401k Plan data: EAST RIDGE RETIRMENT VILLAGE HEALTH INSURANCE PLAN plan

EAST RIDGE RETIRMENT VILLAGE HEALTH INSURANCE PLAN 401k Plan overview

Plan Name	EAST RIDGE RETIRMENT VILLAGE HEALTH INSURANCE PLAN
Plan identification number	508

EAST RIDGE RETIRMENT VILLAGE HEALTH INSURANCE PLAN Benefits

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

401k Sponsoring company profile

EAST RIDGE RETIREMENT VILLAGE has sponsored the creation of one or more 401k plans.

Company Name: EAST RIDGE RETIREMENT VILLAGE

Employer identification number (EIN): 590903331

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EAST RIDGE RETIRMENT VILLAGE HEALTH INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
508 2018-01-01 CHRISTINE SHIPLEY CHRISTINE SHIPLEY 2019-05-13
508 2017-01-01 CATHERINE AYERS CATHERINE AYERS 2018-07-30
508 2016-01-01 CATHERINE AYERS CATHERINE AYERS 2018-07-30
508 2015-01-01 CATHERINE AYERS CATHERINE AYERS 2018-07-30
508 2014-01-01 CATHERINE AYERS CATHERINE AYERS 2018-07-30
508 2013-01-01 CATHERINE AYERS CATHERINE AYERS 2018-07-30

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
508	2018-01-01	CHRISTINE SHIPLEY	CHRISTINE SHIPLEY	2019-05-13
508	2017-01-01	CATHERINE AYERS	CATHERINE AYERS	2018-07-30
508	2016-01-01	CATHERINE AYERS	CATHERINE AYERS	2018-07-30
508	2015-01-01	CATHERINE AYERS	CATHERINE AYERS	2018-07-30
508	2014-01-01	CATHERINE AYERS	CATHERINE AYERS	2018-07-30
508	2013-01-01	CATHERINE AYERS	CATHERINE AYERS	2018-07-30

Plan Statistics for EAST RIDGE RETIRMENT VILLAGE HEALTH INSURANCE PLAN

401k plan membership statisitcs for EAST RIDGE RETIRMENT VILLAGE HEALTH INSURANCE PLAN

Measure Date Value
2018: EAST RIDGE RETIRMENT VILLAGE HEALTH INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 129
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 0
Total of all active and inactive participants 2018-01-01 0
Total participants 2018-01-01 0
2017: EAST RIDGE RETIRMENT VILLAGE HEALTH INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 129
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 121
Total of all active and inactive participants 2017-01-01 121
Total participants 2017-01-01 121
2016: EAST RIDGE RETIRMENT VILLAGE HEALTH INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 117
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 129
Total of all active and inactive participants 2016-01-01 129
Total participants 2016-01-01 129
2015: EAST RIDGE RETIRMENT VILLAGE HEALTH INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 117
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 117
Total of all active and inactive participants 2015-01-01 117
Total participants 2015-01-01 117
2014: EAST RIDGE RETIRMENT VILLAGE HEALTH INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 106
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 117
Total of all active and inactive participants 2014-01-01 117
Total participants 2014-01-01 117
2013: EAST RIDGE RETIRMENT VILLAGE HEALTH INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 123
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 106
Total of all active and inactive participants 2013-01-01 106
Total participants 2013-01-01 106

Measure	Date	Value
2018: EAST RIDGE RETIRMENT VILLAGE HEALTH INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	129
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	0
Total of all active and inactive participants	2018-01-01	0
Total participants	2018-01-01	0
2017: EAST RIDGE RETIRMENT VILLAGE HEALTH INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	129
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	121
Total of all active and inactive participants	2017-01-01	121
Total participants	2017-01-01	121
2016: EAST RIDGE RETIRMENT VILLAGE HEALTH INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	117
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	129
Total of all active and inactive participants	2016-01-01	129
Total participants	2016-01-01	129
2015: EAST RIDGE RETIRMENT VILLAGE HEALTH INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	117
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	117
Total of all active and inactive participants	2015-01-01	117
Total participants	2015-01-01	117
2014: EAST RIDGE RETIRMENT VILLAGE HEALTH INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	106
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	117
Total of all active and inactive participants	2014-01-01	117
Total participants	2014-01-01	117
2013: EAST RIDGE RETIRMENT VILLAGE HEALTH INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	123
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	106
Total of all active and inactive participants	2013-01-01	106
Total participants	2013-01-01	106

Form 5500 Responses for EAST RIDGE RETIRMENT VILLAGE HEALTH INSURANCE PLAN

2018: EAST RIDGE RETIRMENT VILLAGE HEALTH INSURANCE PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	Yes
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: EAST RIDGE RETIRMENT VILLAGE HEALTH INSURANCE PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: EAST RIDGE RETIRMENT VILLAGE HEALTH INSURANCE PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: EAST RIDGE RETIRMENT VILLAGE HEALTH INSURANCE 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 – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: EAST RIDGE RETIRMENT VILLAGE HEALTH INSURANCE 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: EAST RIDGE RETIRMENT VILLAGE HEALTH INSURANCE PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	First time form 5500 has been submitted	Yes
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

Insurance Providers Used on plan

AVMED HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 95263 )

Policy contract number

110283 - 112085

Policy instance

Insurance contract or identification number	110283 - 112085
Number of Individuals Covered	106
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $694,230
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

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Company Name:	EAST RIDGE RETIREMENT VILLAGE
Employer identification number (EIN):	590903331
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities