401k Plan data: CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN plan

CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN 401k Plan overview

Plan Name	CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN
Plan identification number	002

CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT 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
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.
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

CROSS ROAD REST & RETIREMENT CENTER has sponsored the creation of one or more 401k plans.

Company Name: CROSS ROAD REST & RETIREMENT CENTER

Employer identification number (EIN): 581491011

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2016-01-01 STEPHEN RUMBLEY
002 2015-01-01 HAROLD MCMANUS
002 2014-01-01 HAROLD MCMANUS
002 2013-01-01 HAROLD MCMANUS
002 2012-01-01 HAROLD MCMANUS
002 2011-01-01 HAROLD MCMANUS

Plan id#	Filing Submission Date	Name of Administrator
002	2016-01-01	STEPHEN RUMBLEY
002	2015-01-01	HAROLD MCMANUS
002	2014-01-01	HAROLD MCMANUS
002	2013-01-01	HAROLD MCMANUS
002	2012-01-01	HAROLD MCMANUS
002	2011-01-01	HAROLD MCMANUS

Plan Statistics for CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN

401k plan membership statisitcs for CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN

Measure Date Value
2016: CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 125
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 0
Number of participants with account balances 2016-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 129
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 87
Number of retired or separated participants receiving benefits 2015-01-01 7
Number of other retired or separated participants entitled to future benefits 2015-01-01 28
Total of all active and inactive participants 2015-01-01 122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 122
Number of participants with account balances 2015-01-01 69
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 135
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 91
Number of retired or separated participants receiving benefits 2014-01-01 8
Number of other retired or separated participants entitled to future benefits 2014-01-01 24
Total of all active and inactive participants 2014-01-01 123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 123
Number of participants with account balances 2014-01-01 76
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 144
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 96
Number of retired or separated participants receiving benefits 2013-01-01 6
Number of other retired or separated participants entitled to future benefits 2013-01-01 31
Total of all active and inactive participants 2013-01-01 133
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 133
Number of participants with account balances 2013-01-01 79
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 163
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 114
Number of retired or separated participants receiving benefits 2012-01-01 4
Number of other retired or separated participants entitled to future benefits 2012-01-01 25
Total of all active and inactive participants 2012-01-01 143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 143
Number of participants with account balances 2012-01-01 80
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 157
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 129
Number of retired or separated participants receiving benefits 2011-01-01 2
Number of other retired or separated participants entitled to future benefits 2011-01-01 27
Total of all active and inactive participants 2011-01-01 158
Total participants 2011-01-01 158
Number of participants with account balances 2011-01-01 80
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0

Measure	Date	Value
2016: CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	125
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	0
Number of participants with account balances	2016-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	129
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	87
Number of retired or separated participants receiving benefits	2015-01-01	7
Number of other retired or separated participants entitled to future benefits	2015-01-01	28
Total of all active and inactive participants	2015-01-01	122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	122
Number of participants with account balances	2015-01-01	69
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	135
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	91
Number of retired or separated participants receiving benefits	2014-01-01	8
Number of other retired or separated participants entitled to future benefits	2014-01-01	24
Total of all active and inactive participants	2014-01-01	123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	123
Number of participants with account balances	2014-01-01	76
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	144
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	96
Number of retired or separated participants receiving benefits	2013-01-01	6
Number of other retired or separated participants entitled to future benefits	2013-01-01	31
Total of all active and inactive participants	2013-01-01	133
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	133
Number of participants with account balances	2013-01-01	79
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	163
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	114
Number of retired or separated participants receiving benefits	2012-01-01	4
Number of other retired or separated participants entitled to future benefits	2012-01-01	25
Total of all active and inactive participants	2012-01-01	143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	143
Number of participants with account balances	2012-01-01	80
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	157
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	129
Number of retired or separated participants receiving benefits	2011-01-01	2
Number of other retired or separated participants entitled to future benefits	2011-01-01	27
Total of all active and inactive participants	2011-01-01	158
Total participants	2011-01-01	158
Number of participants with account balances	2011-01-01	80
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0

