401k Plan data: LARKSFIELD PLACE LIFE & DISABILITY PLAN plan

LARKSFIELD PLACE LIFE & DISABILITY PLAN 401k Plan overview

Plan Name	LARKSFIELD PLACE LIFE & DISABILITY PLAN
Plan identification number	502

LARKSFIELD PLACE LIFE & DISABILITY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Temporary disability (accident and sickness) Long-term disability cover

401k Sponsoring company profile

LARKSFIELD PLACE RETIREMENT COMMUNITIES, INC. has sponsored the creation of one or more 401k plans.

Company Name: LARKSFIELD PLACE RETIREMENT COMMUNITIES, INC.

Employer identification number (EIN): 480987497

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LARKSFIELD PLACE LIFE & DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2015-01-01 TIM NIKKEL
502 2014-01-01 TIM NIKKEL
502 2013-01-01 TIM NIKKEL
502 2012-01-01 TIM NIKKEL TIM NIKKEL 2013-02-28
502 2011-01-01 TIM NIKKEL

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
502	2015-01-01	TIM NIKKEL
502	2014-01-01	TIM NIKKEL
502	2013-01-01	TIM NIKKEL
502	2012-01-01	TIM NIKKEL	TIM NIKKEL	2013-02-28
502	2011-01-01	TIM NIKKEL

Plan Statistics for LARKSFIELD PLACE LIFE & DISABILITY PLAN

401k plan membership statisitcs for LARKSFIELD PLACE LIFE & DISABILITY PLAN

Measure Date Value
2015: LARKSFIELD PLACE LIFE & DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 236
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 234
Total of all active and inactive participants 2015-01-01 234
Total participants 2015-01-01 234
2014: LARKSFIELD PLACE LIFE & DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 241
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 236
Total of all active and inactive participants 2014-01-01 236
Total participants 2014-01-01 236
2013: LARKSFIELD PLACE LIFE & DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 232
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 241
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 241
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 241
Number of participants with account balances 2013-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: LARKSFIELD PLACE LIFE & DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 171
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 232
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 2012-01-01 232
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 232
Number of participants with account balances 2012-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: LARKSFIELD PLACE LIFE & DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 161
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 171
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 2011-01-01 171
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 171
Number of participants with account balances 2011-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0

Measure	Date	Value
2015: LARKSFIELD PLACE LIFE & DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	236
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	234
Total of all active and inactive participants	2015-01-01	234
Total participants	2015-01-01	234
2014: LARKSFIELD PLACE LIFE & DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	241
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	236
Total of all active and inactive participants	2014-01-01	236
Total participants	2014-01-01	236
2013: LARKSFIELD PLACE LIFE & DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	232
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	241
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	241
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	241
Number of participants with account balances	2013-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: LARKSFIELD PLACE LIFE & DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	171
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	232
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	232
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	232
Number of participants with account balances	2012-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: LARKSFIELD PLACE LIFE & DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	161
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	171
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	171
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	171
Number of participants with account balances	2011-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0

Form 5500 Responses for LARKSFIELD PLACE LIFE & DISABILITY PLAN

2015: LARKSFIELD PLACE LIFE & DISABILITY PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: LARKSFIELD PLACE LIFE & DISABILITY PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: LARKSFIELD PLACE LIFE & DISABILITY PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: LARKSFIELD PLACE LIFE & DISABILITY 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 – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: LARKSFIELD PLACE LIFE & DISABILITY 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 – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes

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Company Name:	LARKSFIELD PLACE RETIREMENT COMMUNITIES, INC.
Employer identification number (EIN):	480987497
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities