| Plan Name | COUNTRY CLUB LIVING |
| Plan identification number | 001 |
| 401k Plan Type | Defined Contribution Pension |
| Plan Features/Benefits |
|
| Company Name: | PVMA-GOLDEN VALLEY, LLC |
| Employer identification number (EIN): | 475044073 |
| NAIC Classification: | 624410 |
| NAIC Description: | Child Day Care Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 001 | 2017-01-01 | SUMMER PICHA | 2018-02-08 | SUMMER PICHA | 2018-02-08 |
| 001 | 2016-01-01 | SUMMER PICHA | 2017-09-25 | SUMMER PICHA | 2017-09-25 |