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| Plan Name | LIFE AD&D |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | COBBLE HILL HEALTH CENTER, INC. |
| Employer identification number (EIN): | 112388200 |
| NAIC Classification: | 623000 |
| NAIC Description: | Nursing and Residential Care Facilities |
Additional information about COBBLE HILL HEALTH CENTER, INC.
| Jurisdiction of Incorporation: | New York Department of State |
| Incorporation Date: | 1976-05-05 |
| Company Identification Number: | 398920 |
| Legal Registered Office Address: |
380 HENRY STREET Kings BROOKLYN United States of America (USA) 11201 |
More information about COBBLE HILL HEALTH CENTER, INC.
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-01-01 | MICHAEL BRECHER | 2024-09-04 |
| Measure | Date | Value |
|---|---|---|
| 2023: LIFE AD&D 2023 401k membership | ||
| Total participants, beginning-of-year | 2023-01-01 | 120 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-01-01 | 174 |
| Number of retired or separated participants receiving benefits | 2023-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2023-01-01 | 0 |
| Total of all active and inactive participants | 2023-01-01 | 174 |
| Number of employers contributing to the scheme | 2023-01-01 | 0 |
| 2023: LIFE AD&D 2023 form 5500 responses | ||
|---|---|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | First time form 5500 has been submitted | Yes |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |||||||||||||||||||||
| Policy contract number | 927300 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
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