401k Plan data: BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P plan

BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P 401k Plan overview

Plan Name	BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P
Plan identification number	001

BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Plan covering Self-Employed individuals.
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

BRAEMOOR HEALTH CENTER, LLC has sponsored the creation of one or more 401k plans.

Company Name: BRAEMOOR HEALTH CENTER, LLC

Employer identification number (EIN): 462199106

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

Additional information about BRAEMOOR HEALTH CENTER, LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 5295514

More information about BRAEMOOR HEALTH CENTER, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2018-01-01
001 2017-01-01 BASSIE GUTMAN
001 2017-01-01 BASSIE GUTMAN
001 2016-01-01 BASSIE GUTMAN DAVID WEINSTOCK 2017-09-19
001 2016-01-01
001 2015-01-01 BASSIE GUTMAN DAVID WEINSTOCK 2017-01-23
001 2014-01-01 ALEXANDRIA LAPIERRE ALEXANDRIA LAPIERRE 2015-06-18
001 2014-01-01 2015-06-18
001 2014-01-01 2015-06-18
001 2013-01-01 ALEXANDRIA N. LAPIERRE ALEXANDRIA N. LAPIERRE 2014-10-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2018-01-01
001	2017-01-01	BASSIE GUTMAN
001	2017-01-01	BASSIE GUTMAN
001	2016-01-01	BASSIE GUTMAN		DAVID WEINSTOCK	2017-09-19
001	2016-01-01
001	2015-01-01	BASSIE GUTMAN		DAVID WEINSTOCK	2017-01-23
001	2014-01-01	ALEXANDRIA LAPIERRE		ALEXANDRIA LAPIERRE	2015-06-18
001	2014-01-01		2015-06-18
001	2014-01-01		2015-06-18
001	2013-01-01	ALEXANDRIA N. LAPIERRE		ALEXANDRIA N. LAPIERRE	2014-10-13

Plan Statistics for BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P

401k plan membership statisitcs for BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P

Measure Date Value
2018: BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P 2018 401k membership
Total participants, beginning-of-year 2018-01-01 49
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 16
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 5
Total of all active and inactive participants 2018-01-01 21
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 21
Number of participants with account balances 2018-01-01 21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P 2017 401k membership
Total participants, beginning-of-year 2017-01-01 70
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 32
Number of retired or separated participants receiving benefits 2017-01-01 3
Number of other retired or separated participants entitled to future benefits 2017-01-01 14
Total of all active and inactive participants 2017-01-01 49
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 49
Number of participants with account balances 2017-01-01 46
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P 2016 401k membership
Total participants, beginning-of-year 2016-01-01 56
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 55
Number of retired or separated participants receiving benefits 2016-01-01 3
Number of other retired or separated participants entitled to future benefits 2016-01-01 12
Total of all active and inactive participants 2016-01-01 70
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 70
Number of participants with account balances 2016-01-01 49
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P 2015 401k membership
Total participants, beginning-of-year 2015-01-01 57
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 40
Number of retired or separated participants receiving benefits 2015-01-01 2
Number of other retired or separated participants entitled to future benefits 2015-01-01 12
Total of all active and inactive participants 2015-01-01 54
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 54
Number of participants with account balances 2015-01-01 52
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P 2014 401k membership
Total participants, beginning-of-year 2014-01-01 113
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 46
Number of retired or separated participants receiving benefits 2014-01-01 2
Number of other retired or separated participants entitled to future benefits 2014-01-01 9
Total of all active and inactive participants 2014-01-01 57
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 57
Number of participants with account balances 2014-01-01 55
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P 2013 401k membership
Total participants, beginning-of-year 2013-01-01 85
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 97
Number of retired or separated participants receiving benefits 2013-01-01 3
Number of other retired or separated participants entitled to future benefits 2013-01-01 13
Total of all active and inactive participants 2013-01-01 113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 113
Number of participants with account balances 2013-01-01 67
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0

