401k Plan data: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST plan

ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 401k Plan overview

Plan Name	ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST
Plan identification number	001

ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 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) received services of leased employees, as defined in Code section 414(n), during the plan year.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

ST MATTHEWS HOUSE INC has sponsored the creation of one or more 401k plans.

Company Name: ST MATTHEWS HOUSE INC

Employer identification number (EIN): 651110501

NAIC Classification: 624200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01 STEVE BROODER 2019-10-14
001 2017-01-01
001 2016-01-01
001 2015-01-01
001 2014-01-01 ANGELA SHEPARD ANGELA SHEPARD 2015-10-15
001 2013-01-01 VANN R ELLLISON
001 2012-01-01 CAREN WATMUFF 2013-07-12 CAREN WATMUFF 2013-07-12
001 2011-01-01 CAREN WATMUFF 2012-07-17 CAREN WATMUFF 2012-07-17
001 2010-01-01 CAREN WATMUFF 2011-07-06

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01	STEVE BROODER	2019-10-14
001	2017-01-01
001	2016-01-01
001	2015-01-01
001	2014-01-01	ANGELA SHEPARD		ANGELA SHEPARD	2015-10-15
001	2013-01-01	VANN R ELLLISON
001	2012-01-01	CAREN WATMUFF	2013-07-12	CAREN WATMUFF	2013-07-12
001	2011-01-01	CAREN WATMUFF	2012-07-17	CAREN WATMUFF	2012-07-17
001	2010-01-01	CAREN WATMUFF	2011-07-06

Plan Statistics for ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST

401k plan membership statisitcs for ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST

Measure Date Value
2022: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2022 401k membership
Total participants, beginning-of-year 2022-01-01 284
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 186
Number of retired or separated participants receiving benefits 2022-01-01 9
Number of other retired or separated participants entitled to future benefits 2022-01-01 56
Total of all active and inactive participants 2022-01-01 251
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 251
Number of participants with account balances 2022-01-01 147
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 3
2021: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2021 401k membership
Total participants, beginning-of-year 2021-01-01 262
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 213
Number of retired or separated participants receiving benefits 2021-01-01 6
Number of other retired or separated participants entitled to future benefits 2021-01-01 54
Total of all active and inactive participants 2021-01-01 273
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 273
Number of participants with account balances 2021-01-01 136
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 12
2020: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2020 401k membership
Total participants, beginning-of-year 2020-01-01 244
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 210
Number of retired or separated participants receiving benefits 2020-01-01 3
Number of other retired or separated participants entitled to future benefits 2020-01-01 40
Total of all active and inactive participants 2020-01-01 253
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 253
Number of participants with account balances 2020-01-01 120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 10
2019: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2019 401k membership
Total participants, beginning-of-year 2019-01-01 250
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 204
Number of retired or separated participants receiving benefits 2019-01-01 4
Number of other retired or separated participants entitled to future benefits 2019-01-01 31
Total of all active and inactive participants 2019-01-01 239
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 239
Number of participants with account balances 2019-01-01 112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 9
2018: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2018 401k membership
Total participants, beginning-of-year 2018-01-01 242
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 221
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 18
Total of all active and inactive participants 2018-01-01 239
Total participants 2018-01-01 239
Number of participants with account balances 2018-01-01 76
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 5
2017: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2017 401k membership
Total participants, beginning-of-year 2017-01-01 216
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 185
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 20
Total of all active and inactive participants 2017-01-01 205
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 205
Number of participants with account balances 2017-01-01 78
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 3
2016: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2016 401k membership
Total participants, beginning-of-year 2016-01-01 196
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 181
Number of other retired or separated participants entitled to future benefits 2016-01-01 22
Total of all active and inactive participants 2016-01-01 203
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 203
Number of participants with account balances 2016-01-01 96
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2015 401k membership
Total participants, beginning-of-year 2015-01-01 210
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 172
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 31
Total of all active and inactive participants 2015-01-01 203
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 203
Number of participants with account balances 2015-01-01 89
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2014 401k membership
Total participants, beginning-of-year 2014-01-01 148
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 187
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 15
Total of all active and inactive participants 2014-01-01 202
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 202
Number of participants with account balances 2014-01-01 109
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2013 401k membership
Total participants, beginning-of-year 2013-01-01 68
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 123
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 12
Total of all active and inactive participants 2013-01-01 135
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 135
Number of participants with account balances 2013-01-01 71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0

Measure	Date	Value
2022: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2022 401k membership
Total participants, beginning-of-year	2022-01-01	284
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	186
Number of retired or separated participants receiving benefits	2022-01-01	9
Number of other retired or separated participants entitled to future benefits	2022-01-01	56
Total of all active and inactive participants	2022-01-01	251
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	251
Number of participants with account balances	2022-01-01	147
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	3
2021: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2021 401k membership
Total participants, beginning-of-year	2021-01-01	262
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	213
Number of retired or separated participants receiving benefits	2021-01-01	6
Number of other retired or separated participants entitled to future benefits	2021-01-01	54
Total of all active and inactive participants	2021-01-01	273
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	273
Number of participants with account balances	2021-01-01	136
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	12
2020: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2020 401k membership
Total participants, beginning-of-year	2020-01-01	244
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	210
Number of retired or separated participants receiving benefits	2020-01-01	3
Number of other retired or separated participants entitled to future benefits	2020-01-01	40
Total of all active and inactive participants	2020-01-01	253
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	253
Number of participants with account balances	2020-01-01	120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	10
2019: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2019 401k membership
Total participants, beginning-of-year	2019-01-01	250
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	204
Number of retired or separated participants receiving benefits	2019-01-01	4
Number of other retired or separated participants entitled to future benefits	2019-01-01	31
Total of all active and inactive participants	2019-01-01	239
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	239
Number of participants with account balances	2019-01-01	112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	9
2018: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2018 401k membership
Total participants, beginning-of-year	2018-01-01	242
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	221
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	18
Total of all active and inactive participants	2018-01-01	239
Total participants	2018-01-01	239
Number of participants with account balances	2018-01-01	76
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	5
2017: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2017 401k membership
Total participants, beginning-of-year	2017-01-01	216
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	185
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	20
Total of all active and inactive participants	2017-01-01	205
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	205
Number of participants with account balances	2017-01-01	78
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	3
2016: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2016 401k membership
Total participants, beginning-of-year	2016-01-01	196
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	181
Number of other retired or separated participants entitled to future benefits	2016-01-01	22
Total of all active and inactive participants	2016-01-01	203
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	203
Number of participants with account balances	2016-01-01	96
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2015 401k membership
Total participants, beginning-of-year	2015-01-01	210
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	172
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	31
Total of all active and inactive participants	2015-01-01	203
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	203
Number of participants with account balances	2015-01-01	89
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2014 401k membership
Total participants, beginning-of-year	2014-01-01	148
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	187
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	15
Total of all active and inactive participants	2014-01-01	202
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	202
Number of participants with account balances	2014-01-01	109
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2013 401k membership
Total participants, beginning-of-year	2013-01-01	68
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	123
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	12
Total of all active and inactive participants	2013-01-01	135
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	135
Number of participants with account balances	2013-01-01	71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0

Financial Data on ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST

Measure	Date	Value
2022 : ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
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	$207,484
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$741,188
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$738,012
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$455,965
Value of total assets at end of year	2022-12-31	$1,542,913
Value of total assets at beginning of year	2022-12-31	$2,076,617
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$3,176
Total interest from all sources	2022-12-31	$2,812
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$46,640
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$46,640
Administrative expenses professional fees incurred	2022-12-31	$816
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$250,000
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	$266,957
Assets. Loans (other than to participants) at end of year	2022-12-31	$61,760
Assets. Loans (other than to participants) at beginning of year	2022-12-31	$44,464
Total non interest bearing cash at end of year	2022-12-31	$654
Total non interest bearing cash at beginning of year	2022-12-31	$561
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	$-533,704
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$1,542,913
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$2,076,617
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 registered invesment companies (eg mutual funds) at end of year	2022-12-31	$1,192,650
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$1,835,382
Interest on participant loans	2022-12-31	$2,812
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$287,849
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$196,210
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-297,933
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	No
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	$189,008
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$738,012
Contract administrator fees	2022-12-31	$2,360
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	CLIFTONLARSONALLEN, LLP
Accountancy firm EIN	2022-12-31	410746749
2021 : ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 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	$17,475
Total income from all sources (including contributions)	2021-12-31	$670,262
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$166,288
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$159,084
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$429,159
Value of total assets at end of year	2021-12-31	$2,076,617
Value of total assets at beginning of year	2021-12-31	$1,590,118
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$7,204
Total interest from all sources	2021-12-31	$3,145
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$145,188
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$145,188
Administrative expenses professional fees incurred	2021-12-31	$646
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$250,000
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	$249,911
Assets. Loans (other than to participants) at end of year	2021-12-31	$44,464
Assets. Loans (other than to participants) at beginning of year	2021-12-31	$44,677
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2021-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2021-12-31	$17,475
Total non interest bearing cash at end of year	2021-12-31	$561
Total non interest bearing cash at beginning of year	2021-12-31	$738
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	$503,974
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$2,076,617
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$1,572,643
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 registered invesment companies (eg mutual funds) at end of year	2021-12-31	$1,835,382
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$1,407,398
Interest on participant loans	2021-12-31	$3,145
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$196,210
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$137,305
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$92,770
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	No
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	$179,248
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$159,084
Contract administrator fees	2021-12-31	$6,558
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	CLIFTONLARSONALLEN, LLP
Accountancy firm EIN	2021-12-31	410746749
2020 : ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 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	$17,475
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$15,911
Total income from all sources (including contributions)	2020-12-31	$546,709
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$322,815
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$301,285
Value of total corrective distributions	2020-12-31	$17,475
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$301,722
Value of total assets at end of year	2020-12-31	$1,590,118
Value of total assets at beginning of year	2020-12-31	$1,364,660
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$4,055
Total interest from all sources	2020-12-31	$4,101
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$34,820
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$34,820
Administrative expenses professional fees incurred	2020-12-31	$750
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$250,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$183,899
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$281
Assets. Loans (other than to participants) at end of year	2020-12-31	$44,677
Assets. Loans (other than to participants) at beginning of year	2020-12-31	$91,412
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2020-12-31	$17,475
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-12-31	$15,911
Total non interest bearing cash at end of year	2020-12-31	$738
Total non interest bearing cash at beginning of year	2020-12-31	$516
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	$223,894
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$1,572,643
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$1,348,749
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 end of year	2020-12-31	$1,407,398
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$1,152,177
Interest on participant loans	2020-12-31	$4,101
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$137,305
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$120,555
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$206,066
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	Yes
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	$117,542
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$301,285
Contract administrator fees	2020-12-31	$3,305
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	CLIFTONLARSONALLEN, LLP
Accountancy firm EIN	2020-12-31	410746749
2019 : ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 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	$15,911
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$12,026
Total income from all sources (including contributions)	2019-12-31	$500,820
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$123,362
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$120,503
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$291,823
Value of total assets at end of year	2019-12-31	$1,364,660
Value of total assets at beginning of year	2019-12-31	$983,317
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$2,859
Total interest from all sources	2019-12-31	$3,938
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$28,331
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$28,331
Administrative expenses professional fees incurred	2019-12-31	$750
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$137,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$141,709
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$66,984
Assets. Loans (other than to participants) at end of year	2019-12-31	$91,412
Assets. Loans (other than to participants) at beginning of year	2019-12-31	$77,294
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$15,911
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$12,026
Administrative expenses (other) incurred	2019-12-31	$42
Total non interest bearing cash at end of year	2019-12-31	$516
Total non interest bearing cash at beginning of year	2019-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$377,458
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$1,348,749
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$971,291
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	$1,152,177
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$807,598
Interest on participant loans	2019-12-31	$3,938
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$120,555
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$98,425
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$176,728
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	Yes
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	$83,130
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$120,503
Contract administrator fees	2019-12-31	$2,067
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	CLIFTONLARSONALLEN, LLP
Accountancy firm EIN	2019-12-31	410746749
2018 : ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$12,026
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$6,707
Total income from all sources (including contributions)	2018-12-31	$162,313
Total of all expenses incurred	2018-12-31	$133,175
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$129,142
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$195,088
Value of total assets at end of year	2018-12-31	$983,318
Value of total assets at beginning of year	2018-12-31	$948,861
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$4,033
Total interest from all sources	2018-12-31	$2,652
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$26,500
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$26,500
Administrative expenses professional fees incurred	2018-12-31	$4,033
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$98,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$121,835
Assets. Loans (other than to participants) at end of year	2018-12-31	$77,294
Assets. Loans (other than to participants) at beginning of year	2018-12-31	$57,983
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2018-12-31	$12,026
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2018-12-31	$6,707
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	$29,138
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$971,292
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$942,154
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 registered invesment companies (eg mutual funds) at end of year	2018-12-31	$807,599
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$822,780
Interest on participant loans	2018-12-31	$2,652
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$98,425
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$68,098
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-61,927
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	$73,253
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$129,142
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	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2018-12-31	410746749
2017 : ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2017 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$6,707
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$2,889
Total income from all sources (including contributions)	2017-12-31	$340,129
Total of all expenses incurred	2017-12-31	$69,087
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$63,537
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$222,067
Value of total assets at end of year	2017-12-31	$948,861
Value of total assets at beginning of year	2017-12-31	$674,001
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$5,550
Total interest from all sources	2017-12-31	$1,807
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$17,168
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$17,168
Administrative expenses professional fees incurred	2017-12-31	$5,550
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$95,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$117,953
Participant contributions at beginning of year	2017-12-31	$4,700
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$24,536
Assets. Loans (other than to participants) at end of year	2017-12-31	$57,983
Assets. Loans (other than to participants) at beginning of year	2017-12-31	$30,839
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2017-12-31	$6,707
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2017-12-31	$2,889
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	$271,042
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$942,154
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$671,112
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 registered invesment companies (eg mutual funds) at end of year	2017-12-31	$822,780
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$590,864
Interest on participant loans	2017-12-31	$1,807
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-12-31	$22
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-12-31	$22
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$68,098
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$44,419
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$99,087
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	$79,578
Employer contributions (assets) at end of year	2017-12-31	$0
Employer contributions (assets) at beginning of year	2017-12-31	$3,157
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$63,537
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	CLIFTON LARSON ALLEN
Accountancy firm EIN	2017-12-31	410746749
2016 : ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2016 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$2,889
Total income from all sources (including contributions)	2016-12-31	$239,494
Total of all expenses incurred	2016-12-31	$107,979
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$106,025
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$189,189
Value of total assets at end of year	2016-12-31	$674,001
Value of total assets at beginning of year	2016-12-31	$539,597
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$1,954
Total interest from all sources	2016-12-31	$526
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$9,261
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$9,261
Administrative expenses professional fees incurred	2016-12-31	$1,954
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$67,500
If this is an individual account plan, was there a blackout period	2016-12-31	Yes
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$96,148
Participant contributions at end of year	2016-12-31	$4,700
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$27,867
Assets. Loans (other than to participants) at end of year	2016-12-31	$30,839
Assets. Loans (other than to participants) at beginning of year	2016-12-31	$10,539
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2016-12-31	$2,889
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$131,515
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$671,112
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$539,597
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$590,864
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$178,187
Income. Interest from loans (other than to participants)	2016-12-31	$526
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2016-12-31	$22
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-12-31	$350,871
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-12-31	$350,871
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$44,419
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$40,518
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$65,174
Employer contributions (assets) at end of year	2016-12-31	$3,157
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$106,025
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	2016-12-31	Yes
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Liabilities. Value of acquisition indebtedness at end of year	2016-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	CLIFTON LARSON ALLEN
Accountancy firm EIN	2016-12-31	410746749
2015 : ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2015 401k financial data
Total income from all sources (including contributions)	2015-12-31	$169,201
Total of all expenses incurred	2015-12-31	$215,845
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$213,922
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$163,051
Value of total assets at end of year	2015-12-31	$539,597
Value of total assets at beginning of year	2015-12-31	$586,241
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$1,923
Total interest from all sources	2015-12-31	$910
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$10,372
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$10,372
Was this plan covered by a fidelity bond	2015-12-31	No
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	$99,359
Participant contributions at end of year	2015-12-31	$10,539
Participant contributions at beginning of year	2015-12-31	$30,185
Participant contributions at end of year	2015-12-31	$0
Participant contributions at beginning of year	2015-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$0
Other income not declared elsewhere	2015-12-31	$0
Administrative expenses (other) incurred	2015-12-31	$1,923
Total non interest bearing cash at end of year	2015-12-31	$0
