401k Plan data: BETH SHOLOM HOME OF VIRGINIA GROUP DENTAL PLAN plan

BETH SHOLOM HOME OF VIRGINIA GROUP DENTAL PLAN 401k Plan overview

Plan Name	BETH SHOLOM HOME OF VIRGINIA GROUP DENTAL PLAN
Plan identification number	507

BETH SHOLOM HOME OF VIRGINIA GROUP DENTAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

BETH SHOLOM HOME OF VIRGINIA has sponsored the creation of one or more 401k plans.

Company Name: BETH SHOLOM HOME OF VIRGINIA

Employer identification number (EIN): 540525702

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

Additional information about BETH SHOLOM HOME OF VIRGINIA

Jurisdiction of Incorporation: Virginia Secretary of State

Incorporation Date: 1945-04-27

Company Identification Number: 0051264

Legal Registered Office Address: 1600 JOHN ROLFE PKWY
PO BOX 1998
RICHMOND
United States of America (USA)
23233

More information about BETH SHOLOM HOME OF VIRGINIA

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BETH SHOLOM HOME OF VIRGINIA GROUP DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
507 2012-02-01
507 2009-02-01 JOHN BELLOTTI JOHN BELLOTTI 2010-08-31

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
507	2012-02-01
507	2009-02-01	JOHN BELLOTTI		JOHN BELLOTTI	2010-08-31

Plan Statistics for BETH SHOLOM HOME OF VIRGINIA GROUP DENTAL PLAN

401k plan membership statisitcs for BETH SHOLOM HOME OF VIRGINIA GROUP DENTAL PLAN

Measure Date Value
2012: BETH SHOLOM HOME OF VIRGINIA GROUP DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-02-01 106
Total number of active participants reported on line 7a of the Form 5500 2012-02-01 97
Number of retired or separated participants receiving benefits 2012-02-01 0
Number of other retired or separated participants entitled to future benefits 2012-02-01 0
Total of all active and inactive participants 2012-02-01 97
2009: BETH SHOLOM HOME OF VIRGINIA GROUP DENTAL PLAN 2009 401k membership
Total participants, beginning-of-year 2009-02-01 90
Total number of active participants reported on line 7a of the Form 5500 2009-02-01 90
Total of all active and inactive participants 2009-02-01 90
Total participants 2009-02-01 90

Measure	Date	Value
2012: BETH SHOLOM HOME OF VIRGINIA GROUP DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-02-01	106
Total number of active participants reported on line 7a of the Form 5500	2012-02-01	97
Number of retired or separated participants receiving benefits	2012-02-01	0
Number of other retired or separated participants entitled to future benefits	2012-02-01	0
Total of all active and inactive participants	2012-02-01	97
2009: BETH SHOLOM HOME OF VIRGINIA GROUP DENTAL PLAN 2009 401k membership
Total participants, beginning-of-year	2009-02-01	90
Total number of active participants reported on line 7a of the Form 5500	2009-02-01	90
Total of all active and inactive participants	2009-02-01	90
Total participants	2009-02-01	90

Form 5500 Responses for BETH SHOLOM HOME OF VIRGINIA GROUP DENTAL PLAN

2012: BETH SHOLOM HOME OF VIRGINIA GROUP DENTAL PLAN 2012 form 5500 responses
2012-02-01	Type of plan entity	Single employer plan
2012-02-01	Submission has been amended	No
2012-02-01	This submission is the final filing	No
2012-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-02-01	Plan is a collectively bargained plan	No
2012-02-01	Plan funding arrangement – Insurance	Yes
2012-02-01	Plan benefit arrangement – Insurance	Yes
2009: BETH SHOLOM HOME OF VIRGINIA GROUP DENTAL PLAN 2009 form 5500 responses
2009-02-01	Type of plan entity	Single employer plan
2009-02-01	Submission has been amended	No
2009-02-01	This submission is the final filing	No
2009-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-02-01	Plan is a collectively bargained plan	No
2009-02-01	Plan funding arrangement – Insurance	Yes
2009-02-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-036246-0001

Policy instance

Insurance contract or identification number	010-036246-0001
Number of Individuals Covered	90
Insurance policy start date	2012-02-01
Insurance policy end date	2013-01-31
Total amount of commissions paid to insurance broker	USD $2,281
Total amount of fees paid to insurance company	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	No
Dental Insurance Welfare Benefit	Yes
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 $45,622
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,281
Insurance broker organization code?	3

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-036246-0002

Policy instance

Insurance contract or identification number	010-036246-0002
Number of Individuals Covered	7
Insurance policy start date	2012-02-01
Insurance policy end date	2013-01-31
Total amount of commissions paid to insurance broker	USD $21
Total amount of fees paid to insurance company	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	No
Dental Insurance Welfare Benefit	Yes
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 $427
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21
Insurance broker organization code?	3

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Company Name:	BETH SHOLOM HOME OF VIRGINIA
Employer identification number (EIN):	540525702
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities

Jurisdiction of Incorporation:	Virginia Secretary of State
Incorporation Date:	1945-04-27
Company Identification Number:	0051264
Legal Registered Office Address:	1600 JOHN ROLFE PKWY PO BOX 1998 RICHMOND United States of America (USA) 23233