401k Plan data: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN plan

THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 401k Plan overview

Plan Name	THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN
Plan identification number	501

THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover 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

THE BLAKEFORD AT GREEN HILLS has sponsored the creation of one or more 401k plans.

Company Name: THE BLAKEFORD AT GREEN HILLS

Employer identification number (EIN): 621533400

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-02-01
501 2021-02-01 ALLISON GRIFFITH
501 2020-02-01
501 2019-02-01
501 2018-02-01
501 2017-02-01 ALLISON GRIFFITH ALLISON GRIFFITH 2018-08-29
501 2016-02-01 ALLISON GRIFFITH
501 2015-02-01 ALLISON GRIFFITH ALLISON GRIFFITH 2016-08-24
501 2014-02-01 ALLISON GRIFFITH
501 2013-02-01 ALLISON GRIFFITH
501 2012-02-01 ALLISON GRIFFITH
501 2011-02-01 ALLISION GRIFFITH

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2021-02-01
501	2021-02-01	ALLISON GRIFFITH
501	2020-02-01
501	2019-02-01
501	2018-02-01
501	2017-02-01	ALLISON GRIFFITH	ALLISON GRIFFITH	2018-08-29
501	2016-02-01	ALLISON GRIFFITH
501	2015-02-01	ALLISON GRIFFITH	ALLISON GRIFFITH	2016-08-24
501	2014-02-01	ALLISON GRIFFITH
501	2013-02-01	ALLISON GRIFFITH
501	2012-02-01	ALLISON GRIFFITH
501	2011-02-01	ALLISION GRIFFITH

Plan Statistics for THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN

401k plan membership statisitcs for THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN

Measure Date Value
2021: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year 2021-02-01 101
Total number of active participants reported on line 7a of the Form 5500 2021-02-01 97
Number of retired or separated participants receiving benefits 2021-02-01 0
Number of other retired or separated participants entitled to future benefits 2021-02-01 2
Total of all active and inactive participants 2021-02-01 99
2020: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year 2020-02-01 142
Total number of active participants reported on line 7a of the Form 5500 2020-02-01 101
Number of retired or separated participants receiving benefits 2020-02-01 0
Number of other retired or separated participants entitled to future benefits 2020-02-01 0
Total of all active and inactive participants 2020-02-01 101
2019: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year 2019-02-01 159
Total number of active participants reported on line 7a of the Form 5500 2019-02-01 94
Number of retired or separated participants receiving benefits 2019-02-01 0
Number of other retired or separated participants entitled to future benefits 2019-02-01 9
Total of all active and inactive participants 2019-02-01 103
2018: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year 2018-02-01 161
Total number of active participants reported on line 7a of the Form 5500 2018-02-01 161
Number of retired or separated participants receiving benefits 2018-02-01 0
Number of other retired or separated participants entitled to future benefits 2018-02-01 1
Total of all active and inactive participants 2018-02-01 162
2017: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year 2017-02-01 103
Total number of active participants reported on line 7a of the Form 5500 2017-02-01 103
Number of retired or separated participants receiving benefits 2017-02-01 2
Number of other retired or separated participants entitled to future benefits 2017-02-01 2
Total of all active and inactive participants 2017-02-01 107
2016: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-02-01 135
Total number of active participants reported on line 7a of the Form 5500 2016-02-01 102
Number of retired or separated participants receiving benefits 2016-02-01 1
Number of other retired or separated participants entitled to future benefits 2016-02-01 0
Total of all active and inactive participants 2016-02-01 103
2015: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-02-01 152
Total number of active participants reported on line 7a of the Form 5500 2015-02-01 137
Number of retired or separated participants receiving benefits 2015-02-01 0
Number of other retired or separated participants entitled to future benefits 2015-02-01 0
Total of all active and inactive participants 2015-02-01 137
2014: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-02-01 122
Total number of active participants reported on line 7a of the Form 5500 2014-02-01 105
Number of retired or separated participants receiving benefits 2014-02-01 1
Number of other retired or separated participants entitled to future benefits 2014-02-01 1
Total of all active and inactive participants 2014-02-01 107
2013: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-02-01 118
Total number of active participants reported on line 7a of the Form 5500 2013-02-01 108
Number of retired or separated participants receiving benefits 2013-02-01 0
Number of other retired or separated participants entitled to future benefits 2013-02-01 0
Total of all active and inactive participants 2013-02-01 108
2012: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-02-01 114
Total number of active participants reported on line 7a of the Form 5500 2012-02-01 121
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 2012-02-01 121
2011: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-02-01 102
Total number of active participants reported on line 7a of the Form 5500 2011-02-01 99
Number of retired or separated participants receiving benefits 2011-02-01 0
Number of other retired or separated participants entitled to future benefits 2011-02-01 0
Total of all active and inactive participants 2011-02-01 99

Measure	Date	Value
2021: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-02-01	101
Total number of active participants reported on line 7a of the Form 5500	2021-02-01	97
Number of retired or separated participants receiving benefits	2021-02-01	0
Number of other retired or separated participants entitled to future benefits	2021-02-01	2
Total of all active and inactive participants	2021-02-01	99
2020: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year	2020-02-01	142
Total number of active participants reported on line 7a of the Form 5500	2020-02-01	101
Number of retired or separated participants receiving benefits	2020-02-01	0
Number of other retired or separated participants entitled to future benefits	2020-02-01	0
Total of all active and inactive participants	2020-02-01	101
2019: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-02-01	159
Total number of active participants reported on line 7a of the Form 5500	2019-02-01	94
Number of retired or separated participants receiving benefits	2019-02-01	0
Number of other retired or separated participants entitled to future benefits	2019-02-01	9
Total of all active and inactive participants	2019-02-01	103
2018: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-02-01	161
Total number of active participants reported on line 7a of the Form 5500	2018-02-01	161
Number of retired or separated participants receiving benefits	2018-02-01	0
Number of other retired or separated participants entitled to future benefits	2018-02-01	1
Total of all active and inactive participants	2018-02-01	162
2017: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-02-01	103
Total number of active participants reported on line 7a of the Form 5500	2017-02-01	103
Number of retired or separated participants receiving benefits	2017-02-01	2
Number of other retired or separated participants entitled to future benefits	2017-02-01	2
Total of all active and inactive participants	2017-02-01	107
2016: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-02-01	135
Total number of active participants reported on line 7a of the Form 5500	2016-02-01	102
Number of retired or separated participants receiving benefits	2016-02-01	1
Number of other retired or separated participants entitled to future benefits	2016-02-01	0
Total of all active and inactive participants	2016-02-01	103
2015: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-02-01	152
Total number of active participants reported on line 7a of the Form 5500	2015-02-01	137
Number of retired or separated participants receiving benefits	2015-02-01	0
Number of other retired or separated participants entitled to future benefits	2015-02-01	0
Total of all active and inactive participants	2015-02-01	137
2014: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-02-01	122
Total number of active participants reported on line 7a of the Form 5500	2014-02-01	105
Number of retired or separated participants receiving benefits	2014-02-01	1
Number of other retired or separated participants entitled to future benefits	2014-02-01	1
Total of all active and inactive participants	2014-02-01	107
2013: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-02-01	118
Total number of active participants reported on line 7a of the Form 5500	2013-02-01	108
Number of retired or separated participants receiving benefits	2013-02-01	0
Number of other retired or separated participants entitled to future benefits	2013-02-01	0
Total of all active and inactive participants	2013-02-01	108
2012: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-02-01	114
Total number of active participants reported on line 7a of the Form 5500	2012-02-01	121
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	121
2011: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-02-01	102
Total number of active participants reported on line 7a of the Form 5500	2011-02-01	99
Number of retired or separated participants receiving benefits	2011-02-01	0
Number of other retired or separated participants entitled to future benefits	2011-02-01	0
Total of all active and inactive participants	2011-02-01	99

