1
Total of all active and inactive participants	2014-01-01	96
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	96
Number of participants with account balances	2014-01-01	21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	2
2013: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	107
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	89
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	3
Total of all active and inactive participants	2013-01-01	92
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	92
Number of participants with account balances	2013-01-01	16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	109
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	115
Number of retired or separated participants receiving benefits	2012-01-01	1
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	116
Number of participants with account balances	2012-01-01	15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	118
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	98
Number of retired or separated participants receiving benefits	2011-01-01	2
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	100
Number of participants with account balances	2011-01-01	14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	87
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	103
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	1
Total of all active and inactive participants	2009-01-01	104
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	104
Number of participants with account balances	2009-01-01	13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN

Measure	Date	Value
2021 : CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$125,862
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$47,633
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$43,514
Value of total corrective distributions	2021-12-31	$240
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$48,923
Value of total assets at end of year	2021-12-31	$598,675
Value of total assets at beginning of year	2021-12-31	$520,446
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$3,879
Total interest from all sources	2021-12-31	$165
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$23,546
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$23,546
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$80,000
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	$44,678
Participant contributions at beginning of year	2021-12-31	$2,988
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	$78,229
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$598,675
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$520,446
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	$579,978
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$502,820
Interest on participant loans	2021-12-31	$38
Interest earned on other investments	2021-12-31	$127
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2021-12-31	$122
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2021-12-31	$122
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2021-12-31	$122
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$14,330
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$5,869
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$53,228
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	No
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	$4,245
Employer contributions (assets) at end of year	2021-12-31	$4,245
Employer contributions (assets) at beginning of year	2021-12-31	$8,647
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$43,514
Contract administrator fees	2021-12-31	$3,879
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Disclaimer
Accountancy firm name	2021-12-31	LEEPER, KEAN & RUMLEY, LLP
Accountancy firm EIN	2021-12-31	561333355
2020 : CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$93,386
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$6,584
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$3,287
Value of total corrective distributions	2020-12-31	$465
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$43,146
Value of total assets at end of year	2020-12-31	$520,446
Value of total assets at beginning of year	2020-12-31	$433,644
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$2,832
Total interest from all sources	2020-12-31	$162
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$14,116
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$14,116
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$80,000
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	$34,499
Participant contributions at end of year	2020-12-31	$2,988
Participant contributions at beginning of year	2020-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$86,802
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$520,446
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$433,644
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	$502,820
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$423,106
Interest on participant loans	2020-12-31	$68
Interest earned on other investments	2020-12-31	$93
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-12-31	$122
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-12-31	$77
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-12-31	$77
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-12-31	$1
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$5,869
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$3,130
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$35,962
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	$8,647
Employer contributions (assets) at end of year	2020-12-31	$8,647
Employer contributions (assets) at beginning of year	2020-12-31	$7,331
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$3,287
Contract administrator fees	2020-12-31	$2,832
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	LEEPER, KEAN & RUMLEY, LLP
Accountancy firm EIN	2020-12-31	561333355
2019 : CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$147,702
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$17,083
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$14,324
Value of total corrective distributions	2019-12-31	$149
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$70,879
Value of total assets at end of year	2019-12-31	$433,644
Value of total assets at beginning of year	2019-12-31	$303,025
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$2,610
Total interest from all sources	2019-12-31	$76
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$12,126
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	$12,126
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$50,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
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	$63,548
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$130,619
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$433,644
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$303,025
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	$423,106
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$293,461
Interest earned on other investments	2019-12-31	$74
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$77
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$129
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$129
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$2
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$3,130
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$2,549
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$64,621
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	$7,331
Employer contributions (assets) at end of year	2019-12-31	$7,331
Employer contributions (assets) at beginning of year	2019-12-31	$6,886
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$14,324
Contract administrator fees	2019-12-31	$2,610
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	LEEPER, KEAN & RUMLEY, LLP
Accountancy firm EIN	2019-12-31	561333355
2018 : CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$47,077
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$16,010
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$13,051
Value of total corrective distributions	2018-12-31	$58
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$70,677
Value of total assets at end of year	2018-12-31	$303,025
Value of total assets at beginning of year	2018-12-31	$271,958
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$2,901
Total interest from all sources	2018-12-31	$119
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$12,909
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$12,909
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$100,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$63,791
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	$31,067
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$303,025
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$271,958
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	$293,461
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$264,635
Interest earned on other investments	2018-12-31	$61
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-12-31	$129
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-12-31	$1,737
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-12-31	$1,737
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-31	$58
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$2,549
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$2,198
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-36,628
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	$6,886
Employer contributions (assets) at end of year	2018-12-31	$6,886
Employer contributions (assets) at beginning of year	2018-12-31	$3,388
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$13,051
Contract administrator fees	2018-12-31	$2,901
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	LEEPER, KEAN & RUMLEY, LLP
Accountancy firm EIN	2018-12-31	561333355
2017 : CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2017 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2017-12-31	$0
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total transfer of assets to this plan	2017-12-31	$257,765
Total transfer of assets from this plan	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$75,679
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$800,859
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$797,761
Expenses. Certain deemed distributions of participant loans	2017-12-31	$0
Value of total corrective distributions	2017-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$52,863
Value of total assets at end of year	2017-12-31	$268,570
Value of total assets at beginning of year	2017-12-31	$735,985
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$3,098
Total interest from all sources	2017-12-31	$3
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$6,099
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	$6,099
Assets. Real estate other than employer real property at end of year	2017-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2017-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2017-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2017-12-31	$0
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$100,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$52,863
Participant contributions at end of year	2017-12-31	$0
Participant contributions at beginning of year	2017-12-31	$0
Participant contributions at end of year	2017-12-31	$0
Participant contributions at beginning of year	2017-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2017-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2017-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2017-12-31	$0
Assets. Loans (other than to participants) at end of year	2017-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2017-12-31	$0
Other income not declared elsewhere	2017-12-31	$0
Administrative expenses (other) incurred	2017-12-31	$3,098
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
Income. Non cash contributions	2017-12-31	$0
Value of net income/loss	2017-12-31	$-725,180
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$268,570
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$735,985
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
Assets. partnership/joint venture interests at end of year	2017-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2017-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$264,635
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$735,985
Value of interest in pooled separate accounts at end of year	2017-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$0
Interest on participant loans	2017-12-31	$0
Income. Interest from loans (other than to participants)	2017-12-31	$0
Interest earned on other investments	2017-12-31	$3
Income. Interest from US Government securities	2017-12-31	$0
Income. Interest from corporate debt instruments	2017-12-31	$0
Value of interest in master investment trust accounts at end of year	2017-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2017-12-31	$0
Value of interest in common/collective trusts at end of year	2017-12-31	$0
Value of interest in common/collective trusts at beginning of year	2017-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-12-31	$1,737
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-12-31	$0
Assets. Value of investments in 103.12 investment entities at end of year	2017-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2017-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$2,198
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2017-12-31	$0
Asset value of US Government securities at end of year	2017-12-31	$0
Asset value of US Government securities at beginning of year	2017-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$16,714
Net investment gain/loss from pooled separate accounts	2017-12-31	$0
Net investment gain or loss from common/collective trusts	2017-12-31	$0
Net gain/loss from 103.12 investment entities	2017-12-31	$0
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	$3,388
Employer contributions (assets) at end of year	2017-12-31	$0
Employer contributions (assets) at beginning of year	2017-12-31	$0
Income. Dividends from preferred stock	2017-12-31	$0
Income. Dividends from common stock	2017-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$797,761
Asset. Corporate debt instrument preferred debt at end of year	2017-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2017-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2017-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2017-12-31	$0
Assets. Corporate common stocks other than exployer securities at end of year	2017-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2017-12-31	$0
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
Aggregate proceeds on sale of assets	2017-12-31	$258,351
Aggregate carrying amount (costs) on sale of assets	2017-12-31	$258,351
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	LEEPER, KEAN & RUMLEY, LLP
Accountancy firm EIN	2017-12-31	561333355
2016 : CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2016 401k financial data
Transfers to/from the plan	2016-12-31	$0
Total plan liabilities at end of year	2016-12-31	$0
Total plan liabilities at beginning of year	2016-12-31	$0
Total income from all sources	2016-12-31	$-152,871
Expenses. Total of all expenses incurred	2016-12-31	$0
Benefits paid (including direct rollovers)	2016-12-31	$0
Total plan assets at end of year	2016-12-31	$731,397
Total plan assets at beginning of year	2016-12-31	$884,268
Value of fidelity bond covering the plan	2016-12-31	$100,000
Total contributions received or receivable from participants	2016-12-31	$38,084
Expenses. Other expenses not covered elsewhere	2016-12-31	$0
Contributions received from other sources (not participants or employers)	2016-12-31	$0
Other income received	2016-12-31	$-195,544
Noncash contributions received	2016-12-31	$0
Net income (gross income less expenses)	2016-12-31	$-152,871
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$731,397
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$884,268
Assets. Value of employer securities	2016-12-31	$0
Total contributions received or receivable from employer(s)	2016-12-31	$4,589
Value of certain deemed distributions of participant loans	2016-12-31	$0
Value of corrective distributions	2016-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2015 401k financial data
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$171,914
Expenses. Total of all expenses incurred	2015-12-31	$45,381
Benefits paid (including direct rollovers)	2015-12-31	$45,381
Total plan assets at end of year	2015-12-31	$884,268
Total plan assets at beginning of year	2015-12-31	$757,735
Value of fidelity bond covering the plan	2015-12-31	$50,000
Total contributions received or receivable from participants	2015-12-31	$33,203
Expenses. Other expenses not covered elsewhere	2015-12-31	$0
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$131,538
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$126,533
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$884,268
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$757,735
Assets. Value of employer securities	2015-12-31	$676,965
Total contributions received or receivable from employer(s)	2015-12-31	$7,173
Value of certain deemed distributions of participant loans	2015-12-31	$0
Value of corrective distributions	2015-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total plan liabilities at end of year	2014-12-31	$0
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$127,976
Expenses. Total of all expenses incurred	2014-12-31	$10,139
Benefits paid (including direct rollovers)	2014-12-31	$10,139
Total plan assets at end of year	2014-12-31	$757,735
Total plan assets at beginning of year	2014-12-31	$639,898
Value of fidelity bond covering the plan	2014-12-31	$50,000
Total contributions received or receivable from participants	2014-12-31	$23,707
Expenses. Other expenses not covered elsewhere	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$98,598
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$117,837
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$757,735
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$639,898
Assets. Value of employer securities	2014-12-31	$541,293
Total contributions received or receivable from employer(s)	2014-12-31	$5,671
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total plan liabilities at end of year	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$82,032
Expenses. Total of all expenses incurred	2013-12-31	$7,978
Benefits paid (including direct rollovers)	2013-12-31	$7,978
Total plan assets at end of year	2013-12-31	$643,469
Total plan assets at beginning of year	2013-12-31	$569,415
Value of fidelity bond covering the plan	2013-12-31	$40,000
Total contributions received or receivable from participants	2013-12-31	$6,044
Expenses. Other expenses not covered elsewhere	2013-12-31	$0
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$53,001
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$74,054
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$643,469
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$569,415
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102	2013-12-31	$25
Assets. Value of employer securities	2013-12-31	$448,981
Total contributions received or receivable from employer(s)	2013-12-31	$22,987
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total plan liabilities at end of year	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$41,913
Expenses. Total of all expenses incurred	2012-12-31	$10,415
Benefits paid (including direct rollovers)	2012-12-31	$10,415
Total plan assets at end of year	2012-12-31	$569,415
Total plan assets at beginning of year	2012-12-31	$537,917
Value of fidelity bond covering the plan	2012-12-31	$40,000
Total contributions received or receivable from participants	2012-12-31	$19,861
Expenses. Other expenses not covered elsewhere	2012-12-31	$0
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$16,442
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$31,498
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$569,415
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$537,917
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102	2012-12-31	$25
Assets. Value of employer securities	2012-12-31	$417,612
Total contributions received or receivable from employer(s)	2012-12-31	$5,610
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$76,536
Expenses. Total of all expenses incurred	2011-12-31	$4,268
Benefits paid (including direct rollovers)	2011-12-31	$4,268
Total plan assets at end of year	2011-12-31	$537,984
Total plan assets at beginning of year	2011-12-31	$465,716
Value of fidelity bond covering the plan	2011-12-31	$40,000
Total contributions received or receivable from participants	2011-12-31	$24,143
Expenses. Other expenses not covered elsewhere	2011-12-31	$0
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$48,382
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$72,268
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$537,984
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$465,716
Assets. Value of employer securities	2011-12-31	$408,875
Total contributions received or receivable from employer(s)	2011-12-31	$4,011
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$137,903
Expenses. Total of all expenses incurred	2010-12-31	$2,292
Benefits paid (including direct rollovers)	2010-12-31	$2,292
Total plan assets at end of year	2010-12-31	$465,716
Total plan assets at beginning of year	2010-12-31	$330,105
Value of fidelity bond covering the plan	2010-12-31	$35,000
Total contributions received or receivable from participants	2010-12-31	$24,214
Expenses. Other expenses not covered elsewhere	2010-12-31	$0
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$109,149
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$135,611
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$465,716
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$330,105
Assets. Value of employer securities	2010-12-31	$356,252
Total contributions received or receivable from employer(s)	2010-12-31	$4,540
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0

Form 5500 Responses for CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN

2021: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	Yes
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	Yes
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	Yes
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	Yes
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: CAROLINA LIFESTYLES SENIOR CARE, INC. 401(K) PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

CUNA MUTUAL GROUP (National Association of Insurance Commissioners NAIC id number: 62626 )
Policy contract number	3208540
Policy instance	1
CUNA MUTUAL GROUP (National Association of Insurance Commissioners NAIC id number: 62626 )
Policy contract number	3208540
Policy instance	1
CUNA MUTUAL GROUP (National Association of Insurance Commissioners NAIC id number: 62626 )
Policy contract number	3208540
Policy instance	1
CUNA MUTUAL GROUP (National Association of Insurance Commissioners NAIC id number: 62626 )
Policy contract number	3208540
Policy instance	1
CUNA MUTUAL GROUP (National Association of Insurance Commissioners NAIC id number: 62626 )
Policy contract number	100051
Policy instance	1

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Company Name:	CAROLINA LIFESTYLES SENIOR CARE, INC.
Employer identification number (EIN):	262722845
NAIC Classification:	624100
NAIC Description:	Individual and Family Services