Total non interest bearing cash at beginning of year	2015-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-46,644
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$539,597
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$586,241
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 registered invesment companies (eg mutual funds) at end of year	2015-12-31	$178,187
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$370,000
Interest on participant loans	2015-12-31	$829
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$350,871
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$186,056
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$186,056
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$81
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-5,132
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	No
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	$63,692
Employer contributions (assets) at end of year	2015-12-31	$0
Employer contributions (assets) at beginning of year	2015-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$213,922
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	CLIFTON LARSON ALLEN
Accountancy firm EIN	2015-12-31	410746749
2014 : ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$167,959
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$52,667
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$51,542
Expenses. Certain deemed distributions of participant loans	2014-12-31	$132
Value of total corrective distributions	2014-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$151,444
Value of total assets at end of year	2014-12-31	$586,241
Value of total assets at beginning of year	2014-12-31	$470,949
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$993
Total interest from all sources	2014-12-31	$1,213
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$22,367
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$22,367
Assets. Real estate other than employer real property at beginning of year	2014-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2014-12-31	$0
Was this plan covered by a fidelity bond	2014-12-31	No
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	$88,947
Participant contributions at end of year	2014-12-31	$30,185
Participant contributions at beginning of year	2014-12-31	$20,562
Participant contributions at end of year	2014-12-31	$0
Participant contributions at beginning of year	2014-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2014-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2014-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2014-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$0
Administrative expenses (other) incurred	2014-12-31	$993
Liabilities. Value of operating payables at beginning of year	2014-12-31	$0
Total non interest bearing cash at beginning of year	2014-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$115,292
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$586,241
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$470,949
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
Assets. partnership/joint venture interests at beginning of year	2014-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$370,000
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$58,912
Value of interest in pooled separate accounts at end of year	2014-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$0
Interest on participant loans	2014-12-31	$1,130
Value of interest in master investment trust accounts at end of year	2014-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2014-12-31	$0
Value of interest in common/collective trusts at end of year	2014-12-31	$0
Value of interest in common/collective trusts at beginning of year	2014-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$186,056
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$391,475
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$391,475
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$83
Assets. Value of investments in 103.12 investment entities at end of year	2014-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2014-12-31	$0
Asset value of US Government securities at beginning of year	2014-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$-7,065
Net investment gain/loss from pooled separate accounts	2014-12-31	$0
Net investment gain or loss from common/collective trusts	2014-12-31	$0
Net gain/loss from 103.12 investment entities	2014-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Assets. Invements in employer securities at beginning of year	2014-12-31	$0
Assets. Value of employer real property at beginning of year	2014-12-31	$0
Contributions received in cash from employer	2014-12-31	$62,497
Employer contributions (assets) at end of year	2014-12-31	$0
Employer contributions (assets) at beginning of year	2014-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$51,542
Asset. Corporate debt instrument preferred debt at beginning of year	2014-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2014-12-31	$0
Contract administrator fees	2014-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2014-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2014-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2014-12-31	$0
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
Liabilities. Value of acquisition indebtedness at beginning of year	2014-12-31	$0
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	CLIFTON LARSON ALLEN
Accountancy firm EIN	2014-12-31	410746749
2013 : ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total plan liabilities at end of year	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$479,273
Expenses. Total of all expenses incurred	2013-12-31	$8,324
Benefits paid (including direct rollovers)	2013-12-31	$8,129
Total plan assets at end of year	2013-12-31	$470,949
Total plan assets at beginning of year	2013-12-31	$0
Value of fidelity bond covering the plan	2013-12-31	$0
Total contributions received or receivable from participants	2013-12-31	$39,628
Expenses. Other expenses not covered elsewhere	2013-12-31	$0
Contributions received from other sources (not participants or employers)	2013-12-31	$13,361
Other income received	2013-12-31	$396,092
Net income (gross income less expenses)	2013-12-31	$470,949
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$470,949
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$0
Assets. Value of participant loans	2013-12-31	$20,562
Total contributions received or receivable from employer(s)	2013-12-31	$30,192
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$195
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2013-12-31	$0
Minimum employer required contribution for this plan year	2013-12-31	$0
Amount contributed by the employer to the plan for this plan year	2013-12-31	$0

Form 5500 Responses for ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST

2022: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 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 – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 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 – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 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 – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 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 – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 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 – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 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 – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: ST. MATTHEWS HOUSE,INC.401(K) PROFIT SHARING PLAN AND TRUST 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	First time form 5500 has been submitted	Yes
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

810522A

Policy instance

Insurance contract or identification number	810522A
Number of Individuals Covered	60
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

810522A

Policy instance

Insurance contract or identification number	810522A
Number of Individuals Covered	58
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

810522A

Policy instance

Insurance contract or identification number	810522A
Number of Individuals Covered	32
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

810522A

Policy instance

Insurance contract or identification number	810522A
Number of Individuals Covered	32
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

810522A

Policy instance

Insurance contract or identification number	810522A
Number of Individuals Covered	32
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

810522A

Policy instance

Insurance contract or identification number	810522A
Number of Individuals Covered	33
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0

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Company Name:	ST MATTHEWS HOUSE INC
Employer identification number (EIN):	651110501
NAIC Classification:	624200