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| Plan Name | BOMBAY LANE, LP DBA WELLINGTON HEALTH PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | BOMBAY LANE, LP |
| Employer identification number (EIN): | 202043683 |
| NAIC Classification: | 623000 |
| NAIC Description: | Nursing and Residential Care Facilities |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2013-08-01 | SCOTT PARKER | |||
| 502 | 2012-08-01 | SCOTT PARKER | |||
| 502 | 2011-08-01 | SCOTT PARKER | |||
| 502 | 2010-08-01 | SCOTT PARKER | |||
| 502 | 2009-08-01 | SCOTT PARKER |
| Measure | Date | Value |
|---|---|---|
| 2013: BOMBAY LANE, LP DBA WELLINGTON HEALTH PLAN 2013 401k membership | ||
| Total participants, beginning-of-year | 2013-08-01 | 115 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-08-01 | 0 |
| Number of retired or separated participants receiving benefits | 2013-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-08-01 | 0 |
| Total of all active and inactive participants | 2013-08-01 | 0 |
| 2012: BOMBAY LANE, LP DBA WELLINGTON HEALTH PLAN 2012 401k membership | ||
| Total participants, beginning-of-year | 2012-08-01 | 130 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-08-01 | 117 |
| Number of retired or separated participants receiving benefits | 2012-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-08-01 | 0 |
| Total of all active and inactive participants | 2012-08-01 | 117 |
| 2011: BOMBAY LANE, LP DBA WELLINGTON HEALTH PLAN 2011 401k membership | ||
| Total participants, beginning-of-year | 2011-08-01 | 148 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-08-01 | 137 |
| Number of retired or separated participants receiving benefits | 2011-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-08-01 | 0 |
| Total of all active and inactive participants | 2011-08-01 | 137 |
| 2010: BOMBAY LANE, LP DBA WELLINGTON HEALTH PLAN 2010 401k membership | ||
| Total participants, beginning-of-year | 2010-08-01 | 132 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-08-01 | 150 |
| Number of retired or separated participants receiving benefits | 2010-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-08-01 | 0 |
| Total of all active and inactive participants | 2010-08-01 | 150 |
| 2009: BOMBAY LANE, LP DBA WELLINGTON HEALTH PLAN 2009 401k membership | ||
| Total participants, beginning-of-year | 2009-08-01 | 122 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-08-01 | 134 |
| Number of retired or separated participants receiving benefits | 2009-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-08-01 | 0 |
| Total of all active and inactive participants | 2009-08-01 | 134 |
| 2013: BOMBAY LANE, LP DBA WELLINGTON HEALTH PLAN 2013 form 5500 responses | ||
|---|---|---|
| 2013-08-01 | Type of plan entity | Single employer plan |
| 2013-08-01 | Submission has been amended | No |
| 2013-08-01 | This submission is the final filing | Yes |
| 2013-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-08-01 | Plan is a collectively bargained plan | No |
| 2013-08-01 | Plan funding arrangement – Insurance | Yes |
| 2013-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: BOMBAY LANE, LP DBA WELLINGTON HEALTH PLAN 2012 form 5500 responses | ||
| 2012-08-01 | Type of plan entity | Single employer plan |
| 2012-08-01 | Submission has been amended | No |
| 2012-08-01 | This submission is the final filing | No |
| 2012-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-08-01 | Plan is a collectively bargained plan | No |
| 2012-08-01 | Plan funding arrangement – Insurance | Yes |
| 2012-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: BOMBAY LANE, LP DBA WELLINGTON HEALTH PLAN 2011 form 5500 responses | ||
| 2011-08-01 | Type of plan entity | Single employer plan |
| 2011-08-01 | Submission has been amended | No |
| 2011-08-01 | This submission is the final filing | No |
| 2011-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-08-01 | Plan is a collectively bargained plan | No |
| 2011-08-01 | Plan funding arrangement – Insurance | Yes |
| 2011-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: BOMBAY LANE, LP DBA WELLINGTON HEALTH PLAN 2010 form 5500 responses | ||
| 2010-08-01 | Type of plan entity | Single employer plan |
| 2010-08-01 | Submission has been amended | No |
| 2010-08-01 | This submission is the final filing | No |
| 2010-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-08-01 | Plan is a collectively bargained plan | No |
| 2010-08-01 | Plan funding arrangement – Insurance | Yes |
| 2010-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: BOMBAY LANE, LP DBA WELLINGTON HEALTH PLAN 2009 form 5500 responses | ||
| 2009-08-01 | Type of plan entity | Single employer plan |
| 2009-08-01 | First time form 5500 has been submitted | Yes |
| 2009-08-01 | Submission has been amended | No |
| 2009-08-01 | This submission is the final filing | No |
| 2009-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-08-01 | Plan is a collectively bargained plan | No |
| 2009-08-01 | Plan funding arrangement – Insurance | Yes |
| 2009-08-01 | Plan benefit arrangement – Insurance | Yes |
| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 543938 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 543938 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 543938 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC. (National Association of Insurance Commissioners NAIC id number: 95519 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 543938 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 543938 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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