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| Plan Name | CROWN POINT HEALTH AND WELFARE PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | J.F. HERITAGE, LLC |
| Employer identification number (EIN): | 274182083 |
| 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 | 2017-12-01 | BILLY JEWELL | 2019-06-18 | ||
| 502 | 2017-12-01 | BILLY JEWEL | 2020-04-17 | ||
| 502 | 2016-12-01 |
| Measure | Date | Value |
|---|---|---|
| 2017: CROWN POINT HEALTH AND WELFARE PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-12-01 | 155 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-12-01 | 144 |
| Number of retired or separated participants receiving benefits | 2017-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-12-01 | 0 |
| Total of all active and inactive participants | 2017-12-01 | 144 |
| Number of employers contributing to the scheme | 2017-12-01 | 0 |
| 2016: CROWN POINT HEALTH AND WELFARE PLAN 2016 401k membership | ||
| Total participants, beginning-of-year | 2016-12-01 | 170 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-12-01 | 153 |
| Number of retired or separated participants receiving benefits | 2016-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-12-01 | 0 |
| Total of all active and inactive participants | 2016-12-01 | 153 |
| 2017: CROWN POINT HEALTH AND WELFARE PLAN 2017 form 5500 responses | ||
|---|---|---|
| 2017-12-01 | Type of plan entity | Single employer plan |
| 2017-12-01 | Submission has been amended | Yes |
| 2017-12-01 | This submission is the final filing | Yes |
| 2017-12-01 | Plan funding arrangement – Insurance | Yes |
| 2017-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: CROWN POINT HEALTH AND WELFARE PLAN 2016 form 5500 responses | ||
| 2016-12-01 | Type of plan entity | Single employer plan |
| 2016-12-01 | First time form 5500 has been submitted | Yes |
| 2016-12-01 | Plan funding arrangement – Insurance | Yes |
| 2016-12-01 | Plan benefit arrangement – Insurance | Yes |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |||||||||||||||||||||||||||||||
| Policy contract number | |||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||
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