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FAIRLAWN HAVEN 401k Plan overview

Plan NameFAIRLAWN HAVEN
Plan identification number 502

FAIRLAWN HAVEN Benefits

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

401k Sponsoring company profile

FAIRLAWN HAVEN has sponsored the creation of one or more 401k plans.

Company Name:FAIRLAWN HAVEN
Employer identification number (EIN):340930124
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Additional information about FAIRLAWN HAVEN

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division
Incorporation Date: 1961-06-22
Company Identification Number: 301604
Legal Registered Office Address: 407 E LUTZ RD
-
ARCHBOLD
United States of America (USA)
43502

More information about FAIRLAWN HAVEN

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FAIRLAWN HAVEN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022023-07-01
5022023-07-01TODD MOORE
5022022-07-01
5022022-07-01TODD MOORE
5022021-07-01
5022021-07-01TODD MOORE
5022020-07-01
5022020-01-01

Form 5500 Responses for FAIRLAWN HAVEN

2023: FAIRLAWN HAVEN 2023 form 5500 responses
2023-07-01Type of plan entitySingle employer plan
2023-07-01Plan funding arrangement – InsuranceYes
2023-07-01Plan benefit arrangement – InsuranceYes
2022: FAIRLAWN HAVEN 2022 form 5500 responses
2022-07-01Type of plan entitySingle employer plan
2022-07-01Plan funding arrangement – InsuranceYes
2022-07-01Plan benefit arrangement – InsuranceYes
2021: FAIRLAWN HAVEN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – InsuranceYes
2020: FAIRLAWN HAVEN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – InsuranceYes
2020-01-01Type of plan entitySingle employer plan
2020-01-01First time form 5500 has been submittedYes
2020-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number09Q6059
Policy instance 2
Insurance contract or identification number09Q6059
Number of Individuals Covered109
Insurance policy start date2023-07-01
Insurance policy end date2024-06-30
Total amount of commissions paid to insurance brokerUSD $22,890
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $701,256
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG00616703000000
Policy instance 1
Insurance contract or identification numberG00616703000000
Number of Individuals Covered78
Insurance policy start date2023-07-01
Insurance policy end date2024-06-30
Total amount of commissions paid to insurance brokerUSD $1,173
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,730
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number09Q6059
Policy instance 2
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG00616703000000
Policy instance 1
ALL SAVERS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 82406 )
Policy contract number5400 22772
Policy instance 2
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG00616703000000
Policy instance 1
ALL SAVERS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 82406 )
Policy contract number5400 22772
Policy instance 2
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG00616703000000
Policy instance 1
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG00616703000000
Policy instance 2
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )
Policy contract number0071734-01
Policy instance 1

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