401k Plan data: CLARK LINDSEY VILLAGE INC, HRA PLAN plan

CLARK LINDSEY VILLAGE INC, HRA PLAN 401k Plan overview

Plan Name	CLARK LINDSEY VILLAGE INC, HRA PLAN
Plan identification number	502

CLARK LINDSEY VILLAGE INC, HRA PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) 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

CLARK-LINDSEY VILLAGE INC has sponsored the creation of one or more 401k plans.

Company Name: CLARK-LINDSEY VILLAGE INC

Employer identification number (EIN): 371017284

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CLARK LINDSEY VILLAGE INC, HRA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2012-01-01 DEBRA REARDANZ
502 2011-01-01 DEBRA REARDANZ
502 2010-01-01 DEBRA REARDANZ - PRESIDENT
502 2009-01-01 DEBRA REARDANZ - PRESIDENT DEBRA REARDANZ - PRESIDENT 2010-08-02

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
502	2012-01-01	DEBRA REARDANZ
502	2011-01-01	DEBRA REARDANZ
502	2010-01-01	DEBRA REARDANZ - PRESIDENT
502	2009-01-01	DEBRA REARDANZ - PRESIDENT	DEBRA REARDANZ - PRESIDENT	2010-08-02

Plan Statistics for CLARK LINDSEY VILLAGE INC, HRA PLAN

401k plan membership statisitcs for CLARK LINDSEY VILLAGE INC, HRA PLAN

Measure Date Value
2012: CLARK LINDSEY VILLAGE INC, HRA PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 94
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 94
2011: CLARK LINDSEY VILLAGE INC, HRA PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 113
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 97
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 97
2010: CLARK LINDSEY VILLAGE INC, HRA PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 114
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 109
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 2010-01-01 109
2009: CLARK LINDSEY VILLAGE INC, HRA PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 107
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 109
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 2009-01-01 109

Measure	Date	Value
2012: CLARK LINDSEY VILLAGE INC, HRA PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	94
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	94
2011: CLARK LINDSEY VILLAGE INC, HRA PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	113
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	97
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	97
2010: CLARK LINDSEY VILLAGE INC, HRA PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	114
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	109
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	109
2009: CLARK LINDSEY VILLAGE INC, HRA PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	107
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	109
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	109

Form 5500 Responses for CLARK LINDSEY VILLAGE INC, HRA PLAN

2012: CLARK LINDSEY VILLAGE INC, HRA 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 – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: CLARK LINDSEY VILLAGE INC, HRA 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 – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: CLARK LINDSEY VILLAGE INC, HRA 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 – General assets of the sponsor	Yes
2010-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: CLARK LINDSEY VILLAGE INC, HRA 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

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Company Name:	CLARK-LINDSEY VILLAGE INC
Employer identification number (EIN):	371017284
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities