401k Plan data: EMPLOYEE SAFETY PROGRAM BENEFIT PLAN plan

EMPLOYEE SAFETY PROGRAM BENEFIT PLAN 401k Plan overview

Plan Name	EMPLOYEE SAFETY PROGRAM BENEFIT PLAN
Plan identification number	501

EMPLOYEE SAFETY PROGRAM BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Temporary disability (accident and sickness) Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

GARDEN VILLA NURSING & REHABILITATION has sponsored the creation of one or more 401k plans.

Company Name: GARDEN VILLA NURSING & REHABILITATION

Employer identification number (EIN): 842847164

NAIC Classification: 623110
NAIC Description: Nursing Care Facilities (Skilled Nursing Facilities)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE SAFETY PROGRAM BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-01-01
501 2020-01-01
501 2019-10-01

Plan Statistics for EMPLOYEE SAFETY PROGRAM BENEFIT PLAN

401k plan membership statisitcs for EMPLOYEE SAFETY PROGRAM BENEFIT PLAN

Measure Date Value
2021: EMPLOYEE SAFETY PROGRAM BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 111
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 106
Total of all active and inactive participants 2021-01-01 106
Total participants 2021-01-01 106
2020: EMPLOYEE SAFETY PROGRAM BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 94
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 111
Total of all active and inactive participants 2020-01-01 111
Total participants 2020-01-01 111
2019: EMPLOYEE SAFETY PROGRAM BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-10-01 105
Total number of active participants reported on line 7a of the Form 5500 2019-10-01 94
Total of all active and inactive participants 2019-10-01 94
Total participants 2019-10-01 94

Measure	Date	Value
2021: EMPLOYEE SAFETY PROGRAM BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	111
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	106
Total of all active and inactive participants	2021-01-01	106
Total participants	2021-01-01	106
2020: EMPLOYEE SAFETY PROGRAM BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	94
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	111
Total of all active and inactive participants	2020-01-01	111
Total participants	2020-01-01	111
2019: EMPLOYEE SAFETY PROGRAM BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-10-01	105
Total number of active participants reported on line 7a of the Form 5500	2019-10-01	94
Total of all active and inactive participants	2019-10-01	94
Total participants	2019-10-01	94

Form 5500 Responses for EMPLOYEE SAFETY PROGRAM BENEFIT PLAN

2021: EMPLOYEE SAFETY PROGRAM BENEFIT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	Yes
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: EMPLOYEE SAFETY PROGRAM BENEFIT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: EMPLOYEE SAFETY PROGRAM BENEFIT PLAN 2019 form 5500 responses
2019-10-01	Type of plan entity	Single employer plan
2019-10-01	First time form 5500 has been submitted	Yes
2019-10-01	Submission has been amended	No
2019-10-01	This submission is the final filing	No
2019-10-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2019-10-01	Plan is a collectively bargained plan	No
2019-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-10-01	Plan benefit arrangement – General assets of the sponsor	Yes

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Company Name:	GARDEN VILLA NURSING & REHABILITATION
Employer identification number (EIN):	842847164
NAIC Classification:	623110
NAIC Description:	Nursing Care Facilities (Skilled Nursing Facilities)