Financial Data on CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN

Measure	Date	Value
2016 : CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN 2016 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-08-29	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-08-29	$294
Total income from all sources (including contributions)	2016-08-29	$65,853
Total of all expenses incurred	2016-08-29	$845,656
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-08-29	$827,305
Expenses. Certain deemed distributions of participant loans	2016-08-29	$6,691
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-08-29	$47,517
Value of total assets at end of year	2016-08-29	$0
Value of total assets at beginning of year	2016-08-29	$780,097
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-08-29	$11,660
Total interest from all sources	2016-08-29	$6,045
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-08-29	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2016-08-29	$0
Was this plan covered by a fidelity bond	2016-08-29	Yes
Value of fidelity bond cover	2016-08-29	$250,000
If this is an individual account plan, was there a blackout period	2016-08-29	No
Were there any nonexempt tranactions with any party-in-interest	2016-08-29	No
Contributions received from participants	2016-08-29	$37,804
Participant contributions at end of year	2016-08-29	$0
Participant contributions at beginning of year	2016-08-29	$7,544
Participant contributions at end of year	2016-08-29	$0
Participant contributions at beginning of year	2016-08-29	$1,660
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-08-29	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2016-08-29	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2016-08-29	$294
Administrative expenses (other) incurred	2016-08-29	$11,660
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-08-29	No
Value of net income/loss	2016-08-29	$-779,803
Value of net assets at end of year (total assets less liabilities)	2016-08-29	$0
Value of net assets at beginning of year (total assets less liabilities)	2016-08-29	$779,803
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-08-29	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-08-29	No
Were any leases to which the plan was party in default or uncollectible	2016-08-29	No
Value of interest in pooled separate accounts at end of year	2016-08-29	$0
Value of interest in pooled separate accounts at beginning of year	2016-08-29	$95,079
Interest on participant loans	2016-08-29	$227
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-08-29	$5,818
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-08-29	$675,399
Net investment gain/loss from pooled separate accounts	2016-08-29	$12,291
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-08-29	No
Was there a failure to transmit to the plan any participant contributions	2016-08-29	No
Has the plan failed to provide any benefit when due under the plan	2016-08-29	No
Contributions received in cash from employer	2016-08-29	$9,713
Employer contributions (assets) at end of year	2016-08-29	$0
Employer contributions (assets) at beginning of year	2016-08-29	$415
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-08-29	$827,305
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2016-08-29	No
Did the plan have assets held for investment	2016-08-29	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	2016-08-29	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-08-29	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-08-29	Yes
Opinion of an independent qualified public accountant for this plan	2016-08-29	Disclaimer
Accountancy firm name	2016-08-29	LNAGDON & CO.
Accountancy firm EIN	2016-08-29	561743537
2015 : CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN 2015 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$294
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$323
Total income from all sources (including contributions)	2015-12-31	$106,505
Total of all expenses incurred	2015-12-31	$79,367
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$75,554
Expenses. Certain deemed distributions of participant loans	2015-12-31	$3,813
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$92,218
Value of total assets at end of year	2015-12-31	$780,097
Value of total assets at beginning of year	2015-12-31	$752,988
Total interest from all sources	2015-12-31	$9,591
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$250,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$70,812
Participant contributions at end of year	2015-12-31	$7,544
Participant contributions at beginning of year	2015-12-31	$13,633
Participant contributions at end of year	2015-12-31	$1,660
Participant contributions at beginning of year	2015-12-31	$2,732
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$3,401
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$52
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-12-31	$294
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$323
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$27,138
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$779,803
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$752,665
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in pooled separate accounts at end of year	2015-12-31	$95,079
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$100,381
Interest on participant loans	2015-12-31	$693
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$8,898
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$675,399
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$635,507
Net investment gain/loss from pooled separate accounts	2015-12-31	$4,696
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$18,005
Employer contributions (assets) at end of year	2015-12-31	$415
Employer contributions (assets) at beginning of year	2015-12-31	$683
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$75,554
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2015-12-31	No
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	LANGDON & CO.
Accountancy firm EIN	2015-12-31	561743537
2014 : CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$323
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$281
Total income from all sources (including contributions)	2014-12-31	$118,074
Total of all expenses incurred	2014-12-31	$120,486
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$118,715
Expenses. Certain deemed distributions of participant loans	2014-12-31	$1,771
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$97,032
Value of total assets at end of year	2014-12-31	$752,988
Value of total assets at beginning of year	2014-12-31	$755,358
Total interest from all sources	2014-12-31	$9,757
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$100,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$78,077
Participant contributions at end of year	2014-12-31	$13,633
Participant contributions at beginning of year	2014-12-31	$1,888
Participant contributions at end of year	2014-12-31	$2,732
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$546
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2014-12-31	$985
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$52
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$3,509
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-12-31	$323
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$281
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-2,412
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$752,665
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$755,077
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in pooled separate accounts at end of year	2014-12-31	$100,381
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$75,684
Interest on participant loans	2014-12-31	$201
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$9,556
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$635,507
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$674,277
Net investment gain/loss from pooled separate accounts	2014-12-31	$11,285
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$18,409
Employer contributions (assets) at end of year	2014-12-31	$683
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$117,730
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	LANGDON & COMPANY
Accountancy firm EIN	2014-12-31	561743537
2013 : CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$281
Total income from all sources (including contributions)	2013-12-31	$210,344
Total of all expenses incurred	2013-12-31	$78,845
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$78,845
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$183,438
Value of total assets at end of year	2013-12-31	$755,358
Value of total assets at beginning of year	2013-12-31	$623,578
Total interest from all sources	2013-12-31	$7,805
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$100,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$74,887
Participant contributions at end of year	2013-12-31	$1,888
Participant contributions at beginning of year	2013-12-31	$775
Participant contributions at beginning of year	2013-12-31	$1,195
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$90,075
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2013-12-31	$432
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$3,509
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-12-31	$14
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-12-31	$281
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$131,499
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$755,077
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$623,578
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in pooled separate accounts at end of year	2013-12-31	$75,684
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$51,389
Interest on participant loans	2013-12-31	$32
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$7,773
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$674,277
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$569,906
Net investment gain/loss from pooled separate accounts	2013-12-31	$19,101
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$18,476
Employer contributions (assets) at beginning of year	2013-12-31	$299
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$78,413
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2013-12-31	No
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	LANGDON & COMPANY
Accountancy firm EIN	2013-12-31	561743537
2012 : CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN 2012 401k financial data
Total income from all sources (including contributions)	2012-12-31	$111,811
Total of all expenses incurred	2012-12-31	$48,647
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$48,647
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$91,996
Value of total assets at end of year	2012-12-31	$623,578
Value of total assets at beginning of year	2012-12-31	$560,414
Total interest from all sources	2012-12-31	$18,156
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$100,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$73,597
Participant contributions at end of year	2012-12-31	$775
Participant contributions at beginning of year	2012-12-31	$1,036
Participant contributions at end of year	2012-12-31	$1,195
Participant contributions at beginning of year	2012-12-31	$2,642
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-12-31	$14
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$4
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$63,164
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$623,578
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$560,414
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in pooled separate accounts at end of year	2012-12-31	$51,389
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$49,004
Interest on participant loans	2012-12-31	$68
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$18,088
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$569,906
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$507,068
Net investment gain/loss from pooled separate accounts	2012-12-31	$1,659
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$18,399
Employer contributions (assets) at end of year	2012-12-31	$299
Employer contributions (assets) at beginning of year	2012-12-31	$660
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$48,647
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2012-12-31	No
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	LANGDON & COMPANY
Accountancy firm EIN	2012-12-31	561743537
2011 : CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN 2011 401k financial data
Total income from all sources (including contributions)	2011-12-31	$104,059
Total of all expenses incurred	2011-12-31	$48,123
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$48,123
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$92,114
Value of total assets at end of year	2011-12-31	$560,414
Value of total assets at beginning of year	2011-12-31	$504,478
Total interest from all sources	2011-12-31	$6,445
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$100,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$73,442
Participant contributions at end of year	2011-12-31	$1,036
Participant contributions at beginning of year	2011-12-31	$1,517
Participant contributions at end of year	2011-12-31	$2,642
Participant contributions at beginning of year	2011-12-31	$4,472
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$311
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2011-12-31	$1,572
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$4
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$75
Total non interest bearing cash at end of year	2011-12-31	$0
Total non interest bearing cash at beginning of year	2011-12-31	$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	2011-12-31	No
Value of net income/loss	2011-12-31	$55,936
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$560,414
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$504,478
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in pooled separate accounts at end of year	2011-12-31	$49,004
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$60,133
Interest on participant loans	2011-12-31	$88
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$6,357
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$507,068
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$437,163
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$5,500
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$18,361
Employer contributions (assets) at end of year	2011-12-31	$660
Employer contributions (assets) at beginning of year	2011-12-31	$1,118
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$46,551
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2011-12-31	No
Assets. Corporate common stocks other than exployer securities at beginning of year	2011-12-31	$0
Did the plan have assets held for investment	2011-12-31	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	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	LANGDON & COMPANY
Accountancy firm EIN	2011-12-31	561743537
2010 : CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN 2010 401k financial data
Total income from all sources (including contributions)	2010-12-31	$114,735
Total of all expenses incurred	2010-12-31	$19,724
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$19,724
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$98,294
Value of total assets at end of year	2010-12-31	$504,478
Value of total assets at beginning of year	2010-12-31	$409,467
Total interest from all sources	2010-12-31	$4,470
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	No
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$78,299
Participant contributions at end of year	2010-12-31	$1,517
Participant contributions at beginning of year	2010-12-31	$1,850
Participant contributions at end of year	2010-12-31	$4,472
Participant contributions at beginning of year	2010-12-31	$1,371
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$702
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$75
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$71
Total non interest bearing cash at end of year	2010-12-31	$0
Total non interest bearing cash at beginning of year	2010-12-31	$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	2010-12-31	No
Value of net income/loss	2010-12-31	$95,011
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$504,478
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$409,467
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in pooled separate accounts at end of year	2010-12-31	$60,133
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$50,024
Interest on participant loans	2010-12-31	$90
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$4,380
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$437,163
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$355,814
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$11,971
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$19,293
Employer contributions (assets) at end of year	2010-12-31	$1,118
Employer contributions (assets) at beginning of year	2010-12-31	$337
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$19,724
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2010-12-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2010-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2010-12-31	$0
Did the plan have assets held for investment	2010-12-31	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	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	LANGDON & COMPANY
Accountancy firm EIN	2010-12-31	561743537

Form 5500 Responses for CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN

2016: CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	This submission is the final filing	Yes
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: CROSS ROAD REST & RETIREMENT CENTER EMPLOYEE RETIREMENT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	Yes
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62944 )
Policy contract number	743871
Policy instance	1
MODERN WOODMEN OF AMERICA (National Association of Insurance Commissioners NAIC id number: 57541 )
Policy contract number	23927205001
Policy instance	2
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62944 )
Policy contract number	743871
Policy instance	1
MODERN WOODMEN OF AMERICA (National Association of Insurance Commissioners NAIC id number: 57541 )
Policy contract number	23927205001
Policy instance	2
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62944 )
Policy contract number	743871
Policy instance	1
MODERN WOODMEN OF AMERICA (National Association of Insurance Commissioners NAIC id number: 57541 )
Policy contract number	23927205001
Policy instance	2
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62944 )
Policy contract number	743871
Policy instance	1
MODERN WOODMEN OF AMERICA (National Association of Insurance Commissioners NAIC id number: 57541 )
Policy contract number	23927205001
Policy instance	2
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62944 )
Policy contract number	743871
Policy instance	1
MODERN WOODMEN OF AMERICA (National Association of Insurance Commissioners NAIC id number: 57541 )
Policy contract number	23927205001
Policy instance	2
MODERN WOODMEN OF AMERICA (National Association of Insurance Commissioners NAIC id number: 57541 )
Policy contract number	23927205001
Policy instance	1
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62944 )
Policy contract number	743871-001
Policy instance	2

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Company Name:	CROSS ROAD REST & RETIREMENT CENTER
Employer identification number (EIN):	581491011
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities