401k Plan data: CASEY'S POND SENIOR LIVING 403B PLAN plan

CASEY'S POND SENIOR LIVING 403B PLAN 401k Plan overview

Plan Name	CASEY'S POND SENIOR LIVING 403B PLAN
Plan identification number	001

CASEY'S POND SENIOR LIVING 403B PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.

401k Sponsoring company profile

COLORADO SENIOR RESIDENCES INC has sponsored the creation of one or more 401k plans.

Company Name: COLORADO SENIOR RESIDENCES INC

Employer identification number (EIN): 271953892

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CASEY'S POND SENIOR LIVING 403B PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 DEBBIE WILLIAMS 2023-08-08
001 2021-01-01 DEBBIE WILLIAMS 2022-09-29
001 2020-01-01 DEBBIE WILLIAMS 2021-10-11
001 2019-01-01 DEBBIE WILLIAMS 2020-10-08
001 2018-01-01
001 2017-01-01 DEBBIE WILLIAMS
001 2016-01-01 DEBBIE WILLIAMS
001 2015-01-01 DEBBIE WILLIAMS DEBBIE WILLIAMS 2016-09-27
001 2014-01-01 DEBBIE WILLIAMS DEBBIE WILLIAMS 2015-08-28
001 2013-05-01 TOM FINLEY 2014-10-13 TOM FINLEY 2014-10-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	DEBBIE WILLIAMS	2023-08-08
001	2021-01-01	DEBBIE WILLIAMS	2022-09-29
001	2020-01-01	DEBBIE WILLIAMS	2021-10-11
001	2019-01-01	DEBBIE WILLIAMS	2020-10-08
001	2018-01-01
001	2017-01-01	DEBBIE WILLIAMS
001	2016-01-01	DEBBIE WILLIAMS
001	2015-01-01	DEBBIE WILLIAMS		DEBBIE WILLIAMS	2016-09-27
001	2014-01-01	DEBBIE WILLIAMS		DEBBIE WILLIAMS	2015-08-28
001	2013-05-01	TOM FINLEY	2014-10-13	TOM FINLEY	2014-10-13

Plan Statistics for CASEY'S POND SENIOR LIVING 403B PLAN

401k plan membership statisitcs for CASEY'S POND SENIOR LIVING 403B PLAN

Measure Date Value
2018: CASEY'S POND SENIOR LIVING 403B PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 217
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 124
Number of other retired or separated participants entitled to future benefits 2018-01-01 50
Total of all active and inactive participants 2018-01-01 174
Total participants 2018-01-01 174
Number of participants with account balances 2018-01-01 67
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: CASEY'S POND SENIOR LIVING 403B PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 226
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 163
Number of other retired or separated participants entitled to future benefits 2017-01-01 57
Total of all active and inactive participants 2017-01-01 220
Total participants 2017-01-01 220
Number of participants with account balances 2017-01-01 109
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 7
2016: CASEY'S POND SENIOR LIVING 403B PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 210
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 166
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 60
Total of all active and inactive participants 2016-01-01 226
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 226
Number of participants with account balances 2016-01-01 118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 11
2015: CASEY'S POND SENIOR LIVING 403B PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 225
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 162
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 48
Total of all active and inactive participants 2015-01-01 210
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 210
Number of participants with account balances 2015-01-01 108
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 8
2014: CASEY'S POND SENIOR LIVING 403B PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 166
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 196
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 26
Total of all active and inactive participants 2014-01-01 222
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 222
Number of participants with account balances 2014-01-01 111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0

Measure	Date	Value
2018: CASEY'S POND SENIOR LIVING 403B PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	217
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	124
Number of other retired or separated participants entitled to future benefits	2018-01-01	50
Total of all active and inactive participants	2018-01-01	174
Total participants	2018-01-01	174
Number of participants with account balances	2018-01-01	67
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: CASEY'S POND SENIOR LIVING 403B PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	226
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	163
Number of other retired or separated participants entitled to future benefits	2017-01-01	57
Total of all active and inactive participants	2017-01-01	220
Total participants	2017-01-01	220
Number of participants with account balances	2017-01-01	109
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	7
2016: CASEY'S POND SENIOR LIVING 403B PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	210
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	166
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	60
Total of all active and inactive participants	2016-01-01	226
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	226
Number of participants with account balances	2016-01-01	118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	11
2015: CASEY'S POND SENIOR LIVING 403B PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	225
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	162
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	48
Total of all active and inactive participants	2015-01-01	210
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	210
Number of participants with account balances	2015-01-01	108
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	8
2014: CASEY'S POND SENIOR LIVING 403B PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	166
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	196
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	26
Total of all active and inactive participants	2014-01-01	222
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	222
Number of participants with account balances	2014-01-01	111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0

Financial Data on CASEY'S POND SENIOR LIVING 403B PLAN

Measure	Date	Value
2018 : CASEY'S POND SENIOR LIVING 403B PLAN 2018 401k financial data
Total income from all sources (including contributions)	2018-12-31	$-6,860
Total of all expenses incurred	2018-12-31	$1,587,159
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$1,561,870
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$45,156
Value of total assets at end of year	2018-12-31	$487,895
Value of total assets at beginning of year	2018-12-31	$2,081,914
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$25,289
Total interest from all sources	2018-12-31	$2,273
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$51,475
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	$51,475
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$1,000,000
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	$45,156
Participant contributions at beginning of year	2018-12-31	$5,178
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	$-1,594,019
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$487,895
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$2,081,914
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	$465,582
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$1,894,837
Interest earned on other investments	2018-12-31	$2,273
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$22,313
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$156,400
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-105,764
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
Employer contributions (assets) at beginning of year	2018-12-31	$25,499
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$1,561,870
Contract administrator fees	2018-12-31	$25,289
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	PLANTE & MORAN, PLLC
Accountancy firm EIN	2018-12-31	381357951
2017 : CASEY'S POND SENIOR LIVING 403B PLAN 2017 401k financial data
Total income from all sources (including contributions)	2017-12-31	$426,299
Total of all expenses incurred	2017-12-31	$100,777
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$72,975
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$141,619
Value of total assets at end of year	2017-12-31	$2,081,914
Value of total assets at beginning of year	2017-12-31	$1,756,392
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$27,802
Total interest from all sources	2017-12-31	$3,019
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$74,818
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	$74,818
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$1,000,000
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	$115,409
Participant contributions at beginning of year	2017-12-31	$0
Participant contributions at end of year	2017-12-31	$5,178
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	$1,142
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	$325,522
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$2,081,914
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$1,756,392
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	$1,894,837
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$1,585,980
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$0
Interest on participant loans	2017-12-31	$26
Interest earned on other investments	2017-12-31	$2,993
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$156,400
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$140,579
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$206,843
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	$25,068
Employer contributions (assets) at end of year	2017-12-31	$25,499
Employer contributions (assets) at beginning of year	2017-12-31	$29,833
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$72,975
Contract administrator fees	2017-12-31	$27,802
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	EKS&H LLLP
Accountancy firm EIN	2017-12-31	461497033
2016 : CASEY'S POND SENIOR LIVING 403B PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$298,885
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$288,810
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$261,586
Expenses. Certain deemed distributions of participant loans	2016-12-31	$1,492
Value of total corrective distributions	2016-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$158,194
Value of total assets at end of year	2016-12-31	$1,756,392
Value of total assets at beginning of year	2016-12-31	$1,746,317
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$25,732
Total interest from all sources	2016-12-31	$2,952
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$73,503
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$73,503
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Funding deficiency by the employer to the plan for this plan year	2016-12-31	$0
Minimum employer required contribution for this plan year	2016-12-31	$0
Amount contributed by the employer to the plan for this plan year	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$105,096
Participant contributions at end of year	2016-12-31	$0
Participant contributions at beginning of year	2016-12-31	$1,711
Assets. Other investments not covered elsewhere at end of year	2016-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2016-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$22,404
Administrative expenses (other) incurred	2016-12-31	$3
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$10,075
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$1,756,392
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$1,746,317
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$1,585,980
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$1,537,513
Value of interest in pooled separate accounts at end of year	2016-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$0
Interest on participant loans	2016-12-31	$45
Interest earned on other investments	2016-12-31	$2,907
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$140,579
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$166,842
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$64,236
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$30,694
Employer contributions (assets) at end of year	2016-12-31	$29,833
Employer contributions (assets) at beginning of year	2016-12-31	$40,251
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$261,586
Contract administrator fees	2016-12-31	$25,729
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	EKS&H LLLP
Accountancy firm EIN	2016-12-31	461497033
2015 : CASEY'S POND SENIOR LIVING 403B PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$166,758
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$360,199
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$333,345
Expenses. Certain deemed distributions of participant loans	2015-12-31	$0
Value of total corrective distributions	2015-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$184,530
Value of total assets at end of year	2015-12-31	$1,746,317
Value of total assets at beginning of year	2015-12-31	$1,939,758
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$26,854
Total interest from all sources	2015-12-31	$4,354
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$61,691
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$61,691
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$144,604
Participant contributions at end of year	2015-12-31	$1,711
Participant contributions at beginning of year	2015-12-31	$2,621
Participant contributions at beginning of year	2015-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2015-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2015-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$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	2015-12-31	No
Value of net income/loss	2015-12-31	$-193,441
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$1,746,317
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$1,939,758
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$1,537,513
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$1,699,987
Value of interest in pooled separate accounts at end of year	2015-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$0
Interest on participant loans	2015-12-31	$91
Interest earned on other investments	2015-12-31	$4,263
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$166,842
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$229,761
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-83,817
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$39,926
Employer contributions (assets) at end of year	2015-12-31	$40,251
Employer contributions (assets) at beginning of year	2015-12-31	$7,389
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$333,345
Contract administrator fees	2015-12-31	$26,854
Liabilities. Value of benefit claims payable at beginning of year	2015-12-31	$0
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	EKS&H LLLP
Accountancy firm EIN	2015-12-31	461497033
2014 : CASEY'S POND SENIOR LIVING 403B PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$2,274,157
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$391,371
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$362,668
Expenses. Certain deemed distributions of participant loans	2014-12-31	$4,775
Value of total corrective distributions	2014-12-31	$1,518
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$2,215,585
Value of total assets at end of year	2014-12-31	$1,939,758
Value of total assets at beginning of year	2014-12-31	$56,972
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$22,410
Total interest from all sources	2014-12-31	$4,753
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$48,299
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$48,299
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$177,919
Participant contributions at end of year	2014-12-31	$2,621
Participant contributions at beginning of year	2014-12-31	$0
Participant contributions at end of year	2014-12-31	$0
Participant contributions at beginning of year	2014-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2014-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2014-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$2,030,277
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$0
Administrative expenses (other) incurred	2014-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$1,882,786
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$1,939,758
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$56,972
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$1,699,987
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$53,790
Value of interest in pooled separate accounts at end of year	2014-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$0
Interest on participant loans	2014-12-31	$43
Interest earned on other investments	2014-12-31	$4,710
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$229,761
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$3,182
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$5,520
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$7,389
Employer contributions (assets) at end of year	2014-12-31	$7,389
Employer contributions (assets) at beginning of year	2014-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$362,668
Contract administrator fees	2014-12-31	$22,410
Liabilities. Value of benefit claims payable at end of year	2014-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2014-12-31	$0
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	EKS&H LLLP
Accountancy firm EIN	2014-12-31	461497033

Form 5500 Responses for CASEY'S POND SENIOR LIVING 403B PLAN

2018: CASEY'S POND SENIOR LIVING 403B PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
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: CASEY'S POND SENIOR LIVING 403B PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
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: CASEY'S POND SENIOR LIVING 403B PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: CASEY'S POND SENIOR LIVING 403B PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: CASEY'S POND SENIOR LIVING 403B PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	First time form 5500 has been submitted	Yes
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

71002

Policy instance

Insurance contract or identification number	71002
Number of Individuals Covered	110
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

71002

Policy instance

Insurance contract or identification number	71002
Number of Individuals Covered	109
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

71002

Policy instance

Insurance contract or identification number	71002
Number of Individuals Covered	111
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

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Company Name:	COLORADO SENIOR RESIDENCES INC
Employer identification number (EIN):	271953892
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities