401k Plan data: SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN plan

SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN 401k Plan overview

Plan Name	SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN
Plan identification number	501

SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN Benefits

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

401k Sponsoring company profile

SALEM NURSING & REHAB CENTER OF AUGUSTA INC has sponsored the creation of one or more 401k plans.

Company Name: SALEM NURSING & REHAB CENTER OF AUGUSTA INC

Employer identification number (EIN): 631147322

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2016-01-01 DOUGLAS MITTLEIDER DOUGLAS MITTLEIDER 2017-04-19
501 2016-01-01 DOUGLAS MITTLEIDER 2017-04-20
501 2015-01-01 DOUGLAS MITTLEIDER DOUGLAS MITTLEIDER 2016-02-25
501 2014-01-01 JACKIE SORRELLS DOUGLAS K MITTLEIDER 2015-03-16
501 2013-01-01 JACKIE SORRELLS DOUGLAS K MITTLEIDER 2014-05-05
501 2012-01-01 JACKIE SORRELLS DOUGLAS K MITTLEIDER 2013-03-01
501 2011-01-01 JACKIE SORRELLS DOUGLAS K MITTLEIDER 2012-04-05
501 2009-01-01 JACKIE SORRELLS DOUGLAS K MITTLEIDER 2010-02-28

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2016-01-01	DOUGLAS MITTLEIDER	DOUGLAS MITTLEIDER	2017-04-19
501	2016-01-01		DOUGLAS MITTLEIDER	2017-04-20
501	2015-01-01	DOUGLAS MITTLEIDER	DOUGLAS MITTLEIDER	2016-02-25
501	2014-01-01	JACKIE SORRELLS	DOUGLAS K MITTLEIDER	2015-03-16
501	2013-01-01	JACKIE SORRELLS	DOUGLAS K MITTLEIDER	2014-05-05
501	2012-01-01	JACKIE SORRELLS	DOUGLAS K MITTLEIDER	2013-03-01
501	2011-01-01	JACKIE SORRELLS	DOUGLAS K MITTLEIDER	2012-04-05
501	2009-01-01	JACKIE SORRELLS	DOUGLAS K MITTLEIDER	2010-02-28

Plan Statistics for SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN

401k plan membership statisitcs for SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN

Measure Date Value
2016: SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 37
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Total of all active and inactive participants 2016-01-01 0
Total participants 2016-01-01 0
2015: SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 38
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 37
Total of all active and inactive participants 2015-01-01 37
Total participants 2015-01-01 37
2014: SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 31
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 38
Total of all active and inactive participants 2014-01-01 38
Total participants 2014-01-01 38
2013: SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 36
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 31
Total of all active and inactive participants 2013-01-01 31
Total participants 2013-01-01 31
2012: SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 27
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 36
Total of all active and inactive participants 2012-01-01 36
2011: SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 29
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 27
Total of all active and inactive participants 2011-01-01 27
2009: SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 33
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 31
Total of all active and inactive participants 2009-01-01 31

Measure	Date	Value
2016: SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	37
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Total of all active and inactive participants	2016-01-01	0
Total participants	2016-01-01	0
2015: SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	38
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	37
Total of all active and inactive participants	2015-01-01	37
Total participants	2015-01-01	37
2014: SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	31
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	38
Total of all active and inactive participants	2014-01-01	38
Total participants	2014-01-01	38
2013: SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	36
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	31
Total of all active and inactive participants	2013-01-01	31
Total participants	2013-01-01	31
2012: SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	27
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	36
Total of all active and inactive participants	2012-01-01	36
2011: SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	29
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	27
Total of all active and inactive participants	2011-01-01	27
2009: SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	33
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	31
Total of all active and inactive participants	2009-01-01	31

Form 5500 Responses for SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN

2016: SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS 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 – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: SALEM NURSING & REHAB CENTER OF AUGUSTA FLEXIBLE BENEFITS PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

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Company Name:	SALEM NURSING & REHAB CENTER OF AUGUSTA INC
Employer identification number (EIN):	631147322
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities