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EMPLOYEE BENEFIT PLAN OF WAVERLY SENIOR SERVICES 401k Plan overview

Plan NameEMPLOYEE BENEFIT PLAN OF WAVERLY SENIOR SERVICES
Plan identification number 001

EMPLOYEE BENEFIT PLAN OF WAVERLY SENIOR SERVICES Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.

401k Sponsoring company profile

WAVERLY SENIOR SERVICES has sponsored the creation of one or more 401k plans.

Company Name:WAVERLY SENIOR SERVICES
Employer identification number (EIN):922896026
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE BENEFIT PLAN OF WAVERLY SENIOR SERVICES

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012023-01-01

Plan Statistics for EMPLOYEE BENEFIT PLAN OF WAVERLY SENIOR SERVICES

401k plan membership statisitcs for EMPLOYEE BENEFIT PLAN OF WAVERLY SENIOR SERVICES

Measure Date Value
2023: EMPLOYEE BENEFIT PLAN OF WAVERLY SENIOR SERVICES 2023 401k membership
Total participants, beginning-of-year2023-01-01445
Total number of active participants reported on line 7a of the Form 55002023-01-01411
Number of retired or separated participants receiving benefits2023-01-013
Number of other retired or separated participants entitled to future benefits2023-01-01128
Total of all active and inactive participants2023-01-01542
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2023-01-010
Total participants2023-01-01542
Number of participants with account balances2023-01-01450
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2023-01-010

Financial Data on EMPLOYEE BENEFIT PLAN OF WAVERLY SENIOR SERVICES

Measure Date Value
2023 : EMPLOYEE BENEFIT PLAN OF WAVERLY SENIOR SERVICES 2023 401k financial data
Unrealized appreciation/depreciation of real estate assets2023-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2023-12-31$0
Total unrealized appreciation/depreciation of assets2023-12-31$0
Total transfer of assets from this plan2023-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-12-31$0
Expenses. Interest paid2023-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022023-12-31$0
Total income from all sources (including contributions)2023-12-31$2,900,226
Total loss/gain on sale of assets2023-12-31$0
Total of all expenses incurred2023-12-31$415,899
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2023-12-31$413,062
Expenses. Certain deemed distributions of participant loans2023-12-31$0
Value of total corrective distributions2023-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2023-12-31$1,213,949
Value of total assets at end of year2023-12-31$13,927,677
Value of total assets at beginning of year2023-12-31$11,443,350
Total of administrative expenses incurred including professional, contract, advisory and management fees2023-12-31$2,837
Total income from rents2023-12-31$0
Total interest from all sources2023-12-31$48,758
Total dividends received (eg from common stock, registered investment company shares)2023-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2023-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2023-12-31$0
Assets. Real estate other than employer real property at end of year2023-12-31$0
Assets. Real estate other than employer real property at beginning of year2023-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2023-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2023-12-31$0
Was this plan covered by a fidelity bond2023-12-31Yes
Value of fidelity bond cover2023-12-31$500,000
If this is an individual account plan, was there a blackout period2023-12-31No
Were there any nonexempt tranactions with any party-in-interest2023-12-31No
Contributions received from participants2023-12-31$183,593
Participant contributions at end of year2023-12-31$364,320
Participant contributions at beginning of year2023-12-31$378,969
Participant contributions at end of year2023-12-31$0
Participant contributions at beginning of year2023-12-31$0
Assets. Other investments not covered elsewhere at end of year2023-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2023-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2023-12-31$148,935
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2023-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2023-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2023-12-31$0
Assets. Loans (other than to participants) at end of year2023-12-31$0
Assets. Loans (other than to participants) at beginning of year2023-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2023-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2023-12-31$0
Other income not declared elsewhere2023-12-31$0
Administrative expenses (other) incurred2023-12-31$2,837
Liabilities. Value of operating payables at end of year2023-12-31$0
Liabilities. Value of operating payables at beginning of year2023-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2023-12-31No
Income. Non cash contributions2023-12-31$0
Value of net income/loss2023-12-31$2,484,327
Value of net assets at end of year (total assets less liabilities)2023-12-31$13,927,677
Value of net assets at beginning of year (total assets less liabilities)2023-12-31$11,443,350
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2023-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2023-12-31No
Were any leases to which the plan was party in default or uncollectible2023-12-31No
Assets. partnership/joint venture interests at end of year2023-12-31$0
Assets. partnership/joint venture interests at beginning of year2023-12-31$0
Investment advisory and management fees2023-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2023-12-31$10,763,135
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2023-12-31$8,423,791
Value of interest in pooled separate accounts at end of year2023-12-31$0
Value of interest in pooled separate accounts at beginning of year2023-12-31$0
Interest on participant loans2023-12-31$18,312
Income. Interest from loans (other than to participants)2023-12-31$0
Interest earned on other investments2023-12-31$30,446
Income. Interest from US Government securities2023-12-31$0
Income. Interest from corporate debt instruments2023-12-31$0
Value of interest in master investment trust accounts at end of year2023-12-31$0
Value of interest in master investment trust accounts at beginning of year2023-12-31$0
Value of interest in common/collective trusts at end of year2023-12-31$0
Value of interest in common/collective trusts at beginning of year2023-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2023-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2023-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2023-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2023-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2023-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2023-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2023-12-31$1,918,801
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2023-12-31$1,801,718
Expenses. Payments to insurance carriers foe the provision of benefits2023-12-31$0
Asset value of US Government securities at end of year2023-12-31$0
Asset value of US Government securities at beginning of year2023-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2023-12-31$0
Net investment gain/loss from pooled separate accounts2023-12-31$1,637,519
Net investment gain or loss from common/collective trusts2023-12-31$0
Net gain/loss from 103.12 investment entities2023-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2023-12-31No
Was there a failure to transmit to the plan any participant contributions2023-12-31Yes
Has the plan failed to provide any benefit when due under the plan2023-12-31No
Contributions received in cash from employer2023-12-31$881,421
Employer contributions (assets) at end of year2023-12-31$881,421
Employer contributions (assets) at beginning of year2023-12-31$838,872
Income. Dividends from preferred stock2023-12-31$0
Income. Dividends from common stock2023-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2023-12-31$413,062
Asset. Corporate debt instrument preferred debt at end of year2023-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2023-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2023-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2023-12-31$0
Contract administrator fees2023-12-31$0
Assets. Corporate common stocks other than exployer securities at end of year2023-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2023-12-31$0
Liabilities. Value of benefit claims payable at end of year2023-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2023-12-31$0
Did the plan have assets held for investment2023-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2023-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2023-12-31No
Aggregate proceeds on sale of assets2023-12-31$0
Aggregate carrying amount (costs) on sale of assets2023-12-31$0
Liabilities. Value of acquisition indebtedness at end of year2023-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2023-12-31$0
Opinion of an independent qualified public accountant for this plan2023-12-31Unqualified
Accountancy firm name2023-12-31CLIFTONLARSONALLEN LLP
Accountancy firm EIN2023-12-31410746749

Form 5500 Responses for EMPLOYEE BENEFIT PLAN OF WAVERLY SENIOR SERVICES

2023: EMPLOYEE BENEFIT PLAN OF WAVERLY SENIOR SERVICES 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Submission has been amendedNo
2023-01-01This submission is the final filingNo
2023-01-01This return/report is a short plan year return/report (less than 12 months)No
2023-01-01Plan is a collectively bargained planNo
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number916446
Policy instance 1
Insurance contract or identification number916446
Number of Individuals Covered450
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $5,359
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 planNo
Contracts With Unallocated Funds Deposit Administration1
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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

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