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| Plan Name | JV HOLDCO LLC DENTAL PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | AHN HEALTHCARE@HOME |
| Employer identification number (EIN): | 472368587 |
| NAIC Classification: | 621610 |
| NAIC Description: | Home Health Care Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2016-01-01 | MICHAEL J. EPERESI, JR. | MICHAEL J. EPERESI, JR. | 2017-10-13 | |
| 502 | 2015-01-01 | MICHAEL J. EPERESI, JR. | MICHAEL J. EPERESI, JR. | 2016-10-14 |
| Measure | Date | Value |
|---|---|---|
| 2016: JV HOLDCO LLC DENTAL PLAN 2016 401k membership | ||
| Total participants, beginning-of-year | 2016-01-01 | 317 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 0 |
| 2015: JV HOLDCO LLC DENTAL PLAN 2015 401k membership | ||
| Total participants, beginning-of-year | 2015-01-01 | 223 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 315 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 317 |
| 2016: JV HOLDCO LLC DENTAL PLAN 2016 form 5500 responses | ||
|---|---|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | This submission is the final filing | Yes |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: JV HOLDCO LLC DENTAL PLAN 2015 form 5500 responses | ||
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | First time form 5500 has been submitted | Yes |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) | |||||||||||||||||||||||||
| Policy contract number | 017551-50 | ||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||
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