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PRISTINE SENIOR LIVING, LLC WRAP SUMMARY PLAN DESCRIPTION 401k Plan overview

Plan NamePRISTINE SENIOR LIVING, LLC WRAP SUMMARY PLAN DESCRIPTION
Plan identification number 501

PRISTINE SENIOR LIVING, LLC WRAP SUMMARY PLAN DESCRIPTION Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

PRISTINE SENIOR LIVING, LLC has sponsored the creation of one or more 401k plans.

Company Name:PRISTINE SENIOR LIVING, LLC
Employer identification number (EIN):464696415
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Additional information about PRISTINE SENIOR LIVING, LLC

Jurisdiction of Incorporation: Indiana Secretary of State
Incorporation Date:
Company Identification Number: 014012700667

More information about PRISTINE SENIOR LIVING, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PRISTINE SENIOR LIVING, LLC WRAP SUMMARY PLAN DESCRIPTION

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012018-01-01OLIVIA DEBOY
5012017-01-01OLIVIA DEBOY
5012016-01-01CECELY JOHNSON

Plan Statistics for PRISTINE SENIOR LIVING, LLC WRAP SUMMARY PLAN DESCRIPTION

401k plan membership statisitcs for PRISTINE SENIOR LIVING, LLC WRAP SUMMARY PLAN DESCRIPTION

Measure Date Value
2018: PRISTINE SENIOR LIVING, LLC WRAP SUMMARY PLAN DESCRIPTION 2018 401k membership
Total participants, beginning-of-year2018-01-01374
Total number of active participants reported on line 7a of the Form 55002018-01-01180
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 participants2018-01-01180
2017: PRISTINE SENIOR LIVING, LLC WRAP SUMMARY PLAN DESCRIPTION 2017 401k membership
Total participants, beginning-of-year2017-01-01332
Total number of active participants reported on line 7a of the Form 55002017-01-01311
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 participants2017-01-01311
2016: PRISTINE SENIOR LIVING, LLC WRAP SUMMARY PLAN DESCRIPTION 2016 401k membership
Total participants, beginning-of-year2016-01-01262
Total number of active participants reported on line 7a of the Form 55002016-01-01312
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 participants2016-01-01312

Form 5500 Responses for PRISTINE SENIOR LIVING, LLC WRAP SUMMARY PLAN DESCRIPTION

2018: PRISTINE SENIOR LIVING, LLC WRAP SUMMARY PLAN DESCRIPTION 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: PRISTINE SENIOR LIVING, LLC WRAP SUMMARY PLAN DESCRIPTION 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: PRISTINE SENIOR LIVING, LLC WRAP SUMMARY PLAN DESCRIPTION 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01First time form 5500 has been submittedYes
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

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUDE0B9NX
Policy instance 7
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUDH0B9NX
Policy instance 6
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUC 0B9NX
Policy instance 5
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0B9NX
Policy instance 4
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number756112
Policy instance 3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUDB0B9NX
Policy instance 2
WESTPOINT INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 39845 )
Policy contract numberESL 10000738 00
Policy instance 1
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number243117
Policy instance 4
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number4106508-V1062
Policy instance 3
SUPERIOR DENTAL CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96280 )
Policy contract numberD2256
Policy instance 2
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number906349
Policy instance 1

Potentially related plans

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