401k Plan data: MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN plan

MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN 401k Plan overview

Plan Name	MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN
Plan identification number	001

MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN 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.
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

100 CHAPIN INC. has sponsored the creation of one or more 401k plans.

Company Name: 100 CHAPIN INC.

Employer identification number (EIN): 472208554

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2021-01-01 HARVEY LICHTMAN 2022-03-07 HARVEY LICHTMAN 2022-03-07
001 2020-01-01 HARVEY LICHTMAN 2021-10-13 HARVEY LICHTMAN 2021-10-13
001 2019-01-01 HARVEY LICHTMAN 2020-07-22 HARVEY LICHTMAN 2020-07-22
001 2018-01-01 HARVEY LICHTMAN 2019-10-15 HARVEY LICHTMAN 2019-10-15
001 2017-01-01
001 2016-06-01 HARVEY LITCHMAN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2021-01-01	HARVEY LICHTMAN	2022-03-07	HARVEY LICHTMAN	2022-03-07
001	2020-01-01	HARVEY LICHTMAN	2021-10-13	HARVEY LICHTMAN	2021-10-13
001	2019-01-01	HARVEY LICHTMAN	2020-07-22	HARVEY LICHTMAN	2020-07-22
001	2018-01-01	HARVEY LICHTMAN	2019-10-15	HARVEY LICHTMAN	2019-10-15
001	2017-01-01
001	2016-06-01	HARVEY LITCHMAN

Plan Statistics for MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN

401k plan membership statisitcs for MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN

Measure Date Value
2021: MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 95
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 0
Number of retired or separated participants receiving benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 0
Total participants 2021-01-01 0
2020: MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 158
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 0
Number of retired or separated participants receiving benefits 2020-01-01 4
Number of other retired or separated participants entitled to future benefits 2020-01-01 91
Total of all active and inactive participants 2020-01-01 95
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 95
Number of participants with account balances 2020-01-01 95
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 2
2019: MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 128
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 134
Number of retired or separated participants receiving benefits 2019-01-01 3
Number of other retired or separated participants entitled to future benefits 2019-01-01 20
Total of all active and inactive participants 2019-01-01 157
Total participants 2019-01-01 157
Number of participants with account balances 2019-01-01 122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 126
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 111
Number of retired or separated participants receiving benefits 2018-01-01 3
Number of other retired or separated participants entitled to future benefits 2018-01-01 20
Total of all active and inactive participants 2018-01-01 134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 134
Number of participants with account balances 2018-01-01 109
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 109
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 116
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 10
Total of all active and inactive participants 2017-01-01 126
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 126
Number of participants with account balances 2017-01-01 99
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-06-01 105
Total number of active participants reported on line 7a of the Form 5500 2016-06-01 111
Number of retired or separated participants receiving benefits 2016-06-01 0
Number of other retired or separated participants entitled to future benefits 2016-06-01 5
Total of all active and inactive participants 2016-06-01 116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-06-01 0
Total participants 2016-06-01 116
Number of participants with account balances 2016-06-01 83
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-06-01 0

Measure	Date	Value
2021: MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	95
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	0
Number of retired or separated participants receiving benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	0
Total participants	2021-01-01	0
2020: MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	158
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	0
Number of retired or separated participants receiving benefits	2020-01-01	4
Number of other retired or separated participants entitled to future benefits	2020-01-01	91
Total of all active and inactive participants	2020-01-01	95
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	95
Number of participants with account balances	2020-01-01	95
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	2
2019: MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	128
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	134
Number of retired or separated participants receiving benefits	2019-01-01	3
Number of other retired or separated participants entitled to future benefits	2019-01-01	20
Total of all active and inactive participants	2019-01-01	157
Total participants	2019-01-01	157
Number of participants with account balances	2019-01-01	122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	126
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	111
Number of retired or separated participants receiving benefits	2018-01-01	3
Number of other retired or separated participants entitled to future benefits	2018-01-01	20
Total of all active and inactive participants	2018-01-01	134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	134
Number of participants with account balances	2018-01-01	109
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	109
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	116
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	10
Total of all active and inactive participants	2017-01-01	126
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	126
Number of participants with account balances	2017-01-01	99
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-06-01	105
Total number of active participants reported on line 7a of the Form 5500	2016-06-01	111
Number of retired or separated participants receiving benefits	2016-06-01	0
Number of other retired or separated participants entitled to future benefits	2016-06-01	5
Total of all active and inactive participants	2016-06-01	116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-06-01	0
Total participants	2016-06-01	116
Number of participants with account balances	2016-06-01	83
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-06-01	0

Financial Data on MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN

Measure	Date	Value
2021 : MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN 2021 401k financial data
Total income from all sources (including contributions)	2021-05-05	$11,817
Total of all expenses incurred	2021-05-05	$398,783
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-05-05	$370,800
Expenses. Certain deemed distributions of participant loans	2021-05-05	$18,866
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-05-05	$0
Value of total assets at end of year	2021-05-05	$0
Value of total assets at beginning of year	2021-05-05	$386,966
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-05-05	$9,117
Total interest from all sources	2021-05-05	$396
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-05-05	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2021-05-05	$0
Was this plan covered by a fidelity bond	2021-05-05	Yes
Value of fidelity bond cover	2021-05-05	$40,000
If this is an individual account plan, was there a blackout period	2021-05-05	No
Were there any nonexempt tranactions with any party-in-interest	2021-05-05	No
Participant contributions at end of year	2021-05-05	$0
Participant contributions at beginning of year	2021-05-05	$18,542
Assets. Loans (other than to participants) at beginning of year	2021-05-05	$0
Other income not declared elsewhere	2021-05-05	$0
Administrative expenses (other) incurred	2021-05-05	$523
Total non interest bearing cash at beginning of year	2021-05-05	$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	2021-05-05	No
Value of net income/loss	2021-05-05	$-386,966
Value of net assets at end of year (total assets less liabilities)	2021-05-05	$0
Value of net assets at beginning of year (total assets less liabilities)	2021-05-05	$386,966
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-05-05	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-05-05	No
Were any leases to which the plan was party in default or uncollectible	2021-05-05	No
Investment advisory and management fees	2021-05-05	$1,822
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-05-05	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-05-05	$352,163
Interest on participant loans	2021-05-05	$396
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2021-05-05	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-05-05	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-05-05	$16,261
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-05-05	$11,421
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-05-05	No
Was there a failure to transmit to the plan any participant contributions	2021-05-05	No
Has the plan failed to provide any benefit when due under the plan	2021-05-05	No
Contributions received in cash from employer	2021-05-05	$0
Employer contributions (assets) at end of year	2021-05-05	$0
Employer contributions (assets) at beginning of year	2021-05-05	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-05-05	$370,800
Contract administrator fees	2021-05-05	$6,772
Did the plan have assets held for investment	2021-05-05	No
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	2021-05-05	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-05-05	Yes
Opinion of an independent qualified public accountant for this plan	2021-05-05	Disclaimer
Accountancy firm name	2021-05-05	MSL, P.A.
Accountancy firm EIN	2021-05-05	593070669
2020 : MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN 2020 401k financial data
Total income from all sources (including contributions)	2020-12-31	$38,832
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$13,258
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$2,795
Value of total assets at end of year	2020-12-31	$386,966
Value of total assets at beginning of year	2020-12-31	$361,392
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$10,463
Total interest from all sources	2020-12-31	$126
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2020-12-31	$0
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$40,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Participant contributions at end of year	2020-12-31	$18,542
Participant contributions at beginning of year	2020-12-31	$0
Other income not declared elsewhere	2020-12-31	$38,706
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$25,574
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$386,966
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$361,392
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Investment advisory and management fees	2020-12-31	$5,837
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$352,163
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$346,192
Interest on participant loans	2020-12-31	$74
Interest earned on other investments	2020-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-12-31	$52
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$16,261
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Employer contributions (assets) at beginning of year	2020-12-31	$15,200
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$2,795
Contract administrator fees	2020-12-31	$4,626
Did the plan have assets held for investment	2020-12-31	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	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Aggregate proceeds on sale of assets	2020-12-31	$0
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	MSL, P.A.
Accountancy firm EIN	2020-12-31	593070669
2019 : MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN 2019 401k financial data
Total income from all sources (including contributions)	2019-12-31	$172,167
Total income from all sources (including contributions)	2019-12-31	$172,167
Total of all expenses incurred	2019-12-31	$19,022
Total of all expenses incurred	2019-12-31	$19,022
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$7,023
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$7,023
Value of total corrective distributions	2019-12-31	$0
Value of total corrective distributions	2019-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$122,057
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$122,057
Value of total assets at end of year	2019-12-31	$361,392
Value of total assets at end of year	2019-12-31	$361,392
Value of total assets at beginning of year	2019-12-31	$208,247
Value of total assets at beginning of year	2019-12-31	$208,247
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$11,999
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$11,999
Total interest from all sources	2019-12-31	$46
Total interest from all sources	2019-12-31	$46
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$20,000
Value of fidelity bond cover	2019-12-31	$20,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$106,857
Contributions received from participants	2019-12-31	$106,857
Participant contributions at end of year	2019-12-31	$0
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$1,916
Participant contributions at beginning of year	2019-12-31	$1,916
Other income not declared elsewhere	2019-12-31	$0
Other income not declared elsewhere	2019-12-31	$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	2019-12-31	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	2019-12-31	No
Value of net income/loss	2019-12-31	$153,145
Value of net income/loss	2019-12-31	$153,145
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$361,392
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$361,392
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$208,247
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$208,247
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Investment advisory and management fees	2019-12-31	$8,004
Investment advisory and management fees	2019-12-31	$8,004
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$346,192
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$346,192
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$189,359
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$189,359
Interest on participant loans	2019-12-31	$36
Interest on participant loans	2019-12-31	$36
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$10
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$10
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$1,092
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$1,092
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$50,064
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$50,064
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$15,200
Contributions received in cash from employer	2019-12-31	$15,200
Employer contributions (assets) at end of year	2019-12-31	$15,200
Employer contributions (assets) at end of year	2019-12-31	$15,200
Employer contributions (assets) at beginning of year	2019-12-31	$15,880
Employer contributions (assets) at beginning of year	2019-12-31	$15,880
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$7,023
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$7,023
Contract administrator fees	2019-12-31	$3,995
Contract administrator fees	2019-12-31	$3,995
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan have assets held for investment	2019-12-31	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	2019-12-31	No
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	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	MSL, P.A.
Accountancy firm name	2019-12-31	MSL, P.A.
Accountancy firm EIN	2019-12-31	593070669
Accountancy firm EIN	2019-12-31	593070669
2018 : MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN 2018 401k financial data
Total income from all sources (including contributions)	2018-12-31	$84,472
Total of all expenses incurred	2018-12-31	$10,470
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$1,800
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$94,769
Value of total assets at end of year	2018-12-31	$208,247
Value of total assets at beginning of year	2018-12-31	$134,245
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$8,670
Total interest from all sources	2018-12-31	$49
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Administrative expenses professional fees incurred	2018-12-31	$0
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$20,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$78,889
Participant contributions at end of year	2018-12-31	$1,916
Participant contributions at beginning of year	2018-12-31	$1,000
Other income not declared elsewhere	2018-12-31	$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	2018-12-31	No
Value of net income/loss	2018-12-31	$74,002
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$208,247
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$134,245
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Investment advisory and management fees	2018-12-31	$5,558
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$189,359
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$117,981
Interest on participant loans	2018-12-31	$49
Interest earned on other investments	2018-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$1,092
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-10,346
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$15,880
Employer contributions (assets) at end of year	2018-12-31	$15,880
Employer contributions (assets) at beginning of year	2018-12-31	$15,264
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$1,800
Contract administrator fees	2018-12-31	$3,112
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	MOORE STEPHENS LOVELACE, P.A.
Accountancy firm EIN	2018-12-31	593070669
2017 : MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$99,637
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$3,325
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$90,061
Value of total assets at end of year	2017-12-31	$134,245
Value of total assets at beginning of year	2017-12-31	$37,933
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$3,325
Total interest from all sources	2017-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$20,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$72,800
Participant contributions at end of year	2017-12-31	$1,000
Participant contributions at end of year	2017-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$1,997
Total non interest bearing cash at beginning of year	2017-12-31	$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	2017-12-31	No
Value of net income/loss	2017-12-31	$96,312
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$134,245
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$37,933
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Investment advisory and management fees	2017-12-31	$1,429
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$117,338
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$29,469
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$643
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$9,576
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$15,264
Employer contributions (assets) at end of year	2017-12-31	$15,264
Employer contributions (assets) at beginning of year	2017-12-31	$8,464
Contract administrator fees	2017-12-31	$1,896
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	MOORE STEPHENS LOVELACE, P.A.
Accountancy firm EIN	2017-12-31	593070669
2016 : MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$38,519
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$586
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$38,043
Value of total assets at end of year	2016-12-31	$37,933
Value of total assets at beginning of year	2016-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$586
Total interest from all sources	2016-12-31	$0
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	$0
Was this plan covered by a fidelity bond	2016-12-31	No
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	$29,579
Participant contributions at end of year	2016-12-31	$0
Participant contributions at beginning of year	2016-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-12-31	$0
Total non interest bearing cash at end of year	2016-12-31	$0
Total non interest bearing cash at beginning of year	2016-12-31	$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	2016-12-31	No
Value of net income/loss	2016-12-31	$37,933
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$37,933
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$0
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
Investment advisory and management fees	2016-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$29,469
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$476
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	$8,464
Employer contributions (assets) at end of year	2016-12-31	$8,464
Employer contributions (assets) at beginning of year	2016-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$0
Contract administrator fees	2016-12-31	$586
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
Aggregate proceeds on sale of assets	2016-12-31	$0

Form 5500 Responses for MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN

2021: MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	Yes
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN 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: MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
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: MAJESTIC REHABILITATION AND NURSING CENTER AT RED BANK 401(K) PLAN 2016 form 5500 responses
2016-06-01	Type of plan entity	Single employer plan
2016-06-01	First time form 5500 has been submitted	Yes
2016-06-01	Submission has been amended	No
2016-06-01	This submission is the final filing	No
2016-06-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2016-06-01	Plan is a collectively bargained plan	No
2016-06-01	Plan funding arrangement – Trust	Yes
2016-06-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

GAP-CP-JG4B

Policy instance

Insurance contract or identification number	GAP-CP-JG4B
Insurance policy start date	2021-01-01
Insurance policy end date	2021-05-05
Total amount of commissions paid to insurance broker	USD $38
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $38
Insurance broker organization code?	3

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

GAP-CP-JG4B

Policy instance

Insurance contract or identification number	GAP-CP-JG4B
Number of Individuals Covered	95
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $80
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $80
Insurance broker organization code?	3

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

GAP-CP-JG4B

Policy instance

Insurance contract or identification number	GAP-CP-JG4B
Number of Individuals Covered	122
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $11
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11
Insurance broker organization code?	3

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

GAP-CP-JG4B

Policy instance

Insurance contract or identification number	GAP-CP-JG4B
Number of Individuals Covered	109
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $9
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9
Insurance broker organization code?	3

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

226-80658

Policy instance

Insurance contract or identification number	226-80658
Number of Individuals Covered	99
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4
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?	Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Other information about contract	GUARANTEED INVESTMENTS, UNALLOCATED CONTRACTS
Commission paid to Insurance Broker	USD $4
Insurance broker organization code?	3
Insurance broker name	NATIONWIDE SECURITIES LLC

Potentially related plans

MAJESTIC REHABILITATION AND NURSING CENTER 401(K) PLAN [EIN = 472667560]

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Company Name:	100 CHAPIN INC.
Employer identification number (EIN):	472208554
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities