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SAINT JOHN XXIII HOME LONG TERM DISABILITY PLAN 401k Plan overview

Plan NameSAINT JOHN XXIII HOME LONG TERM DISABILITY PLAN
Plan identification number 504

SAINT JOHN XXIII HOME LONG TERM DISABILITY PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Long-term disability cover
  • 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.

401k Sponsoring company profile

SAINT JOHN XXIII HOME has sponsored the creation of one or more 401k plans.

Company Name:SAINT JOHN XXIII HOME
Employer identification number (EIN):251214797
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SAINT JOHN XXIII HOME LONG TERM DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5042019-01-01KIRK HAWTHORNE2020-07-27
5042018-01-01
5042017-01-01
5042016-01-01
5042015-01-01KIRK HAWTHORNE
5042014-01-01KIRK HAWTHORNE
5042013-01-01KIRK HAWTHORNE
5042012-01-01KIRK HAWTHORNE
5042011-01-01KIRK HAWTHORNE
5042010-01-01KIRK HAWTHORNE

Plan Statistics for SAINT JOHN XXIII HOME LONG TERM DISABILITY PLAN

401k plan membership statisitcs for SAINT JOHN XXIII HOME LONG TERM DISABILITY PLAN

Measure Date Value
2019: SAINT JOHN XXIII HOME LONG TERM DISABILITY PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0181
Total number of active participants reported on line 7a of the Form 55002019-01-0174
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-0174
2018: SAINT JOHN XXIII HOME LONG TERM DISABILITY PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0187
Total number of active participants reported on line 7a of the Form 55002018-01-0181
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 participants2018-01-0181
2017: SAINT JOHN XXIII HOME LONG TERM DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0188
Total number of active participants reported on line 7a of the Form 55002017-01-0187
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 participants2017-01-0187
2016: SAINT JOHN XXIII HOME LONG TERM DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0191
Total number of active participants reported on line 7a of the Form 55002016-01-0188
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-0188
2015: SAINT JOHN XXIII HOME LONG TERM DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0194
Total number of active participants reported on line 7a of the Form 55002015-01-0191
Total of all active and inactive participants2015-01-0191
2014: SAINT JOHN XXIII HOME LONG TERM DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0190
Total number of active participants reported on line 7a of the Form 55002014-01-0194
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-0194
2013: SAINT JOHN XXIII HOME LONG TERM DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0195
Total number of active participants reported on line 7a of the Form 55002013-01-0190
Total of all active and inactive participants2013-01-0190
2012: SAINT JOHN XXIII HOME LONG TERM DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0192
Total number of active participants reported on line 7a of the Form 55002012-01-0195
Total of all active and inactive participants2012-01-0195
2011: SAINT JOHN XXIII HOME LONG TERM DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0199
Total number of active participants reported on line 7a of the Form 55002011-01-0192
Total of all active and inactive participants2011-01-0192
2010: SAINT JOHN XXIII HOME LONG TERM DISABILITY PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01101
Total number of active participants reported on line 7a of the Form 55002010-01-0199
Total of all active and inactive participants2010-01-0199

Form 5500 Responses for SAINT JOHN XXIII HOME LONG TERM DISABILITY PLAN

2019: SAINT JOHN XXIII HOME LONG TERM DISABILITY PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: SAINT JOHN XXIII HOME LONG TERM DISABILITY PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: SAINT JOHN XXIII HOME LONG TERM DISABILITY PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: SAINT JOHN XXIII HOME LONG TERM DISABILITY PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: SAINT JOHN XXIII HOME LONG TERM DISABILITY PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: SAINT JOHN XXIII HOME LONG TERM DISABILITY PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: SAINT JOHN XXIII HOME LONG TERM DISABILITY PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: SAINT JOHN XXIII HOME LONG TERM DISABILITY PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: SAINT JOHN XXIII HOME LONG TERM DISABILITY PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: SAINT JOHN XXIII HOME LONG TERM DISABILITY PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01First time form 5500 has been submittedYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTS05926673
Policy instance 1
Insurance contract or identification numberTS05926673
Number of Individuals Covered74
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $2,715
Total amount of fees paid to insurance companyUSD $0
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 Administration0
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 BenefitYes
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
Welfare Benefit Premiums Paid to CarrierUSD $14,864
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,111
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTS05926673
Policy instance 1
Insurance contract or identification numberTS05926673
Number of Individuals Covered81
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $3,390
Total amount of fees paid to insurance companyUSD $0
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 Administration0
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 BenefitYes
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
Welfare Benefit Premiums Paid to CarrierUSD $18,099
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,672
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTS05926673
Policy instance 1
Insurance contract or identification numberTS05926673
Number of Individuals Covered87
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,712
Total amount of fees paid to insurance companyUSD $0
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 Administration0
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 BenefitYes
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
Welfare Benefit Premiums Paid to CarrierUSD $14,525
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,141
Insurance broker organization code?3
Insurance broker nameARMS INSURANCE GROUP LLC

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