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.
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.
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

ER SENIOR MANAGEMENT, LLC has sponsored the creation of one or more 401k plans.

Company Name: ER SENIOR MANAGEMENT, LLC

Employer identification number (EIN): 473121222

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

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 2022-01-01 BRIAN E DOWD 2023-10-09 BRIAN E DOWD 2023-10-09
001 2021-01-01 BRIAN E DOWD 2022-10-13 BRIAN E DOWD 2022-10-13
001 2020-01-01 BRIAN E DOWD 2021-10-14 BRIAN E DOWD 2021-10-14
001 2019-01-01 BRIAN DOWD 2020-09-24 BRIAN DOWD 2020-09-24
001 2018-01-01
001 2017-01-01 BRIAN DOWD BRIAN DOWD 2018-10-15

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	BRIAN E DOWD	2023-10-09	BRIAN E DOWD	2023-10-09
001	2021-01-01	BRIAN E DOWD	2022-10-13	BRIAN E DOWD	2022-10-13
001	2020-01-01	BRIAN E DOWD	2021-10-14	BRIAN E DOWD	2021-10-14
001	2019-01-01	BRIAN DOWD	2020-09-24	BRIAN DOWD	2020-09-24
001	2018-01-01
001	2017-01-01	BRIAN DOWD		BRIAN DOWD	2018-10-15

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
2022: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 759
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 22
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 95
Total of all active and inactive participants 2022-01-01 117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 117
Number of participants with account balances 2022-01-01 95
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 504
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 594
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 31
Total of all active and inactive participants 2021-01-01 625
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 625
Number of participants with account balances 2021-01-01 86
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 444
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 334
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 25
Total of all active and inactive participants 2020-01-01 359
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 359
Number of participants with account balances 2020-01-01 49
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 516
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 362
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 24
Total of all active and inactive participants 2019-01-01 386
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 386
Number of participants with account balances 2019-01-01 47
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 608
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 555
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 31
Total of all active and inactive participants 2018-01-01 586
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 586
Number of participants with account balances 2018-01-01 58
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 451
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 334
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 33
Total of all active and inactive participants 2017-01-01 367
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 367
Number of participants with account balances 2017-01-01 60
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 1

Measure	Date	Value
2022: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	759
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	22
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	95
Total of all active and inactive participants	2022-01-01	117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	117
Number of participants with account balances	2022-01-01	95
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	504
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	594
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	31
Total of all active and inactive participants	2021-01-01	625
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	625
Number of participants with account balances	2021-01-01	86
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	444
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	334
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	25
Total of all active and inactive participants	2020-01-01	359
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	359
Number of participants with account balances	2020-01-01	49
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	516
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	362
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	24
Total of all active and inactive participants	2019-01-01	386
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	386
Number of participants with account balances	2019-01-01	47
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	608
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	555
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	31
Total of all active and inactive participants	2018-01-01	586
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	586
Number of participants with account balances	2018-01-01	58
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	451
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	334
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	33
Total of all active and inactive participants	2017-01-01	367
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	367
Number of participants with account balances	2017-01-01	60
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	1

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

Measure	Date	Value
2022 : EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total transfer of assets from this plan	2022-12-31	$570,980
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$431,942
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$283,714
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$260,700
Expenses. Certain deemed distributions of participant loans	2022-12-31	$3,594
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$627,286
Value of total assets at end of year	2022-12-31	$707,382
Value of total assets at beginning of year	2022-12-31	$1,130,134
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$19,420
Total interest from all sources	2022-12-31	$285
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Administrative expenses professional fees incurred	2022-12-31	$19,420
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$113,013
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$425,143
Participant contributions at end of year	2022-12-31	$0
Participant contributions at beginning of year	2022-12-31	$4,083
Participant contributions at end of year	2022-12-31	$10,563
Participant contributions at beginning of year	2022-12-31	$12,007
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$156,930
Other income not declared elsewhere	2022-12-31	$3
Administrative expenses (other) incurred	2022-12-31	$0
Total non interest bearing cash at end of year	2022-12-31	$248
Total non interest bearing cash at beginning of year	2022-12-31	$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	2022-12-31	No
Value of net income/loss	2022-12-31	$148,228
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$707,382
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$1,130,134
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in pooled separate accounts at end of year	2022-12-31	$696,571
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$1,114,022
Interest on participant loans	2022-12-31	$285
Net investment gain/loss from pooled separate accounts	2022-12-31	$-195,632
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$45,213
Employer contributions (assets) at beginning of year	2022-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$260,700
Did the plan have assets held for investment	2022-12-31	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	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	MULLINS CLEMMONS & MAYES, PLLC
Accountancy firm EIN	2022-12-31	621409003
2021 : EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$463,270
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$96,717
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$84,103
Value of total corrective distributions	2021-12-31	$56
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$391,083
Value of total assets at end of year	2021-12-31	$1,130,134
Value of total assets at beginning of year	2021-12-31	$763,581
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$12,558
Total interest from all sources	2021-12-31	$46
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Administrative expenses professional fees incurred	2021-12-31	$12,558
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$76,358
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$145,388
Participant contributions at end of year	2021-12-31	$4,083
Participant contributions at beginning of year	2021-12-31	$1,646
Participant contributions at end of year	2021-12-31	$12,007
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$245,695
Administrative expenses (other) incurred	2021-12-31	$0
Total non interest bearing cash at end of year	2021-12-31	$22
Total non interest bearing cash at beginning of year	2021-12-31	$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	2021-12-31	No
Value of net income/loss	2021-12-31	$366,553
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$1,130,134
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$763,581
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in pooled separate accounts at end of year	2021-12-31	$1,114,022
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$761,913
Interest on participant loans	2021-12-31	$46
Net investment gain/loss from pooled separate accounts	2021-12-31	$72,141
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$0
Employer contributions (assets) at end of year	2021-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$84,103
Did the plan have assets held for investment	2021-12-31	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	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	MULLINS CLEMMONS & MAYES, PLLC
Accountancy firm EIN	2021-12-31	621409003
2020 : EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$195,263
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$102,465
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$66,759
Expenses. Certain deemed distributions of participant loans	2020-12-31	$6,141
Value of total corrective distributions	2020-12-31	$19,604
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$114,415
Value of total assets at end of year	2020-12-31	$763,581
Value of total assets at beginning of year	2020-12-31	$670,783
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$9,961
Total interest from all sources	2020-12-31	$510
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$70,000
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
Contributions received from participants	2020-12-31	$78,473
Participant contributions at end of year	2020-12-31	$1,646
Participant contributions at beginning of year	2020-12-31	$11,177
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$35,942
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-12-31	$0
Administrative expenses (other) incurred	2020-12-31	$0
Total non interest bearing cash at end of year	2020-12-31	$22
Total non interest bearing cash at beginning of year	2020-12-31	$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	2020-12-31	No
Value of net income/loss	2020-12-31	$92,798
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$763,581
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$670,783
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
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$0
Value of interest in pooled separate accounts at end of year	2020-12-31	$761,913
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$659,584
Interest on participant loans	2020-12-31	$510
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$0
Net investment gain/loss from pooled separate accounts	2020-12-31	$80,338
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
Contributions received in cash from employer	2020-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$66,759
Contract administrator fees	2020-12-31	$9,961
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
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	MULLINS CLEMMONS & MAYES, PLLC
Accountancy firm EIN	2020-12-31	621409003
2019 : EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$177,838
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$49,197
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$36,335
Expenses. Certain deemed distributions of participant loans	2019-12-31	$1,893
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$93,238
Value of total assets at end of year	2019-12-31	$670,783
Value of total assets at beginning of year	2019-12-31	$542,142
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$10,969
Total interest from all sources	2019-12-31	$750
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
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
Value of fidelity bond cover	2019-12-31	$70,000
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
Contributions received from participants	2019-12-31	$93,238
Participant contributions at end of year	2019-12-31	$11,177
Participant contributions at beginning of year	2019-12-31	$9,835
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$0
Other income not declared elsewhere	2019-12-31	$8
Administrative expenses (other) incurred	2019-12-31	$0
Total non interest bearing cash at end of year	2019-12-31	$22
Total non interest bearing cash at beginning of year	2019-12-31	$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	2019-12-31	No
Value of net income/loss	2019-12-31	$128,641
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$670,783
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$542,142
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 leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$0
Value of interest in pooled separate accounts at end of year	2019-12-31	$659,584
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$532,285
Interest on participant loans	2019-12-31	$750
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$0
Net investment gain/loss from pooled separate accounts	2019-12-31	$83,842
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
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	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$36,335
Contract administrator fees	2019-12-31	$10,969
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
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
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	MULLINS CLEMMONS & MAYES, PLLC
Accountancy firm EIN	2019-12-31	621409003
2018 : EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$89,763
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$173,800
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$163,807
Expenses. Certain deemed distributions of participant loans	2018-12-31	$18
Value of total corrective distributions	2018-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$114,897
Value of total assets at end of year	2018-12-31	$542,142
Value of total assets at beginning of year	2018-12-31	$626,179
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$9,975
Total interest from all sources	2018-12-31	$788
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$62,618
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	$79,847
Participant contributions at end of year	2018-12-31	$9,835
Participant contributions at beginning of year	2018-12-31	$20,006
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$35,050
Administrative expenses (other) incurred	2018-12-31	$0
Total non interest bearing cash at end of year	2018-12-31	$22
Total non interest bearing cash at beginning of year	2018-12-31	$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	2018-12-31	No
Value of net income/loss	2018-12-31	$-84,037
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$542,142
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$626,179
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
Value of interest in pooled separate accounts at end of year	2018-12-31	$532,285
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$606,151
Interest on participant loans	2018-12-31	$788
Net investment gain/loss from pooled separate accounts	2018-12-31	$-25,922
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	Yes
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	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$163,807
Contract administrator fees	2018-12-31	$9,975
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	MULLINS CLEMMONS & MAYES, PLLC
Accountancy firm EIN	2018-12-31	621409003
2017 : EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING 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	$256,435
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$324,311
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$283,622
Expenses. Certain deemed distributions of participant loans	2017-12-31	$21,944
Value of total corrective distributions	2017-12-31	$7,449
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$175,619
Value of total assets at end of year	2017-12-31	$626,179
Value of total assets at beginning of year	2017-12-31	$694,055
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$11,296
Total interest from all sources	2017-12-31	$943
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	$69,405
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	$118,590
Participant contributions at end of year	2017-12-31	$20,006
Participant contributions at beginning of year	2017-12-31	$32,899
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$57,029
Administrative expenses (other) incurred	2017-12-31	$0
Total non interest bearing cash at end of year	2017-12-31	$22
Total non interest bearing cash at beginning of year	2017-12-31	$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	2017-12-31	No
Value of net income/loss	2017-12-31	$-67,876
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$626,179
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$694,055
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
Value of interest in pooled separate accounts at end of year	2017-12-31	$606,151
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$661,134
Interest on participant loans	2017-12-31	$943
Interest earned on other investments	2017-12-31	$0
Net investment gain/loss from pooled separate accounts	2017-12-31	$79,873
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	Yes
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	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$283,622
Contract administrator fees	2017-12-31	$11,296
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	MULLINS CLEMMONS & MAYES, PLLC
Accountancy firm EIN	2017-12-31	621409003

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

2022: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING 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	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
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: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING 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: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING 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: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING 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: EVERGREEN SENIOR LIVING 401(K) PROFIT SHARING 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

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	176
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $8,774
Total amount of fees paid to insurance company	USD $2,812
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Commission paid to Insurance Broker	USD $8,774
Amount paid for insurance broker fees	0
Insurance broker organization code?	4

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	156
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $6,419
Total amount of fees paid to insurance company	USD $1,284
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Commission paid to Insurance Broker	USD $6,419
Amount paid for insurance broker fees	0
Insurance broker organization code?	4

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	107
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $5,017
Total amount of fees paid to insurance company	USD $936
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Commission paid to Insurance Broker	USD $5,017
Amount paid for insurance broker fees	0
Insurance broker organization code?	4

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	104
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,547
Total amount of fees paid to insurance company	USD $2,205
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Commission paid to Insurance Broker	USD $4,547
Amount paid for insurance broker fees	0
Insurance broker organization code?	4

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	110
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $4,304
Total amount of fees paid to insurance company	USD $1,563
Amount paid for insurance broker fees	1563
Insurance broker organization code?	5
Commission paid to Insurance Broker	USD $4,304

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	112
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,721
Total amount of fees paid to insurance company	USD $2,190
Commission paid to Insurance Broker	USD $4,721
Amount paid for insurance broker fees	0
Insurance broker organization code?	4
Insurance broker name	EMPLOYEE BENEFIT SERVICES, INC

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Company Name:	ER SENIOR MANAGEMENT, LLC
Employer identification number (EIN):	473121222
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities