401k Plan data: MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN plan

MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 401k Plan overview

Plan Name	MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN
Plan identification number	001

MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(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.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
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.

401k Sponsoring company profile

MOTHER ANGELINE MCCRORY MANOR, INC. has sponsored the creation of one or more 401k plans.

Company Name: MOTHER ANGELINE MCCRORY MANOR, INC.

Employer identification number (EIN): 912134683

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

Additional information about MOTHER ANGELINE MCCRORY MANOR, INC.

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division

Incorporation Date: 2001-03-13

Company Identification Number: 1220514

Legal Registered Office Address: 41 S. HIGH STREET - #2600
-
COLUMBUS
United States of America (USA)
43215

More information about MOTHER ANGELINE MCCRORY MANOR, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2017-01-01
001 2017-01-01 JAMES P. SILK 2019-10-04
001 2016-01-01
001 2015-01-01
001 2014-01-01 SHERRY WORTHINGTON
001 2013-01-01 SHERRY WORTHINGTON
001 2012-01-01 SHERRY WORTHINGTON
001 2011-01-01 SHERRY WORTHINGTON
001 2009-01-01 SHERRY WORTHINGTON
001 2009-01-01 SHERRY WORTHINGTON
001 2009-01-01 SHERRY WORTHINGTON
001 2009-01-01 SHERRY WORTHINGTON
001 2009-01-01 SHERRY WORTHINGTON

Plan Statistics for MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN

401k plan membership statisitcs for MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN

Measure Date Value
2017: MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 316
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 301
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 62
Total of all active and inactive participants 2017-01-01 363
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 363
Number of participants with account balances 2017-01-01 62
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 37
2016: MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 308
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 287
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 29
Total of all active and inactive participants 2016-01-01 316
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 316
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 5
2015: MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 267
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 246
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 37
Total of all active and inactive participants 2015-01-01 283
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 283
Number of participants with account balances 2015-01-01 107
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 5
2014: MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 257
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 249
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 18
Total of all active and inactive participants 2014-01-01 267
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 267
Number of participants with account balances 2014-01-01 86
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 281
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 250
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 26
Total of all active and inactive participants 2013-01-01 276
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 276
Number of participants with account balances 2013-01-01 100
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 3
2012: MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 210
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 253
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 28
Total of all active and inactive participants 2012-01-01 281
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 281
Number of participants with account balances 2012-01-01 102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 2
2011: MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 129
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 184
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 26
Total of all active and inactive participants 2011-01-01 210
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 210
Number of participants with account balances 2011-01-01 93
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 4
2009: MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 94
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 105
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 4
Total of all active and inactive participants 2009-01-01 109
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 109
Number of participants with account balances 2009-01-01 87
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 1

Measure	Date	Value
2017: MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	316
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	301
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	62
Total of all active and inactive participants	2017-01-01	363
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	363
Number of participants with account balances	2017-01-01	62
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	37
2016: MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	308
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	287
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	29
Total of all active and inactive participants	2016-01-01	316
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	316
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	5
2015: MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	267
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	246
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	37
Total of all active and inactive participants	2015-01-01	283
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	283
Number of participants with account balances	2015-01-01	107
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	5
2014: MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	257
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	249
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	18
Total of all active and inactive participants	2014-01-01	267
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	267
Number of participants with account balances	2014-01-01	86
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	281
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	250
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	26
Total of all active and inactive participants	2013-01-01	276
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	276
Number of participants with account balances	2013-01-01	100
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	3
2012: MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	210
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	253
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	28
Total of all active and inactive participants	2012-01-01	281
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	281
Number of participants with account balances	2012-01-01	102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	2
2011: MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	129
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	184
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	26
Total of all active and inactive participants	2011-01-01	210
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	210
Number of participants with account balances	2011-01-01	93
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	4
2009: MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	94
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	105
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	4
Total of all active and inactive participants	2009-01-01	109
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	109
Number of participants with account balances	2009-01-01	87
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	1

Financial Data on MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN

Measure	Date	Value
2017 : MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$237,423
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$125,278
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$106,532
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$134,615
Value of total assets at end of year	2017-12-31	$937,222
Value of total assets at beginning of year	2017-12-31	$825,077
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$18,746
Total interest from all sources	2017-12-31	$2,077
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$1,250,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$118,031
Participant contributions at end of year	2017-12-31	$14,799
Participant contributions at beginning of year	2017-12-31	$3,705
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	$112,145
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$937,222
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$825,077
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Investment advisory and management fees	2017-12-31	$3,523
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$699,485
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$573,718
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-12-31	$22,318
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-12-31	$22,848
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-12-31	$22,848
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-12-31	$2,077
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$184,036
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$207,628
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$100,731
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	$16,584
Employer contributions (assets) at end of year	2017-12-31	$16,584
Employer contributions (assets) at beginning of year	2017-12-31	$17,178
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$106,532
Contract administrator fees	2017-12-31	$15,223
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	HW&CO.
Accountancy firm EIN	2017-12-31	341663157
2016 : MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$197,024
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$111,523
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$94,718
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$137,008
Value of total assets at end of year	2016-12-31	$825,077
Value of total assets at beginning of year	2016-12-31	$739,576
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$16,805
Total interest from all sources	2016-12-31	$2,377
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$1,250,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$100,805
Participant contributions at end of year	2016-12-31	$3,705
Participant contributions at beginning of year	2016-12-31	$7,094
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$19,025
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	$85,501
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$825,077
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$739,576
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Investment advisory and management fees	2016-12-31	$5,563
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$573,718
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$494,170
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2016-12-31	$22,848
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-12-31	$27,130
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-12-31	$27,130
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-12-31	$2,377
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$207,628
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$196,083
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$57,639
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	Yes
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	$17,178
Employer contributions (assets) at end of year	2016-12-31	$17,178
Employer contributions (assets) at beginning of year	2016-12-31	$15,099
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$94,718
Contract administrator fees	2016-12-31	$11,242
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
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	HW&CO.
Accountancy firm EIN	2016-12-31	341663157
2015 : MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$93,714
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$83,192
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$69,422
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$109,088
Value of total assets at end of year	2015-12-31	$739,576
Value of total assets at beginning of year	2015-12-31	$729,054
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$13,770
Total interest from all sources	2015-12-31	$2,228
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
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	$1,250,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$93,989
Participant contributions at end of year	2015-12-31	$7,094
Participant contributions at beginning of year	2015-12-31	$3,284
Administrative expenses (other) incurred	2015-12-31	$750
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	$10,522
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$739,576
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$729,054
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
Investment advisory and management fees	2015-12-31	$3,025
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$494,170
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$483,673
Interest earned on other investments	2015-12-31	$2,228
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$27,130
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$26,338
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$26,338
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$196,083
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$201,712
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-17,602
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	$15,099
Employer contributions (assets) at end of year	2015-12-31	$15,099
Employer contributions (assets) at beginning of year	2015-12-31	$14,047
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$69,422
Contract administrator fees	2015-12-31	$9,995
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	HW&CO.
Accountancy firm EIN	2015-12-31	341663157
2014 : MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 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	$124,831
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$31,846
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$19,341
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$101,942
Value of total assets at end of year	2014-12-31	$729,054
Value of total assets at beginning of year	2014-12-31	$636,069
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$12,505
Total interest from all sources	2014-12-31	$2,576
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
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	$1,250,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$87,083
Participant contributions at end of year	2014-12-31	$3,284
Participant contributions at beginning of year	2014-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$812
Administrative expenses (other) incurred	2014-12-31	$375
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	$92,985
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$729,054
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$636,069
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
Investment advisory and management fees	2014-12-31	$2,853
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$483,673
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$418,162
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$26,338
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$27,954
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$27,954
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$2,576
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$201,712
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$175,397
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$20,313
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	$14,047
Employer contributions (assets) at end of year	2014-12-31	$14,047
Employer contributions (assets) at beginning of year	2014-12-31	$14,556
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$19,341
Contract administrator fees	2014-12-31	$9,277
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	HW&CO.
Accountancy firm EIN	2014-12-31	341663157
2013 : MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$175,357
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$78,409
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$67,484
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$91,108
Value of total assets at end of year	2013-12-31	$636,069
Value of total assets at beginning of year	2013-12-31	$539,121
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$10,925
Total interest from all sources	2013-12-31	$2,816
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
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	$1,250,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$76,168
Participant contributions at end of year	2013-12-31	$0
Participant contributions at beginning of year	2013-12-31	$2,790
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	$96,948
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$636,069
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$539,121
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
Investment advisory and management fees	2013-12-31	$2,943
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$418,162
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$328,978
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$27,954
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$46,092
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$46,092
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$2,816
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$175,397
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$149,387
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$81,433
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	$14,940
Employer contributions (assets) at end of year	2013-12-31	$14,556
Employer contributions (assets) at beginning of year	2013-12-31	$11,874
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$67,484
Contract administrator fees	2013-12-31	$7,982
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	HW&CO.
Accountancy firm EIN	2013-12-31	341663157
2012 : MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$123,599
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$15,106
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$5,839
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$77,607
Value of total assets at end of year	2012-12-31	$539,121
Value of total assets at beginning of year	2012-12-31	$430,628
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$9,267
Total interest from all sources	2012-12-31	$3,043
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
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	$1,250,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$64,161
Participant contributions at end of year	2012-12-31	$2,790
Participant contributions at beginning of year	2012-12-31	$2,513
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$1,572
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	$108,493
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$539,121
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$430,628
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
Investment advisory and management fees	2012-12-31	$2,338
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$328,978
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$248,222
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$46,092
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$50,477
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$50,477
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$3,043
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$149,387
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$110,584
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$42,949
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	$11,874
Employer contributions (assets) at end of year	2012-12-31	$11,874
Employer contributions (assets) at beginning of year	2012-12-31	$18,832
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$5,839
Contract administrator fees	2012-12-31	$6,929
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	HOWARD WERSHBALE & CO
Accountancy firm EIN	2012-12-31	341663157
2011 : MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$95,567
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$63,660
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$54,678
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$103,286
Value of total assets at end of year	2011-12-31	$430,628
Value of total assets at beginning of year	2011-12-31	$398,721
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$8,982
Total interest from all sources	2011-12-31	$2,434
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
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	$1,250,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$82,634
Participant contributions at end of year	2011-12-31	$2,513
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$1,820
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	$31,907
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$430,628
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$398,721
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
Investment advisory and management fees	2011-12-31	$2,668
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$248,222
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$241,730
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$50,477
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$42,140
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$42,140
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$2,434
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$110,584
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$96,297
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-10,153
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	Yes
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	$18,832
Employer contributions (assets) at end of year	2011-12-31	$18,832
Employer contributions (assets) at beginning of year	2011-12-31	$18,554
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$54,678
Contract administrator fees	2011-12-31	$6,314
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	HOWARD WERSHBALE & CO
Accountancy firm EIN	2011-12-31	341663157
2010 : MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$150,064
Expenses. Total of all expenses incurred	2010-12-31	$121,499
Benefits paid (including direct rollovers)	2010-12-31	$121,499
Total plan assets at end of year	2010-12-31	$386,816
Total plan assets at beginning of year	2010-12-31	$358,251
Total contributions received or receivable from participants	2010-12-31	$106,763
Contributions received from other sources (not participants or employers)	2010-12-31	$885
Other income received	2010-12-31	$22,112
Net income (gross income less expenses)	2010-12-31	$28,565
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$386,816
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$358,251
Total contributions received or receivable from employer(s)	2010-12-31	$20,304
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN

2017: MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 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 – 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: MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 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 – 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: MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
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: MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
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
2009: MOTHER ANGELINE MCCRORY MANOR, INC. 403B PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

GAP-B2-WZ88

Policy instance

Insurance contract or identification number	GAP-B2-WZ88
Number of Individuals Covered	35
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,086
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
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
Commission paid to Insurance Broker	USD $2,086
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	INVESTMENT
Insurance broker organization code?	3
Insurance broker name	INVEST FINANCIAL CORPORATION

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

Policy contract number

GAP-B2-WZ88

Policy instance

Insurance contract or identification number	GAP-B2-WZ88
Number of Individuals Covered	107
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,139
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
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
Commission paid to Insurance Broker	USD $2,139
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	INVESTMENT
Insurance broker organization code?	3
Insurance broker name	INVEST FINANCIAL CORPORATION

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

Policy contract number

GAP-B2-WZ88

Policy instance

Insurance contract or identification number	GAP-B2-WZ88
Number of Individuals Covered	86
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $752
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
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
Commission paid to Insurance Broker	USD $752
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	INVESTMENT
Insurance broker organization code?	3
Insurance broker name	INVEST FINANCIAL CORPORATION

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

Policy contract number

GAP-B2-WZ88

Policy instance

Insurance contract or identification number	GAP-B2-WZ88
Number of Individuals Covered	100
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $556
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
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
Commission paid to Insurance Broker	USD $556
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	ADMINISTRATIVE
Insurance broker organization code?	3
Insurance broker name	INVEST FINANCIAL CORPORATION

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

Policy contract number

GAP-B2-WZ88

Policy instance

Insurance contract or identification number	GAP-B2-WZ88
Number of Individuals Covered	28
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $583
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
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
Commission paid to Insurance Broker	USD $583
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	ADMINISTRATIVE
Insurance broker organization code?	3
Insurance broker name	INVEST FINANCIAL CORPORATION

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

Policy contract number

GAP-B2-WZ88

Policy instance

Insurance contract or identification number	GAP-B2-WZ88
Number of Individuals Covered	184
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $770
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
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

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

Policy contract number

GAP-B2-WZ88

Policy instance

Insurance contract or identification number	GAP-B2-WZ88
Number of Individuals Covered	129
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,193
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
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
Commission paid to Insurance Broker	USD $1,193
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	ADMINISTRATIVE
Insurance broker organization code?	3
Insurance broker name	INVEST FINANCIAL CORPORATION

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Company Name:	MOTHER ANGELINE MCCRORY MANOR, INC.
Employer identification number (EIN):	912134683
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities

Jurisdiction of Incorporation:	Ohio Secretary of State Business Services Division
Incorporation Date:	2001-03-13
Company Identification Number:	1220514
Legal Registered Office Address:	41 S. HIGH STREET - #2600 - COLUMBUS United States of America (USA) 43215

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2017-01-01
001	2017-01-01	JAMES P. SILK	2019-10-04
001	2016-01-01
001	2015-01-01
001	2014-01-01	SHERRY WORTHINGTON
001	2013-01-01	SHERRY WORTHINGTON
001	2012-01-01	SHERRY WORTHINGTON
001	2011-01-01	SHERRY WORTHINGTON
001	2009-01-01	SHERRY WORTHINGTON
001	2009-01-01	SHERRY WORTHINGTON
001	2009-01-01	SHERRY WORTHINGTON
001	2009-01-01	SHERRY WORTHINGTON
001	2009-01-01	SHERRY WORTHINGTON