Form 5500 Responses for THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN

2021: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2021 form 5500 responses
2021-02-01	Type of plan entity	Single employer plan
2021-02-01	Submission has been amended	No
2021-02-01	This submission is the final filing	No
2021-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-02-01	Plan is a collectively bargained plan	No
2021-02-01	Plan funding arrangement – Insurance	Yes
2021-02-01	Plan benefit arrangement – Insurance	Yes
2020: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2020 form 5500 responses
2020-02-01	Type of plan entity	Single employer plan
2020-02-01	Submission has been amended	No
2020-02-01	This submission is the final filing	No
2020-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-02-01	Plan is a collectively bargained plan	No
2020-02-01	Plan funding arrangement – Insurance	Yes
2020-02-01	Plan benefit arrangement – Insurance	Yes
2019: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2019 form 5500 responses
2019-02-01	Type of plan entity	Single employer plan
2019-02-01	Submission has been amended	No
2019-02-01	This submission is the final filing	No
2019-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-02-01	Plan is a collectively bargained plan	No
2019-02-01	Plan funding arrangement – Insurance	Yes
2019-02-01	Plan benefit arrangement – Insurance	Yes
2018: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2018 form 5500 responses
2018-02-01	Type of plan entity	Single employer plan
2018-02-01	Submission has been amended	No
2018-02-01	This submission is the final filing	No
2018-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-02-01	Plan is a collectively bargained plan	No
2018-02-01	Plan funding arrangement – Insurance	Yes
2018-02-01	Plan benefit arrangement – Insurance	Yes
2017: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2017 form 5500 responses
2017-02-01	Type of plan entity	Single employer plan
2017-02-01	Submission has been amended	No
2017-02-01	This submission is the final filing	No
2017-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-02-01	Plan is a collectively bargained plan	No
2017-02-01	Plan funding arrangement – Insurance	Yes
2017-02-01	Plan benefit arrangement – Insurance	Yes
2016: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2016 form 5500 responses
2016-02-01	Type of plan entity	Single employer plan
2016-02-01	Submission has been amended	No
2016-02-01	This submission is the final filing	No
2016-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-02-01	Plan is a collectively bargained plan	No
2016-02-01	Plan funding arrangement – Insurance	Yes
2016-02-01	Plan benefit arrangement – Insurance	Yes
2015: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2015 form 5500 responses
2015-02-01	Type of plan entity	Single employer plan
2015-02-01	Submission has been amended	No
2015-02-01	This submission is the final filing	No
2015-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-02-01	Plan is a collectively bargained plan	No
2015-02-01	Plan funding arrangement – Insurance	Yes
2015-02-01	Plan benefit arrangement – Insurance	Yes
2014: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2014 form 5500 responses
2014-02-01	Type of plan entity	Single employer plan
2014-02-01	Submission has been amended	No
2014-02-01	This submission is the final filing	No
2014-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-02-01	Plan is a collectively bargained plan	No
2014-02-01	Plan funding arrangement – Insurance	Yes
2014-02-01	Plan benefit arrangement – Insurance	Yes
2013: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2013 form 5500 responses
2013-02-01	Type of plan entity	Single employer plan
2013-02-01	Submission has been amended	No
2013-02-01	This submission is the final filing	No
2013-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-02-01	Plan is a collectively bargained plan	No
2013-02-01	Plan funding arrangement – Insurance	Yes
2013-02-01	Plan benefit arrangement – Insurance	Yes
2012: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS 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
2011: THE BLAKEFORD AT GREEN HILLS EMPLOYEE BENEFITS PLAN 2011 form 5500 responses
2011-02-01	Type of plan entity	Single employer plan
2011-02-01	Submission has been amended	No
2011-02-01	This submission is the final filing	No
2011-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-02-01	Plan is a collectively bargained plan	No
2011-02-01	Plan funding arrangement – Insurance	Yes
2011-02-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	SGD610399*
Policy instance	3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number	00618394
Policy instance	2
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number	BGJ49
Policy instance	1
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	SGD610399*
Policy instance	3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number	00618394
Policy instance	2
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number	BGJ49
Policy instance	1
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	SGD610399*
Policy instance	3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number	00618394
Policy instance	2
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number	BGJ49
Policy instance	1
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10188885*
Policy instance	3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number	00618394
Policy instance	2
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number	BGJ49
Policy instance	1
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number	BGJ49
Policy instance	1
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number	101612
Policy instance	2
DELTA DENTAL OF TENNESSEE (National Association of Insurance Commissioners NAIC id number: 54526 )
Policy contract number	8215
Policy instance	3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10188885*
Policy instance	4
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number	BGJ49
Policy instance	4
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number	101612
Policy instance	1
DELTA DENTAL OF TENNESSEE (National Association of Insurance Commissioners NAIC id number: 54526 )
Policy contract number	8215
Policy instance	2
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract number	F018416
Policy instance	3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10188885*
Policy instance	5
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number	BGJ49
Policy instance	5
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number	484894
Policy instance	4
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract number	F018416
Policy instance	3
DELTA DENTAL OF TENNESSEE (National Association of Insurance Commissioners NAIC id number: 54526 )
Policy contract number	8215
Policy instance	2
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number	101612
Policy instance	1
DELTA DENTAL OF TENNESSEE (National Association of Insurance Commissioners NAIC id number: 54526 )
Policy contract number	8215
Policy instance	2
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract number	F018416
Policy instance	3
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number	101612
Policy instance	1
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number	BGJ49
Policy instance	4
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract number	BGJ49
Policy instance	4
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	G000ACGA
Policy instance	3
DELTA DENTAL OF TENNESSEE (National Association of Insurance Commissioners NAIC id number: 54526 )
Policy contract number	8215
Policy instance	2
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number	101612
Policy instance	1
DELTA DENTAL OF TENNESSEE (National Association of Insurance Commissioners NAIC id number: 54526 )
Policy contract number	8215
Policy instance	2
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number	G000ACGA
Policy instance	3
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number	101612
Policy instance	1

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Company Name:	THE BLAKEFORD AT GREEN HILLS
Employer identification number (EIN):	621533400
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities