401k Plan data: FIRST COMMUNITY VILLAGE FIRST COMMUNITY FINAL plan

FIRST COMMUNITY VILLAGE FIRST COMMUNITY FINAL 401k Plan overview

Plan Name	FIRST COMMUNITY VILLAGE FIRST COMMUNITY FINAL
Plan identification number	002

FIRST COMMUNITY VILLAGE FIRST COMMUNITY FINAL Benefits

401k Plan Type	Defined Contribution Pension
Plan Features/Benefits	Money purchase (other than target benefit) 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.

401k Sponsoring company profile

FIRST COMMUNITY VILLAGE has sponsored the creation of one or more 401k plans.

Company Name: FIRST COMMUNITY VILLAGE

Employer identification number (EIN): 310655502

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

Additional information about FIRST COMMUNITY VILLAGE

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division

Incorporation Date: 1961-03-17

Company Identification Number: 298822

Legal Registered Office Address: 904 MASTER DRIVE
-
GALLOWAY
United States of America (USA)
43119

More information about FIRST COMMUNITY VILLAGE

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FIRST COMMUNITY VILLAGE FIRST COMMUNITY FINAL

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2012-01-01 DAVID KAYUHA
002 2011-01-01 DAVID KAYUHA
002 2009-01-01 DIANE TOMLINSON DIANE TOMLINSON 2010-10-05

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
002	2012-01-01	DAVID KAYUHA
002	2011-01-01	DAVID KAYUHA
002	2009-01-01	DIANE TOMLINSON	DIANE TOMLINSON	2010-10-05

Plan Statistics for FIRST COMMUNITY VILLAGE FIRST COMMUNITY FINAL

401k plan membership statisitcs for FIRST COMMUNITY VILLAGE FIRST COMMUNITY FINAL

Measure Date Value
2012: FIRST COMMUNITY VILLAGE FIRST COMMUNITY FINAL 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 0
Number of retired or separated participants receiving benefits 2012-01-01 0
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 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 0
Number of participants with account balances 2012-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: FIRST COMMUNITY VILLAGE FIRST COMMUNITY FINAL 2011 401k membership
Total participants, beginning-of-year 2011-01-01 230
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1
Number of retired or separated participants receiving benefits 2011-01-01 0
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 1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 1
Number of participants with account balances 2011-01-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: FIRST COMMUNITY VILLAGE FIRST COMMUNITY FINAL 2009 401k membership
Total participants, beginning-of-year 2009-01-01 224
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 185
Number of retired or separated participants receiving benefits 2009-01-01 9
Number of other retired or separated participants entitled to future benefits 2009-01-01 36
Total of all active and inactive participants 2009-01-01 230
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 1
Total participants 2009-01-01 231
Number of participants with account balances 2009-01-01 231
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2012: FIRST COMMUNITY VILLAGE FIRST COMMUNITY FINAL 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	0
Number of retired or separated participants receiving benefits	2012-01-01	0
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	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	0
Number of participants with account balances	2012-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: FIRST COMMUNITY VILLAGE FIRST COMMUNITY FINAL 2011 401k membership
Total participants, beginning-of-year	2011-01-01	230
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1
Number of retired or separated participants receiving benefits	2011-01-01	0
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	1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	1
Number of participants with account balances	2011-01-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: FIRST COMMUNITY VILLAGE FIRST COMMUNITY FINAL 2009 401k membership
Total participants, beginning-of-year	2009-01-01	224
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	185
Number of retired or separated participants receiving benefits	2009-01-01	9
Number of other retired or separated participants entitled to future benefits	2009-01-01	36
Total of all active and inactive participants	2009-01-01	230
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	1
Total participants	2009-01-01	231
Number of participants with account balances	2009-01-01	231
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on FIRST COMMUNITY VILLAGE FIRST COMMUNITY FINAL

Measure	Date	Value
2012 : FIRST COMMUNITY VILLAGE FIRST COMMUNITY FINAL 2012 401k financial data
Total income from all sources	2012-05-03	$-53
Expenses. Total of all expenses incurred	2012-05-03	$20,564
Benefits paid (including direct rollovers)	2012-05-03	$20,564
Total plan assets at end of year	2012-05-03	$0
Total plan assets at beginning of year	2012-05-03	$20,617
Value of fidelity bond covering the plan	2012-05-03	$500,000
Other income received	2012-05-03	$-53
Net income (gross income less expenses)	2012-05-03	$-20,617
Net plan assets at end of year (total assets less liabilities)	2012-05-03	$0
Net plan assets at beginning of year (total assets less liabilities)	2012-05-03	$20,617
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-05-03	$0
Funding deficiency by the employer to the plan for this plan year	2012-05-03	$0
Minimum employer required contribution for this plan year	2012-05-03	$0
Amount contributed by the employer to the plan for this plan year	2012-05-03	$0
2011 : FIRST COMMUNITY VILLAGE FIRST COMMUNITY FINAL 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$27,451
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$2,841,611
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$2,831,591
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$0
Value of total assets at end of year	2011-12-31	$20,617
Value of total assets at beginning of year	2011-12-31	$2,834,777
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$10,020
Total interest from all sources	2011-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2011-12-31	$0
Administrative expenses professional fees incurred	2011-12-31	$10,020
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$500,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2011-12-31	$0
Minimum employer required contribution for this plan year	2011-12-31	$0
Amount contributed by the employer to the plan for this plan year	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$-2,814,160
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$20,617
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$2,834,777
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in pooled separate accounts at end of year	2011-12-31	$20,617
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$1,775,730
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$964,114
Net investment gain or loss from common/collective trusts	2011-12-31	$27,451
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Employer contributions (assets) at end of year	2011-12-31	$0
Employer contributions (assets) at beginning of year	2011-12-31	$94,933
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$2,831,591
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	HOWARD WERSHBALE & CO
Accountancy firm EIN	2011-12-31	341663157
2010 : FIRST COMMUNITY VILLAGE FIRST COMMUNITY FINAL 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$511,778
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$366,422
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$366,422
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$316,456
Value of total assets at end of year	2010-12-31	$2,834,777
Value of total assets at beginning of year	2010-12-31	$2,689,421
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$0
Total interest from all sources	2010-12-31	$26,966
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$500,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2010-12-31	$0
Minimum employer required contribution for this plan year	2010-12-31	$307,446
Amount contributed by the employer to the plan for this plan year	2010-12-31	$307,446
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$8,710
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$145,356
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$2,834,777
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$2,689,421
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in pooled separate accounts at end of year	2010-12-31	$1,775,730
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$1,612,529
Interest earned on other investments	2010-12-31	$26,966
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$964,114
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$970,960
Net investment gain or loss from common/collective trusts	2010-12-31	$168,356
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$307,746
Employer contributions (assets) at end of year	2010-12-31	$94,933
Employer contributions (assets) at beginning of year	2010-12-31	$105,932
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$366,422
Did the plan have assets held for investment	2010-12-31	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	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	HOWARD WERSHBALE & CO
Accountancy firm EIN	2010-12-31	341663157
2009 : FIRST COMMUNITY VILLAGE FIRST COMMUNITY FINAL 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2009-12-31	$0
Minimum employer required contribution for this plan year	2009-12-31	$316,806
Amount contributed by the employer to the plan for this plan year	2009-12-31	$316,806

Form 5500 Responses for FIRST COMMUNITY VILLAGE FIRST COMMUNITY FINAL

2012: FIRST COMMUNITY VILLAGE FIRST COMMUNITY FINAL 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	Yes
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: FIRST COMMUNITY VILLAGE FIRST COMMUNITY FINAL 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
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 – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: FIRST COMMUNITY VILLAGE FIRST COMMUNITY FINAL 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 – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

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Company Name:	FIRST COMMUNITY VILLAGE
Employer identification number (EIN):	310655502
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities

Jurisdiction of Incorporation:	Ohio Secretary of State Business Services Division
Incorporation Date:	1961-03-17
Company Identification Number:	298822
Legal Registered Office Address:	904 MASTER DRIVE - GALLOWAY United States of America (USA) 43119