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ST CLARAS MANOR TAX DEFERRED ANNUITY PLAN 401k Plan overview

Plan NameST CLARAS MANOR TAX DEFERRED ANNUITY PLAN
Plan identification number 002

ST CLARAS MANOR TAX DEFERRED ANNUITY PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
  • 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

ST CLARAS MANOR has sponsored the creation of one or more 401k plans.

Company Name:ST CLARAS MANOR
Employer identification number (EIN):376075710
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ST CLARAS MANOR TAX DEFERRED ANNUITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022019-01-01CONNIE HOSELTON2020-07-08
0022018-01-01CONNIE HOSELTON2019-07-29
0022017-01-01CONNIE HOSELTON2018-08-06
0022017-01-01CONNIE HOSELTON2018-08-03
0022016-01-01CONNIE HOSELTON2017-09-12
0022015-01-01CONNIE HOSELTON2016-10-05
0022014-01-01CONNIE HOSELTON2015-10-01 CONNIE HOSELTON2015-10-01
0022013-01-01CONNIE HOSELTON2014-07-11 CONNIE HOSELTON2014-07-11
0022012-01-01CONNIE HOSELTON2014-07-11 CONNIE HOSELTON2014-07-11
0022011-01-01CONNIE HOSELTON2012-10-11 CONNIE HOSELTON2012-10-11

Financial Data on ST CLARAS MANOR TAX DEFERRED ANNUITY PLAN

Measure Date Value
2010 : ST CLARAS MANOR TAX DEFERRED ANNUITY PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets2010-12-31$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$22,255
Total loss/gain on sale of assets2010-12-31$0
Total of all expenses incurred2010-12-31$16,479
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$16,479
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$6,477
Value of total assets at end of year2010-12-31$148,740
Value of total assets at beginning of year2010-12-31$142,964
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$0
Total interest from all sources2010-12-31$1,344
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 year2010-12-31No
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$100,000
If this is an individual account plan, was there a blackout period2010-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$6,477
Participant contributions at end of year2010-12-31$0
Participant contributions at beginning of year2010-12-31$61,624
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$5,776
Value of net assets at end of year (total assets less liabilities)2010-12-31$148,740
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$142,964
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$113,890
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$62,984
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$1,344
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$34,850
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$18,356
Net investment gain/loss from registered investment companies (e.g. mutual funds)2010-12-31$14,434
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$16,479
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31J.M. ABBOTT & ASSOCIATES
Accountancy firm EIN2010-12-31371188139

Insurance Providers Used on plan

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG62070
Policy instance 1
Insurance contract or identification numberG62070
Number of Individuals Covered58
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,843
Total amount of fees paid to insurance companyUSD $71
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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