Measure	Date	Value
2018: BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P 2018 401k membership
Total participants, beginning-of-year	2018-01-01	49
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	16
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	5
Total of all active and inactive participants	2018-01-01	21
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	21
Number of participants with account balances	2018-01-01	21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P 2017 401k membership
Total participants, beginning-of-year	2017-01-01	70
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	32
Number of retired or separated participants receiving benefits	2017-01-01	3
Number of other retired or separated participants entitled to future benefits	2017-01-01	14
Total of all active and inactive participants	2017-01-01	49
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	49
Number of participants with account balances	2017-01-01	46
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P 2016 401k membership
Total participants, beginning-of-year	2016-01-01	56
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	55
Number of retired or separated participants receiving benefits	2016-01-01	3
Number of other retired or separated participants entitled to future benefits	2016-01-01	12
Total of all active and inactive participants	2016-01-01	70
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	70
Number of participants with account balances	2016-01-01	49
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P 2015 401k membership
Total participants, beginning-of-year	2015-01-01	57
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	40
Number of retired or separated participants receiving benefits	2015-01-01	2
Number of other retired or separated participants entitled to future benefits	2015-01-01	12
Total of all active and inactive participants	2015-01-01	54
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	54
Number of participants with account balances	2015-01-01	52
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P 2014 401k membership
Total participants, beginning-of-year	2014-01-01	113
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	46
Number of retired or separated participants receiving benefits	2014-01-01	2
Number of other retired or separated participants entitled to future benefits	2014-01-01	9
Total of all active and inactive participants	2014-01-01	57
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	57
Number of participants with account balances	2014-01-01	55
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P 2013 401k membership
Total participants, beginning-of-year	2013-01-01	85
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	97
Number of retired or separated participants receiving benefits	2013-01-01	3
Number of other retired or separated participants entitled to future benefits	2013-01-01	13
Total of all active and inactive participants	2013-01-01	113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	113
Number of participants with account balances	2013-01-01	67
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0

Financial Data on BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P

Measure	Date	Value
2018 : BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P 2018 401k financial data
Transfers to/from the plan	2018-12-31	$-886,646
Total income from all sources	2018-12-31	$47,332
Expenses. Total of all expenses incurred	2018-12-31	$5,975
Benefits paid (including direct rollovers)	2018-12-31	$0
Total plan assets at end of year	2018-12-31	$298,393
Total plan assets at beginning of year	2018-12-31	$1,143,682
Total contributions received or receivable from participants	2018-12-31	$0
Expenses. Other expenses not covered elsewhere	2018-12-31	$351
Contributions received from other sources (not participants or employers)	2018-12-31	$-368
Other income received	2018-12-31	$47,700
Net income (gross income less expenses)	2018-12-31	$41,357
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$298,393
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$1,143,682
Assets. Value of participant loans	2018-12-31	$469
Total contributions received or receivable from employer(s)	2018-12-31	$0
Value of certain deemed distributions of participant loans	2018-12-31	$0
Value of corrective distributions	2018-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$5,624
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
2017 : BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P 2017 401k financial data
Total income from all sources	2017-12-31	$147,470
Expenses. Total of all expenses incurred	2017-12-31	$124,528
Benefits paid (including direct rollovers)	2017-12-31	$115,202
Total plan assets at end of year	2017-12-31	$1,143,682
Total plan assets at beginning of year	2017-12-31	$1,120,740
Total contributions received or receivable from participants	2017-12-31	$27,222
Expenses. Other expenses not covered elsewhere	2017-12-31	$409
Contributions received from other sources (not participants or employers)	2017-12-31	$0
Other income received	2017-12-31	$120,248
Net income (gross income less expenses)	2017-12-31	$22,942
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$1,143,682
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$1,120,740
Assets. Value of participant loans	2017-12-31	$1,936
Total contributions received or receivable from employer(s)	2017-12-31	$0
Value of certain deemed distributions of participant loans	2017-12-31	$0
Value of corrective distributions	2017-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$8,917
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
2016 : BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P 2016 401k financial data
Total income from all sources	2016-12-31	$78,124
Expenses. Total of all expenses incurred	2016-12-31	$65,987
Benefits paid (including direct rollovers)	2016-12-31	$56,744
Total plan assets at end of year	2016-12-31	$1,120,740
Total plan assets at beginning of year	2016-12-31	$1,108,603
Value of fidelity bond covering the plan	2016-12-31	$200,000
Total contributions received or receivable from participants	2016-12-31	$35,749
Expenses. Other expenses not covered elsewhere	2016-12-31	$0
Contributions received from other sources (not participants or employers)	2016-12-31	$0
Other income received	2016-12-31	$42,375
Net income (gross income less expenses)	2016-12-31	$12,137
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$1,120,740
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$1,108,603
Assets. Value of participant loans	2016-12-31	$6,427
Total contributions received or receivable from employer(s)	2016-12-31	$0
Value of certain deemed distributions of participant loans	2016-12-31	$0
Value of corrective distributions	2016-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$9,243
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P 2015 401k financial data
Total income from all sources	2015-12-31	$70,602
Expenses. Total of all expenses incurred	2015-12-31	$160,599
Benefits paid (including direct rollovers)	2015-12-31	$142,780
Total plan assets at end of year	2015-12-31	$1,108,603
Total plan assets at beginning of year	2015-12-31	$1,198,600
Total contributions received or receivable from participants	2015-12-31	$40,165
Expenses. Other expenses not covered elsewhere	2015-12-31	$0
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$30,437
Net income (gross income less expenses)	2015-12-31	$-89,997
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$1,108,603
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$1,198,600
Assets. Value of participant loans	2015-12-31	$8,227
Total contributions received or receivable from employer(s)	2015-12-31	$0
Value of certain deemed distributions of participant loans	2015-12-31	$8,213
Value of corrective distributions	2015-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$9,606
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P 2014 401k financial data
Total income from all sources	2014-12-31	$105,052
Expenses. Total of all expenses incurred	2014-12-31	$586,618
Benefits paid (including direct rollovers)	2014-12-31	$575,347
Total plan assets at end of year	2014-12-31	$1,198,600
Total plan assets at beginning of year	2014-12-31	$1,680,166
Total contributions received or receivable from participants	2014-12-31	$47,830
Expenses. Other expenses not covered elsewhere	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$57,222
Net income (gross income less expenses)	2014-12-31	$-481,566
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$1,198,600
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$1,680,166
Assets. Value of participant loans	2014-12-31	$35,544
Total contributions received or receivable from employer(s)	2014-12-31	$0
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$11,271
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P 2013 401k financial data
Total income from all sources	2013-12-31	$222,324
Expenses. Total of all expenses incurred	2013-12-31	$417,198
Benefits paid (including direct rollovers)	2013-12-31	$402,754
Total plan assets at end of year	2013-12-31	$1,680,166
Total plan assets at beginning of year	2013-12-31	$1,875,040
Total contributions received or receivable from participants	2013-12-31	$87,175
Expenses. Other expenses not covered elsewhere	2013-12-31	$0
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$133,996
Net income (gross income less expenses)	2013-12-31	$-194,874
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$1,680,166
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$1,875,040
Assets. Value of participant loans	2013-12-31	$29,372
Total contributions received or receivable from employer(s)	2013-12-31	$1,153
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$264
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$14,180
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0

Form 5500 Responses for BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P

2018: BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	Yes
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	Yes
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – 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: BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P 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: BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	Yes
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: BRAEMOOR HEALTH CENTER 401(K) RETIREMENT SAVINGS P 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

Insurance Providers Used on plan

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

FL 7819

Policy instance

Insurance contract or identification number	FL 7819
Number of Individuals Covered	49
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $375
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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?	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $375
Insurance broker organization code?	1
Insurance broker name	PARK AVENUE SECURITIES LLC

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

FL 7819

Policy instance

Insurance contract or identification number	FL 7819
Number of Individuals Covered	54
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $500
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?	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $500
Insurance broker organization code?	1
Insurance broker name	PARK AVENUE SECURITIES LLC

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

FL 7819

Policy instance

Insurance contract or identification number	FL 7819
Number of Individuals Covered	57
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $591
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?	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $468
Insurance broker organization code?	1
Insurance broker name	LPL FINANCIAL CORPORATION

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

FL 7819

Policy instance

Insurance contract or identification number	FL 7819
Number of Individuals Covered	113
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $766
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?	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $766
Insurance broker organization code?	1
Insurance broker name	LPL FINANCIAL CORPORATION

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Company Name:	BRAEMOOR HEALTH CENTER, LLC
Employer identification number (EIN):	462199106
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	5295514