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| Plan Name | ST. JOHNSVILLE REHABILITATION AND NURSING CENTER |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | ST JOHNSVILLE A |
| Employer identification number (EIN): | 201388111 |
| NAIC Classification: | 623000 |
| NAIC Description: | Nursing and Residential Care Facilities |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2012-01-01 | MICHELE DYGERT | MICHELE DYGERT | 2014-01-31 | |
| 502 | 2011-01-01 | LISA VOLK | 2012-06-15 | LISA VOLK | 2012-06-15 |
| 2012: ST. JOHNSVILLE REHABILITATION AND NURSING CENTER 2012 form 5500 responses | ||
|---|---|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 ) | |
| Policy contract number | 00122381 |
| Policy instance | 1 |
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