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| Plan Name | HARBOR HOMES, INC. MEDICAL PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | HARBOR HOMES, INC. |
| Employer identification number (EIN): | 020351932 |
| NAIC Classification: | 624100 |
| NAIC Description: | Individual and Family Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2019-01-01 | JESSICA KEARNS | 2020-09-11 | ||
| 501 | 2018-03-01 | ||||
| 501 | 2017-03-01 | PETER KELLEHER | PETER KELLEHER | 2018-09-26 |
| Measure | Date | Value |
|---|---|---|
| 2019: HARBOR HOMES, INC. MEDICAL PLAN 2019 401k membership | ||
| Total participants, beginning-of-year | 2019-01-01 | 208 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 0 |
| Number of employers contributing to the scheme | 2019-01-01 | 0 |
| 2018: HARBOR HOMES, INC. MEDICAL PLAN 2018 401k membership | ||
| Total participants, beginning-of-year | 2018-03-01 | 141 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-03-01 | 207 |
| Number of retired or separated participants receiving benefits | 2018-03-01 | 1 |
| Total of all active and inactive participants | 2018-03-01 | 208 |
| 2017: HARBOR HOMES, INC. MEDICAL PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-03-01 | 107 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-03-01 | 138 |
| Number of retired or separated participants receiving benefits | 2017-03-01 | 3 |
| Total of all active and inactive participants | 2017-03-01 | 141 |
| 2019: HARBOR HOMES, INC. MEDICAL PLAN 2019 form 5500 responses | ||
|---|---|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | This submission is the final filing | Yes |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: HARBOR HOMES, INC. MEDICAL PLAN 2018 form 5500 responses | ||
| 2018-03-01 | Type of plan entity | Single employer plan |
| 2018-03-01 | Submission has been amended | No |
| 2018-03-01 | This submission is the final filing | No |
| 2018-03-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2018-03-01 | Plan is a collectively bargained plan | No |
| 2018-03-01 | Plan funding arrangement – Insurance | Yes |
| 2018-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: HARBOR HOMES, INC. MEDICAL PLAN 2017 form 5500 responses | ||
| 2017-03-01 | Type of plan entity | Single employer plan |
| 2017-03-01 | First time form 5500 has been submitted | Yes |
| 2017-03-01 | Submission has been amended | No |
| 2017-03-01 | This submission is the final filing | No |
| 2017-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-03-01 | Plan is a collectively bargained plan | No |
| 2017-03-01 | Plan funding arrangement – Insurance | Yes |
| 2017-03-01 | Plan benefit arrangement – Insurance | Yes |
| HARVARD PILGRIM HEALTH CARE OF NE, INC. (National Association of Insurance Commissioners NAIC id number: 96917 ) | |||||||||||||||||||||||||||||||||||||
| Policy contract number | 433110000 ET AL | ||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||
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| HARVARD PILGRIM HEALTH CARE OF NE, INC. (National Association of Insurance Commissioners NAIC id number: 96917 ) | |||||||||||||||||||||||||||||||||||||
| Policy contract number | 088004 | ||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||
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| HARVARD PILGRIM HEALTH CARE OF NE, INC. (National Association of Insurance Commissioners NAIC id number: 96917 ) | |||||||||||||||||||||||||||||||||||||
| Policy contract number | 088004 | ||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||
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