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WELFARE BENEFIT PLAN OF NOVA IC, INC. 401k Plan overview

Plan NameWELFARE BENEFIT PLAN OF NOVA IC, INC.
Plan identification number 502

WELFARE BENEFIT PLAN OF NOVA IC, INC. Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental
  • Vision

401k Sponsoring company profile

NOVA IC, INC. has sponsored the creation of one or more 401k plans.

Company Name:NOVA IC, INC.
Employer identification number (EIN):561699150
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WELFARE BENEFIT PLAN OF NOVA IC, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022015-12-01SUSAN HINNANT SUSAN HINNANT2017-08-30
5022014-12-01SUSAN HINNANT SUSAN HINNANT2016-06-28
5022013-12-01SUSAN HINNANT SUSAN HINNANT2015-07-23
5022012-12-01SUSAN HINNANT SUSAN HINNANT2014-07-11
5022011-12-01SUSAN HINNANT SUSAN HINNANT2013-06-26
5022010-12-01SUSAN HINNANT
5022009-12-01SUSAN HINNANT
5022008-12-01

Plan Statistics for WELFARE BENEFIT PLAN OF NOVA IC, INC.

401k plan membership statisitcs for WELFARE BENEFIT PLAN OF NOVA IC, INC.

Measure Date Value
2015: WELFARE BENEFIT PLAN OF NOVA IC, INC. 2015 401k membership
Total participants, beginning-of-year2015-12-0149
Total number of active participants reported on line 7a of the Form 55002015-12-0145
Total of all active and inactive participants2015-12-0145
Total participants2015-12-0145
2014: WELFARE BENEFIT PLAN OF NOVA IC, INC. 2014 401k membership
Total participants, beginning-of-year2014-12-0174
Total number of active participants reported on line 7a of the Form 55002014-12-0149
Total of all active and inactive participants2014-12-0149
Total participants2014-12-0149
2013: WELFARE BENEFIT PLAN OF NOVA IC, INC. 2013 401k membership
Total participants, beginning-of-year2013-12-01108
Total number of active participants reported on line 7a of the Form 55002013-12-0174
Total of all active and inactive participants2013-12-0174
Total participants2013-12-0174
Number of employers contributing to the scheme2013-12-010
2012: WELFARE BENEFIT PLAN OF NOVA IC, INC. 2012 401k membership
Total participants, beginning-of-year2012-12-0198
Total number of active participants reported on line 7a of the Form 55002012-12-01108
Total of all active and inactive participants2012-12-01108
Total participants2012-12-01108
Number of employers contributing to the scheme2012-12-010
2011: WELFARE BENEFIT PLAN OF NOVA IC, INC. 2011 401k membership
Total participants, beginning-of-year2011-12-0185
Total number of active participants reported on line 7a of the Form 55002011-12-0198
Total of all active and inactive participants2011-12-0198
Total participants2011-12-0198
Number of employers contributing to the scheme2011-12-010
2010: WELFARE BENEFIT PLAN OF NOVA IC, INC. 2010 401k membership
Total participants, beginning-of-year2010-12-0191
Total number of active participants reported on line 7a of the Form 55002010-12-0185
Total of all active and inactive participants2010-12-0185
Total participants2010-12-0185
Number of employers contributing to the scheme2010-12-010
2009: WELFARE BENEFIT PLAN OF NOVA IC, INC. 2009 401k membership
Total participants, beginning-of-year2009-12-01106
Total number of active participants reported on line 7a of the Form 55002009-12-0191
Total of all active and inactive participants2009-12-0191
Total participants2009-12-0191
Number of employers contributing to the scheme2009-12-010

Form 5500 Responses for WELFARE BENEFIT PLAN OF NOVA IC, INC.

2015: WELFARE BENEFIT PLAN OF NOVA IC, INC. 2015 form 5500 responses
2015-12-01Type of plan entitySingle employer plan
2015-12-01Submission has been amendedNo
2015-12-01This submission is the final filingNo
2015-12-01This return/report is a short plan year return/report (less than 12 months)No
2015-12-01Plan is a collectively bargained planNo
2015-12-01Plan funding arrangement – InsuranceYes
2015-12-01Plan benefit arrangement – InsuranceYes
2014: WELFARE BENEFIT PLAN OF NOVA IC, INC. 2014 form 5500 responses
2014-12-01Type of plan entitySingle employer plan
2014-12-01Submission has been amendedNo
2014-12-01This submission is the final filingNo
2014-12-01This return/report is a short plan year return/report (less than 12 months)No
2014-12-01Plan is a collectively bargained planNo
2014-12-01Plan funding arrangement – InsuranceYes
2014-12-01Plan benefit arrangement – InsuranceYes
2013: WELFARE BENEFIT PLAN OF NOVA IC, INC. 2013 form 5500 responses
2013-12-01Type of plan entitySingle employer plan
2013-12-01Submission has been amendedNo
2013-12-01This submission is the final filingNo
2013-12-01This return/report is a short plan year return/report (less than 12 months)No
2013-12-01Plan is a collectively bargained planNo
2013-12-01Plan funding arrangement – InsuranceYes
2013-12-01Plan benefit arrangement – InsuranceYes
2012: WELFARE BENEFIT PLAN OF NOVA IC, INC. 2012 form 5500 responses
2012-12-01Type of plan entitySingle employer plan
2012-12-01Submission has been amendedNo
2012-12-01This submission is the final filingNo
2012-12-01This return/report is a short plan year return/report (less than 12 months)No
2012-12-01Plan is a collectively bargained planNo
2012-12-01Plan funding arrangement – InsuranceYes
2012-12-01Plan benefit arrangement – InsuranceYes
2011: WELFARE BENEFIT PLAN OF NOVA IC, INC. 2011 form 5500 responses
2011-12-01Type of plan entityMulti-employer plan
2011-12-01Submission has been amendedNo
2011-12-01This submission is the final filingNo
2011-12-01This return/report is a short plan year return/report (less than 12 months)No
2011-12-01Plan is a collectively bargained planNo
2011-12-01Plan funding arrangement – InsuranceYes
2011-12-01Plan benefit arrangement – InsuranceYes
2010: WELFARE BENEFIT PLAN OF NOVA IC, INC. 2010 form 5500 responses
2010-12-01Type of plan entityMulti-employer plan
2010-12-01Submission has been amendedNo
2010-12-01This submission is the final filingNo
2010-12-01This return/report is a short plan year return/report (less than 12 months)No
2010-12-01Plan is a collectively bargained planNo
2010-12-01Plan funding arrangement – InsuranceYes
2010-12-01Plan benefit arrangement – InsuranceYes
2009: WELFARE BENEFIT PLAN OF NOVA IC, INC. 2009 form 5500 responses
2009-12-01Type of plan entityMulti-employer plan
2009-12-01Submission has been amendedNo
2009-12-01This submission is the final filingNo
2009-12-01This return/report is a short plan year return/report (less than 12 months)No
2009-12-01Plan is a collectively bargained planNo
2009-12-01Plan funding arrangement – InsuranceYes
2009-12-01Plan benefit arrangement – InsuranceYes
2008: WELFARE BENEFIT PLAN OF NOVA IC, INC. 2008 form 5500 responses
2008-12-01Type of plan entityMulti-employer plan
2008-12-01Submission has been amendedNo
2008-12-01This submission is the final filingNo
2008-12-01This return/report is a short plan year return/report (less than 12 months)No
2008-12-01Plan is a collectively bargained planNo

Insurance Providers Used on plan

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-031463
Policy instance 1
Insurance contract or identification number010-031463
Number of Individuals Covered107
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $1,795
Total amount of fees paid to insurance companyUSD $1,142
Are there contracts with allocated funds for individual policies?Yes
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1142
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $1,795
Insurance broker nameBB&T INSURANCE SERVICES, INC.
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number008174
Policy instance 2
Insurance contract or identification number008174
Number of Individuals Covered45
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $7,000
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,000
Insurance broker organization code?3
Insurance broker nameSTANLEY D. CARR
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number008174
Policy instance 2
Insurance contract or identification number008174
Number of Individuals Covered92
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $12,139
Are there contracts with allocated funds for individual policies?Yes
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,139
Insurance broker organization code?3
Insurance broker nameSTANLEY D CARR
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-031463
Policy instance 1
Insurance contract or identification number010-031463
Number of Individuals Covered162
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $2,215
Total amount of fees paid to insurance companyUSD $1,207
Are there contracts with allocated funds for individual policies?Yes
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1207
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $2,215
Insurance broker nameBB&T INSURANCE SERVICES, INC.
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-031463
Policy instance 1
Insurance contract or identification number010-031463
Number of Individuals Covered108
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $2,335
Total amount of fees paid to insurance companyUSD $1,203
Are there contracts with allocated funds for individual policies?Yes
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1203
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $2,335
Insurance broker nameBB&T INSURANCE SERVICES, INC.
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number008174
Policy instance 2
Insurance contract or identification number008174
Number of Individuals Covered103
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $16,525
Are there contracts with allocated funds for individual policies?Yes
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,525
Insurance broker organization code?3
Insurance broker nameSTANLEY D. CARR
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-031463
Policy instance 1
Insurance contract or identification number010-031463
Number of Individuals Covered98
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $2,186
Total amount of fees paid to insurance companyUSD $1,200
Are there contracts with allocated funds for individual policies?Yes
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number008174
Policy instance 2
Insurance contract or identification number008174
Number of Individuals Covered89
Insurance policy start date2011-03-01
Insurance policy end date2012-02-28
Total amount of commissions paid to insurance brokerUSD $15,340
Are there contracts with allocated funds for individual policies?Yes
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number008174
Policy instance 1
Insurance contract or identification number008174
Number of Individuals Covered85
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $14,183
Are there contracts with allocated funds for individual policies?Yes
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-031463
Policy instance 2
Insurance contract or identification number010-031463
Number of Individuals Covered85
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $2,704
Are there contracts with allocated funds for individual policies?Yes
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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