| Plan Name | GROUP VOLUNTARY PLANS FOR EMPLOYEES OF ANNE CARLSEN |
| Plan identification number | 507 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | ANNE CARLSEN CENTER |
| Employer identification number (EIN): | 870694180 |
| NAIC Classification: | 623000 |
| NAIC Description: | Nursing and Residential Care Facilities |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 507 | 2022-01-01 | ||||
| 507 | 2022-01-01 | TIMOTHY EISSINGER | |||
| 507 | 2021-01-01 | ||||
| 507 | 2021-01-01 | TIM EISSINGER | |||
| 507 | 2020-01-01 | ||||
| 507 | 2019-10-01 |
| Measure | Date | Value |
|---|---|---|
| 2022: GROUP VOLUNTARY PLANS FOR EMPLOYEES OF ANNE CARLSEN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-01-01 | 349 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 449 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 449 |
| 2021: GROUP VOLUNTARY PLANS FOR EMPLOYEES OF ANNE CARLSEN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-01-01 | 293 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 349 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 349 |
| 2020: GROUP VOLUNTARY PLANS FOR EMPLOYEES OF ANNE CARLSEN 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-01-01 | 159 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 293 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 293 |
| 2019: GROUP VOLUNTARY PLANS FOR EMPLOYEES OF ANNE CARLSEN 2019 401k membership | ||
| Total participants, beginning-of-year | 2019-10-01 | 109 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-10-01 | 159 |
| Number of retired or separated participants receiving benefits | 2019-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-10-01 | 0 |
| Total of all active and inactive participants | 2019-10-01 | 159 |
| 2022: GROUP VOLUNTARY PLANS FOR EMPLOYEES OF ANNE CARLSEN 2022 form 5500 responses | ||
|---|---|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | No |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: GROUP VOLUNTARY PLANS FOR EMPLOYEES OF ANNE CARLSEN 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 | No |
| 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 – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: GROUP VOLUNTARY PLANS FOR EMPLOYEES OF ANNE CARLSEN 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 – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: GROUP VOLUNTARY PLANS FOR EMPLOYEES OF ANNE CARLSEN 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 – Insurance | Yes |
| 2019-10-01 | Plan benefit arrangement – Insurance | Yes |
| ASSURITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71439 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 1100000498 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| |||||||||||||||||||||||||||||||||||||||||||||||||||||
| ASSURITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71439 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 1100000498 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| ASSURITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71439 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 1100000498 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||