401k Plan data: THE WARTBURG HOME DENTAL PLAN plan

THE WARTBURG HOME DENTAL PLAN 401k Plan overview

Plan Name	THE WARTBURG HOME DENTAL PLAN
Plan identification number	503

THE WARTBURG HOME DENTAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20. Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

THE WARTBURG HOME has sponsored the creation of one or more 401k plans.

Company Name: THE WARTBURG HOME

Employer identification number (EIN): 131740497

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE WARTBURG HOME DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2017-01-01
503 2014-01-01 DOROTHEA F BELL
503 2013-01-01 DOROTHEA BELL
503 2012-01-01 DOROTHEA BELL DOROTHEA BELL 2013-11-27
503 2011-01-01 DOROTHEA BELL DOROTHEA BELL 2013-11-27
503 2010-01-01 DOROTHEA BELL DOROTHEA BELL 2013-11-27
503 2009-01-01 DOROTHEA BELL DOROTHEA BELL 2013-11-27
503 2008-01-01 DOROTHEA BELL DOROTHEA BELL 2013-11-27
503 2007-01-01 DOROTHEA BELL DOROTHEA BELL 2013-11-27
503 2006-01-01 DOROTHEA BELL DOROTHEA BELL 2013-11-27
503 2005-01-01 DOROTHEA BELL DOROTHEA BELL 2013-11-27
503 2004-01-01 DOROTHEA BELL DOROTHEA BELL 2013-11-27
503 2003-01-01 DOROTHEA BELL DOROTHEA BELL 2013-11-27
503 2002-01-01 DOROTHEA BELL DOROTHEA BELL 2013-11-27
503 2001-01-01 DOROTHEA BELL DOROTHEA BELL 2013-11-27

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
503	2017-01-01
503	2014-01-01	DOROTHEA F BELL
503	2013-01-01	DOROTHEA BELL
503	2012-01-01	DOROTHEA BELL	DOROTHEA BELL	2013-11-27
503	2011-01-01	DOROTHEA BELL	DOROTHEA BELL	2013-11-27
503	2010-01-01	DOROTHEA BELL	DOROTHEA BELL	2013-11-27
503	2009-01-01	DOROTHEA BELL	DOROTHEA BELL	2013-11-27
503	2008-01-01	DOROTHEA BELL	DOROTHEA BELL	2013-11-27
503	2007-01-01	DOROTHEA BELL	DOROTHEA BELL	2013-11-27
503	2006-01-01	DOROTHEA BELL	DOROTHEA BELL	2013-11-27
503	2005-01-01	DOROTHEA BELL	DOROTHEA BELL	2013-11-27
503	2004-01-01	DOROTHEA BELL	DOROTHEA BELL	2013-11-27
503	2003-01-01	DOROTHEA BELL	DOROTHEA BELL	2013-11-27
503	2002-01-01	DOROTHEA BELL	DOROTHEA BELL	2013-11-27
503	2001-01-01	DOROTHEA BELL	DOROTHEA BELL	2013-11-27

Plan Statistics for THE WARTBURG HOME DENTAL PLAN

401k plan membership statisitcs for THE WARTBURG HOME DENTAL PLAN

Measure Date Value
2017: THE WARTBURG HOME DENTAL PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 100
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 0
Total of all active and inactive participants 2017-01-01 100
2014: THE WARTBURG HOME DENTAL PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 85
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 0
Total of all active and inactive participants 2014-01-01 85
2013: THE WARTBURG HOME DENTAL PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 113
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 96
Number of retired or separated participants receiving benefits 2013-01-01 4
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 100
2012: THE WARTBURG HOME DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 120
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 113
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 0
Total of all active and inactive participants 2012-01-01 113
2011: THE WARTBURG HOME DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 105
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 120
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 0
Total of all active and inactive participants 2011-01-01 120
2010: THE WARTBURG HOME DENTAL PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 105
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 105
2009: THE WARTBURG HOME DENTAL PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 100
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 0
Total of all active and inactive participants 2009-01-01 100
2008: THE WARTBURG HOME DENTAL PLAN 2008 401k membership
Total participants, beginning-of-year 2008-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2008-01-01 100
Number of retired or separated participants receiving benefits 2008-01-01 0
Number of other retired or separated participants entitled to future benefits 2008-01-01 0
Total of all active and inactive participants 2008-01-01 100
2007: THE WARTBURG HOME DENTAL PLAN 2007 401k membership
Total participants, beginning-of-year 2007-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2007-01-01 100
Number of retired or separated participants receiving benefits 2007-01-01 0
Number of other retired or separated participants entitled to future benefits 2007-01-01 0
Total of all active and inactive participants 2007-01-01 100
2006: THE WARTBURG HOME DENTAL PLAN 2006 401k membership
Total participants, beginning-of-year 2006-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2006-01-01 100
Number of retired or separated participants receiving benefits 2006-01-01 0
Number of other retired or separated participants entitled to future benefits 2006-01-01 0
Total of all active and inactive participants 2006-01-01 100
2005: THE WARTBURG HOME DENTAL PLAN 2005 401k membership
Total participants, beginning-of-year 2005-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2005-01-01 100
Number of retired or separated participants receiving benefits 2005-01-01 0
Number of other retired or separated participants entitled to future benefits 2005-01-01 0
Total of all active and inactive participants 2005-01-01 100
2004: THE WARTBURG HOME DENTAL PLAN 2004 401k membership
Total participants, beginning-of-year 2004-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2004-01-01 100
Number of retired or separated participants receiving benefits 2004-01-01 0
Number of other retired or separated participants entitled to future benefits 2004-01-01 0
Total of all active and inactive participants 2004-01-01 100
2003: THE WARTBURG HOME DENTAL PLAN 2003 401k membership
Total participants, beginning-of-year 2003-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2003-01-01 100
Number of retired or separated participants receiving benefits 2003-01-01 0
Number of other retired or separated participants entitled to future benefits 2003-01-01 0
Total of all active and inactive participants 2003-01-01 100
2002: THE WARTBURG HOME DENTAL PLAN 2002 401k membership
Total participants, beginning-of-year 2002-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2002-01-01 100
Number of retired or separated participants receiving benefits 2002-01-01 0
Number of other retired or separated participants entitled to future benefits 2002-01-01 0
Total of all active and inactive participants 2002-01-01 100
2001: THE WARTBURG HOME DENTAL PLAN 2001 401k membership
Total participants, beginning-of-year 2001-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2001-01-01 100
Number of retired or separated participants receiving benefits 2001-01-01 0
Number of other retired or separated participants entitled to future benefits 2001-01-01 0
Total of all active and inactive participants 2001-01-01 100

Measure	Date	Value
2017: THE WARTBURG HOME DENTAL PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	100
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	0
Total of all active and inactive participants	2017-01-01	100
2014: THE WARTBURG HOME DENTAL PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	85
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	0
Total of all active and inactive participants	2014-01-01	85
2013: THE WARTBURG HOME DENTAL PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	113
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	96
Number of retired or separated participants receiving benefits	2013-01-01	4
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	100
2012: THE WARTBURG HOME DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	120
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	113
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	0
Total of all active and inactive participants	2012-01-01	113
2011: THE WARTBURG HOME DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	105
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	120
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	0
Total of all active and inactive participants	2011-01-01	120
2010: THE WARTBURG HOME DENTAL PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	105
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	105
2009: THE WARTBURG HOME DENTAL PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	100
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	0
Total of all active and inactive participants	2009-01-01	100
2008: THE WARTBURG HOME DENTAL PLAN 2008 401k membership
Total participants, beginning-of-year	2008-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2008-01-01	100
Number of retired or separated participants receiving benefits	2008-01-01	0
Number of other retired or separated participants entitled to future benefits	2008-01-01	0
Total of all active and inactive participants	2008-01-01	100
2007: THE WARTBURG HOME DENTAL PLAN 2007 401k membership
Total participants, beginning-of-year	2007-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2007-01-01	100
Number of retired or separated participants receiving benefits	2007-01-01	0
Number of other retired or separated participants entitled to future benefits	2007-01-01	0
Total of all active and inactive participants	2007-01-01	100
2006: THE WARTBURG HOME DENTAL PLAN 2006 401k membership
Total participants, beginning-of-year	2006-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2006-01-01	100
Number of retired or separated participants receiving benefits	2006-01-01	0
Number of other retired or separated participants entitled to future benefits	2006-01-01	0
Total of all active and inactive participants	2006-01-01	100
2005: THE WARTBURG HOME DENTAL PLAN 2005 401k membership
Total participants, beginning-of-year	2005-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2005-01-01	100
Number of retired or separated participants receiving benefits	2005-01-01	0
Number of other retired or separated participants entitled to future benefits	2005-01-01	0
Total of all active and inactive participants	2005-01-01	100
2004: THE WARTBURG HOME DENTAL PLAN 2004 401k membership
Total participants, beginning-of-year	2004-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2004-01-01	100
Number of retired or separated participants receiving benefits	2004-01-01	0
Number of other retired or separated participants entitled to future benefits	2004-01-01	0
Total of all active and inactive participants	2004-01-01	100
2003: THE WARTBURG HOME DENTAL PLAN 2003 401k membership
Total participants, beginning-of-year	2003-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2003-01-01	100
Number of retired or separated participants receiving benefits	2003-01-01	0
Number of other retired or separated participants entitled to future benefits	2003-01-01	0
Total of all active and inactive participants	2003-01-01	100
2002: THE WARTBURG HOME DENTAL PLAN 2002 401k membership
Total participants, beginning-of-year	2002-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2002-01-01	100
Number of retired or separated participants receiving benefits	2002-01-01	0
Number of other retired or separated participants entitled to future benefits	2002-01-01	0
Total of all active and inactive participants	2002-01-01	100
2001: THE WARTBURG HOME DENTAL PLAN 2001 401k membership
Total participants, beginning-of-year	2001-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2001-01-01	100
Number of retired or separated participants receiving benefits	2001-01-01	0
Number of other retired or separated participants entitled to future benefits	2001-01-01	0
Total of all active and inactive participants	2001-01-01	100

Form 5500 Responses for THE WARTBURG HOME DENTAL PLAN

2017: THE WARTBURG HOME DENTAL PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2014: THE WARTBURG HOME DENTAL 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 benefit arrangement – Insurance	Yes
2013: THE WARTBURG HOME DENTAL 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 benefit arrangement – Insurance	Yes
2012: THE WARTBURG HOME DENTAL 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 benefit arrangement – Insurance	Yes
2011: THE WARTBURG HOME DENTAL 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 benefit arrangement – Insurance	Yes
2010: THE WARTBURG HOME DENTAL PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: THE WARTBURG HOME DENTAL 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 – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2008: THE WARTBURG HOME DENTAL PLAN 2008 form 5500 responses
2008-01-01	Type of plan entity	Single employer plan
2008-01-01	Submission has been amended	No
2008-01-01	This submission is the final filing	No
2008-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-01-01	Plan is a collectively bargained plan	No
2008-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2008-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2007: THE WARTBURG HOME DENTAL PLAN 2007 form 5500 responses
2007-01-01	Type of plan entity	Single employer plan
2007-01-01	Submission has been amended	No
2007-01-01	This submission is the final filing	No
2007-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2007-01-01	Plan is a collectively bargained plan	No
2007-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2007-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2006: THE WARTBURG HOME DENTAL PLAN 2006 form 5500 responses
2006-01-01	Type of plan entity	Single employer plan
2006-01-01	Submission has been amended	No
2006-01-01	This submission is the final filing	No
2006-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2006-01-01	Plan is a collectively bargained plan	No
2006-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2006-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2005: THE WARTBURG HOME DENTAL PLAN 2005 form 5500 responses
2005-01-01	Type of plan entity	Single employer plan
2005-01-01	Submission has been amended	No
2005-01-01	This submission is the final filing	No
2005-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2005-01-01	Plan is a collectively bargained plan	No
2005-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2005-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2004: THE WARTBURG HOME DENTAL PLAN 2004 form 5500 responses
2004-01-01	Type of plan entity	Single employer plan
2004-01-01	Submission has been amended	No
2004-01-01	This submission is the final filing	No
2004-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2004-01-01	Plan is a collectively bargained plan	No
2004-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2004-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2003: THE WARTBURG HOME DENTAL PLAN 2003 form 5500 responses
2003-01-01	Type of plan entity	Single employer plan
2003-01-01	Submission has been amended	No
2003-01-01	This submission is the final filing	No
2003-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2003-01-01	Plan is a collectively bargained plan	No
2003-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2003-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2002: THE WARTBURG HOME DENTAL PLAN 2002 form 5500 responses
2002-01-01	Type of plan entity	Single employer plan
2002-01-01	Submission has been amended	No
2002-01-01	This submission is the final filing	No
2002-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2002-01-01	Plan is a collectively bargained plan	No
2002-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2002-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2001: THE WARTBURG HOME DENTAL PLAN 2001 form 5500 responses
2001-01-01	Type of plan entity	Single employer plan
2001-01-01	Submission has been amended	No
2001-01-01	This submission is the final filing	No
2001-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2001-01-01	Plan is a collectively bargained plan	No
2001-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2001-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

TM05924041

Policy instance

Insurance contract or identification number	TM05924041
Number of Individuals Covered	100
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

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Company Name:	THE WARTBURG HOME
Employer identification number (EIN):	131740497
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities