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ANDOVER SUBACUTE AND REHAB CENTER TWO, INC. HEALTH PLAN 401k Plan overview

Plan NameANDOVER SUBACUTE AND REHAB CENTER TWO, INC. HEALTH PLAN
Plan identification number 501

ANDOVER SUBACUTE AND REHAB CENTER TWO, INC. HEALTH PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental

401k Sponsoring company profile

ANDOVER SUBACUTE & REHAB CENTER SERVICES TWO, INC. has sponsored the creation of one or more 401k plans.

Company Name:ANDOVER SUBACUTE & REHAB CENTER SERVICES TWO, INC.
Employer identification number (EIN):113705004
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ANDOVER SUBACUTE AND REHAB CENTER TWO, INC. HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012018-01-01
5012017-01-01CRAIG GOODSTADT CRAIG GOODSTADT
5012017-01-01CRAIG GOODSTADT CRAIG GOODSTADT2018-10-12
5012016-01-01CRAIG GOODSTADT CRAIG GOODSTADT2017-08-24
5012015-01-01CRAIG GOODSTADT CRAIG GOODSTADT2016-09-30
5012014-01-01CRAIG GOODSTADT CRAIG GOODSTADT2015-10-07
5012013-01-01CRAIG GOODSTADT CRAIG GOODSTADT2014-06-09
5012012-01-01CRAIG GOODSTADT CRAIG GOODSTADT2013-07-02
5012011-01-01CRAIG GOODSTADT
5012010-01-01CRAIG GOODSTADT
5012009-01-01CRAIG GOODSTADT

Plan Statistics for ANDOVER SUBACUTE AND REHAB CENTER TWO, INC. HEALTH PLAN

401k plan membership statisitcs for ANDOVER SUBACUTE AND REHAB CENTER TWO, INC. HEALTH PLAN

Measure Date Value
2018: ANDOVER SUBACUTE AND REHAB CENTER TWO, INC. HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01317
Total number of active participants reported on line 7a of the Form 55002018-01-010
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-010
2017: ANDOVER SUBACUTE AND REHAB CENTER TWO, INC. HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01321
Total number of active participants reported on line 7a of the Form 55002017-01-01317
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01317
2016: ANDOVER SUBACUTE AND REHAB CENTER TWO, INC. HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01296
Total number of active participants reported on line 7a of the Form 55002016-01-01321
Total of all active and inactive participants2016-01-01321
2015: ANDOVER SUBACUTE AND REHAB CENTER TWO, INC. HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01288
Total number of active participants reported on line 7a of the Form 55002015-01-01296
Total of all active and inactive participants2015-01-01296
2014: ANDOVER SUBACUTE AND REHAB CENTER TWO, INC. HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01301
Total number of active participants reported on line 7a of the Form 55002014-01-01288
Total of all active and inactive participants2014-01-01288
2013: ANDOVER SUBACUTE AND REHAB CENTER TWO, INC. HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01324
Total number of active participants reported on line 7a of the Form 55002013-01-01301
Total of all active and inactive participants2013-01-01301
2012: ANDOVER SUBACUTE AND REHAB CENTER TWO, INC. HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01340
Total number of active participants reported on line 7a of the Form 55002012-01-01324
Total of all active and inactive participants2012-01-01324
2011: ANDOVER SUBACUTE AND REHAB CENTER TWO, INC. HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01367
Total number of active participants reported on line 7a of the Form 55002011-01-01340
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01340
2010: ANDOVER SUBACUTE AND REHAB CENTER TWO, INC. HEALTH PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01401
Total number of active participants reported on line 7a of the Form 55002010-01-01367
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-01367
2009: ANDOVER SUBACUTE AND REHAB CENTER TWO, INC. HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01410
Total number of active participants reported on line 7a of the Form 55002009-01-01401
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01401

Form 5500 Responses for ANDOVER SUBACUTE AND REHAB CENTER TWO, INC. HEALTH PLAN

2018: ANDOVER SUBACUTE AND REHAB CENTER TWO, INC. HEALTH PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01This submission is the final filingYes
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: ANDOVER SUBACUTE AND REHAB CENTER TWO, INC. HEALTH PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedYes
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: ANDOVER SUBACUTE AND REHAB CENTER TWO, INC. HEALTH PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: ANDOVER SUBACUTE AND REHAB CENTER TWO, INC. HEALTH PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: ANDOVER SUBACUTE AND REHAB CENTER TWO, INC. HEALTH PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: ANDOVER SUBACUTE AND REHAB CENTER TWO, INC. HEALTH PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: ANDOVER SUBACUTE AND REHAB CENTER TWO, INC. HEALTH PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: ANDOVER SUBACUTE AND REHAB CENTER TWO, INC. HEALTH PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: ANDOVER SUBACUTE AND REHAB CENTER TWO, INC. HEALTH PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: ANDOVER SUBACUTE AND REHAB CENTER TWO, INC. HEALTH PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )
Policy contract number818750
Policy instance 1
Insurance contract or identification number818750
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5448608
Policy instance 2
Insurance contract or identification number5448608
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )
Policy contract number818750
Policy instance 1
Insurance contract or identification number818750
Number of Individuals Covered317
Insurance policy start date2017-01-01
Insurance policy end date2017-05-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $200,559
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5448608
Policy instance 2
Insurance contract or identification number5448608
Number of Individuals Covered8
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $849
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $441
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Insurance broker nameKORE INSURANCE HOLDINGS LLC

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