401k Plan data: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN plan

EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN
Plan identification number	001

EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
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.
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

ERB OPCO SAV, LLC has sponsored the creation of one or more 401k plans.

Company Name: ERB OPCO SAV, LLC

Employer identification number (EIN): 453088464

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

Additional information about ERB OPCO SAV, LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 5029682

More information about ERB OPCO SAV, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 BRIAN DOWD BRIAN DOWD 2017-10-13
001 2015-01-01 BRIAN DOWD BRIAN DOWD 2016-10-15
001 2014-01-01 BRIAN DOWD BRIAN DOWD 2015-10-15
001 2013-01-01 DAWN KELLY DAWN KELLY 2014-10-15
001 2012-10-01 TERRY FRISBY TERRY FRISBY 2013-07-26

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2016-01-01	BRIAN DOWD	BRIAN DOWD	2017-10-13
001	2015-01-01	BRIAN DOWD	BRIAN DOWD	2016-10-15
001	2014-01-01	BRIAN DOWD	BRIAN DOWD	2015-10-15
001	2013-01-01	DAWN KELLY	DAWN KELLY	2014-10-15
001	2012-10-01	TERRY FRISBY	TERRY FRISBY	2013-07-26

Plan Statistics for EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN

Measure Date Value
2016: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 458
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 411
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 18
Total of all active and inactive participants 2016-01-01 429
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 429
Number of participants with account balances 2016-01-01 67
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 2
2015: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 193
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 377
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 16
Total of all active and inactive participants 2015-01-01 393
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 393
Number of participants with account balances 2015-01-01 73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 1
2014: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 144
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 140
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 12
Total of all active and inactive participants 2014-01-01 152
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 152
Number of participants with account balances 2014-01-01 42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 1
2013: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 174
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 136
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 8
Total of all active and inactive participants 2013-01-01 144
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 144
Number of participants with account balances 2013-01-01 44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 1
2012: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-10-01 181
Total number of active participants reported on line 7a of the Form 5500 2012-10-01 171
Number of retired or separated participants receiving benefits 2012-10-01 0
Number of other retired or separated participants entitled to future benefits 2012-10-01 0
Total of all active and inactive participants 2012-10-01 171
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-10-01 0
Total participants 2012-10-01 171
Number of participants with account balances 2012-10-01 41
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-10-01 0

Measure	Date	Value
2016: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	458
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	411
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	18
Total of all active and inactive participants	2016-01-01	429
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	429
Number of participants with account balances	2016-01-01	67
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	2
2015: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	193
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	377
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	16
Total of all active and inactive participants	2015-01-01	393
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	393
Number of participants with account balances	2015-01-01	73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	1
2014: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	144
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	140
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	12
Total of all active and inactive participants	2014-01-01	152
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	152
Number of participants with account balances	2014-01-01	42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	1
2013: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	174
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	136
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	8
Total of all active and inactive participants	2013-01-01	144
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	144
Number of participants with account balances	2013-01-01	44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	1
2012: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-10-01	181
Total number of active participants reported on line 7a of the Form 5500	2012-10-01	171
Number of retired or separated participants receiving benefits	2012-10-01	0
Number of other retired or separated participants entitled to future benefits	2012-10-01	0
Total of all active and inactive participants	2012-10-01	171
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-10-01	0
Total participants	2012-10-01	171
Number of participants with account balances	2012-10-01	41
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-10-01	0

Financial Data on EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2016 : EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING 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	$289
Total income from all sources (including contributions)	2016-12-31	$285,648
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$129,844
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$114,650
Expenses. Certain deemed distributions of participant loans	2016-12-31	$2,661
Value of total corrective distributions	2016-12-31	$1,178
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$239,472
Value of total assets at end of year	2016-12-31	$694,055
Value of total assets at beginning of year	2016-12-31	$538,540
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$11,355
Total interest from all sources	2016-12-31	$1,130
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Administrative expenses professional fees incurred	2016-12-31	$1,925
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$53,825
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$212,391
Participant contributions at end of year	2016-12-31	$32,899
Participant contributions at beginning of year	2016-12-31	$24,336
Participant contributions at beginning of year	2016-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$27,081
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2016-12-31	$289
Administrative expenses (other) incurred	2016-12-31	$0
Total non interest bearing cash at end of year	2016-12-31	$22
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	$155,804
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$694,055
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$538,251
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 pooled separate accounts at end of year	2016-12-31	$661,134
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$514,204
Interest on participant loans	2016-12-31	$1,130
Net investment gain/loss from pooled separate accounts	2016-12-31	$45,046
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	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$114,650
Contract administrator fees	2016-12-31	$9,430
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	MULLINS CLEMMONS & MAYES, PLLC
Accountancy firm EIN	2016-12-31	621409003
2015 : EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING 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	$289
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	$380,231
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$92,379
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$85,357
Value of total corrective distributions	2015-12-31	$289
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$392,433
Value of total assets at end of year	2015-12-31	$538,540
Value of total assets at beginning of year	2015-12-31	$250,399
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$6,733
Total interest from all sources	2015-12-31	$244
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Administrative expenses professional fees incurred	2015-12-31	$550
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$53,825
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	$192,335
Participant contributions at end of year	2015-12-31	$24,336
Participant contributions at beginning of year	2015-12-31	$4,499
Participant contributions at end of year	2015-12-31	$0
Participant contributions at beginning of year	2015-12-31	$627
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$200,098
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-12-31	$289
Other income not declared elsewhere	2015-12-31	$10
Administrative expenses (other) incurred	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	$287,852
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$538,251
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$250,399
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 pooled separate accounts at end of year	2015-12-31	$514,204
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$245,273
Interest on participant loans	2015-12-31	$244
Net investment gain/loss from pooled separate accounts	2015-12-31	$-12,456
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	Yes
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	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$85,357
Contract administrator fees	2015-12-31	$6,183
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	MULLINS CLEMMONS & MAYES, PLLC
Accountancy firm EIN	2015-12-31	621409003
2014 : EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING 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	$120,867
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$42,882
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$38,726
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$111,887
Value of total assets at end of year	2014-12-31	$250,399
Value of total assets at beginning of year	2014-12-31	$172,414
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$4,156
Total interest from all sources	2014-12-31	$155
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Administrative expenses professional fees incurred	2014-12-31	$475
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$40,000
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	$92,960
Participant contributions at end of year	2014-12-31	$4,499
Participant contributions at end of year	2014-12-31	$627
Participant contributions at beginning of year	2014-12-31	$104
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$18,927
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	$77,985
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$250,399
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$172,414
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 pooled separate accounts at end of year	2014-12-31	$245,273
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$172,310
Interest on participant loans	2014-12-31	$155
Net investment gain/loss from pooled separate accounts	2014-12-31	$8,825
Net investment gain or loss from common/collective trusts	2014-12-31	$0
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	Yes
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	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$38,726
Contract administrator fees	2014-12-31	$3,681
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	MULLINS CLEMMONS & MAYES, PLLC
Accountancy firm EIN	2014-12-31	621409003
2013 : EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$156,736
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$17,209
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$13,923
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$141,288
Value of total assets at end of year	2013-12-31	$172,414
Value of total assets at beginning of year	2013-12-31	$32,887
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$3,286
Total interest from all sources	2013-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Administrative expenses professional fees incurred	2013-12-31	$375
Was this plan covered by a fidelity bond	2013-12-31	No
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$128,984
Participant contributions at end of year	2013-12-31	$104
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$10,436
Administrative expenses (other) incurred	2013-12-31	$12
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$139,527
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$172,414
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$32,887
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Investment advisory and management fees	2013-12-31	$0
Value of interest in pooled separate accounts at end of year	2013-12-31	$172,310
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$32,887
Net investment gain/loss from pooled separate accounts	2013-12-31	$15,448
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$1,868
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$13,923
Contract administrator fees	2013-12-31	$2,899
Did the plan have assets held for investment	2013-12-31	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	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	MULLINS CLEMMONS & MAYES, PLLC
Accountancy firm EIN	2013-12-31	621409003
2012 : EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$33,345
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$458
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$32,654
Value of total assets at end of year	2012-12-31	$32,887
Value of total assets at beginning of year	2012-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$458
Total interest from all sources	2012-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	No
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$29,002
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$3,652
Administrative expenses (other) incurred	2012-12-31	$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	2012-12-31	No
Value of net income/loss	2012-12-31	$32,887
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$32,887
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in pooled separate accounts at end of year	2012-12-31	$32,887
Net investment gain/loss from pooled separate accounts	2012-12-31	$691
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$0
Contract administrator fees	2012-12-31	$458
Did the plan have assets held for investment	2012-12-31	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	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No

Form 5500 Responses for EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN

2016: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING 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: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING 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
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING 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 – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
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 – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2012 form 5500 responses
2012-10-01	Type of plan entity	Single employer plan
2012-10-01	First time form 5500 has been submitted	Yes
2012-10-01	Submission has been amended	Yes
2012-10-01	This submission is the final filing	No
2012-10-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2012-10-01	Plan is a collectively bargained plan	No
2012-10-01	Plan funding arrangement – Insurance	Yes
2012-10-01	Plan funding arrangement – Trust	Yes
2012-10-01	Plan benefit arrangement – Insurance	Yes
2012-10-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

107745

Policy instance

Insurance contract or identification number	107745
Number of Individuals Covered	124
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,674
Total amount of fees paid to insurance company	USD $729
Commission paid to Insurance Broker	USD $2,674
Insurance broker organization code?	4
Amount paid for insurance broker fees	729
Insurance broker name	EMPLOYEE BENEFIT SERVICES, INC.

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

107745

Policy instance

Insurance contract or identification number	107745
Number of Individuals Covered	90
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,487
Total amount of fees paid to insurance company	USD $575
Commission paid to Insurance Broker	USD $1,487
Amount paid for insurance broker fees	0
Insurance broker organization code?	4
Insurance broker name	EMPLOYEE BENEFIT SERVICES, INC.

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

107745

Policy instance

Insurance contract or identification number	107745
Insurance policy start date	2013-10-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $706
Total amount of fees paid to insurance company	USD $1,360
Commission paid to Insurance Broker	USD $706
Insurance broker organization code?	4
Amount paid for insurance broker fees	1348
Additional information about fees paid to insurance broker	REDEMPTION FEES
Insurance broker name	FEDERATED INVESTMENT MANAGEMENT CO

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

107745

Policy instance

Insurance contract or identification number	107745
Number of Individuals Covered	89
Insurance policy start date	2012-10-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $19
Total amount of fees paid to insurance company	USD $153
Commission paid to Insurance Broker	USD $19
Insurance broker organization code?	4
Amount paid for insurance broker fees	153
Insurance broker name	EMPLOYEE BENEFIT SERVICES, INC.

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Company Name:	ERB OPCO SAV, LLC
Employer identification number (EIN):	453088464
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	5029682