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GOLDEN POND 401(K) PLAN 401k Plan overview

Plan NameGOLDEN POND 401(K) PLAN
Plan identification number 001

GOLDEN POND 401(K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

GOLDEN POND ASSISTED LIVING has sponsored the creation of one or more 401k plans.

Company Name:GOLDEN POND ASSISTED LIVING
Employer identification number (EIN):043056975
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GOLDEN POND 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01DOUG NOBLE2023-09-08
0012021-01-01
0012020-01-01
0012019-01-01
0012018-01-01MIA CRAWFORD
0012017-01-01MIA CRAWFORD
0012016-01-01DYANA STEEVES

Plan Statistics for GOLDEN POND 401(K) PLAN

401k plan membership statisitcs for GOLDEN POND 401(K) PLAN

Measure Date Value
2021: GOLDEN POND 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01102
Total number of active participants reported on line 7a of the Form 55002021-01-0162
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0128
Total of all active and inactive participants2021-01-0190
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-0190
Number of participants with account balances2021-01-0154
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: GOLDEN POND 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01105
Total number of active participants reported on line 7a of the Form 55002020-01-0177
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0120
Total of all active and inactive participants2020-01-0197
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-0197
Number of participants with account balances2020-01-0155
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: GOLDEN POND 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0188
Total number of active participants reported on line 7a of the Form 55002019-01-0184
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-0116
Total of all active and inactive participants2019-01-01100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01100
Number of participants with account balances2019-01-0157
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: GOLDEN POND 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0162
Total number of active participants reported on line 7a of the Form 55002018-01-0139
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-0112
Total of all active and inactive participants2018-01-0151
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-0151
Number of participants with account balances2018-01-0130
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-011
2017: GOLDEN POND 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0187
Total number of active participants reported on line 7a of the Form 55002017-01-0144
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-0112
Total of all active and inactive participants2017-01-0156
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0156
Number of participants with account balances2017-01-0131
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-018
2016: GOLDEN POND 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0164
Total number of active participants reported on line 7a of the Form 55002016-01-0167
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-014
Total of all active and inactive participants2016-01-0171
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0171
Number of participants with account balances2016-01-0139
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-016

Financial Data on GOLDEN POND 401(K) PLAN

Measure Date Value
2021 : GOLDEN POND 401(K) PLAN 2021 401k financial data
Total income from all sources2021-12-31$349,202
Expenses. Total of all expenses incurred2021-12-31$89,869
Benefits paid (including direct rollovers)2021-12-31$83,579
Total plan assets at end of year2021-12-31$1,080,360
Total plan assets at beginning of year2021-12-31$821,027
Value of fidelity bond covering the plan2021-12-31$100,000
Total contributions received or receivable from participants2021-12-31$172,304
Other income received2021-12-31$110,393
Net income (gross income less expenses)2021-12-31$259,333
Net plan assets at end of year (total assets less liabilities)2021-12-31$1,080,360
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$821,027
Assets. Value of participant loans2021-12-31$45,688
Total contributions received or receivable from employer(s)2021-12-31$66,505
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$6,290
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
2020 : GOLDEN POND 401(K) PLAN 2020 401k financial data
Total income from all sources2020-12-31$304,972
Expenses. Total of all expenses incurred2020-12-31$202,395
Benefits paid (including direct rollovers)2020-12-31$196,913
Total plan assets at end of year2020-12-31$821,027
Total plan assets at beginning of year2020-12-31$718,450
Value of fidelity bond covering the plan2020-12-31$100,000
Total contributions received or receivable from participants2020-12-31$175,876
Other income received2020-12-31$51,123
Net income (gross income less expenses)2020-12-31$102,577
Net plan assets at end of year (total assets less liabilities)2020-12-31$821,027
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$718,450
Assets. Value of participant loans2020-12-31$76,311
Total contributions received or receivable from employer(s)2020-12-31$77,973
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$5,482
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
2019 : GOLDEN POND 401(K) PLAN 2019 401k financial data
Total income from all sources2019-12-31$344,399
Expenses. Total of all expenses incurred2019-12-31$101,383
Benefits paid (including direct rollovers)2019-12-31$94,303
Total plan assets at end of year2019-12-31$718,450
Total plan assets at beginning of year2019-12-31$475,434
Value of fidelity bond covering the plan2019-12-31$100,000
Total contributions received or receivable from participants2019-12-31$175,060
Other income received2019-12-31$100,038
Net income (gross income less expenses)2019-12-31$243,016
Net plan assets at end of year (total assets less liabilities)2019-12-31$718,450
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$475,434
Assets. Value of participant loans2019-12-31$5,778
Total contributions received or receivable from employer(s)2019-12-31$69,301
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$7,080
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
2018 : GOLDEN POND 401(K) PLAN 2018 401k financial data
Total income from all sources2018-12-31$162,328
Expenses. Total of all expenses incurred2018-12-31$62,304
Benefits paid (including direct rollovers)2018-12-31$55,471
Total plan assets at end of year2018-12-31$475,434
Total plan assets at beginning of year2018-12-31$375,410
Value of fidelity bond covering the plan2018-12-31$100,000
Total contributions received or receivable from participants2018-12-31$139,848
Other income received2018-12-31$-31,959
Net income (gross income less expenses)2018-12-31$100,024
Net plan assets at end of year (total assets less liabilities)2018-12-31$475,434
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$375,410
Total contributions received or receivable from employer(s)2018-12-31$54,439
Value of corrective distributions2018-12-31$926
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$5,907
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
2017 : GOLDEN POND 401(K) PLAN 2017 401k financial data
Total income from all sources2017-12-31$252,284
Expenses. Total of all expenses incurred2017-12-31$360,250
Benefits paid (including direct rollovers)2017-12-31$352,364
Total plan assets at end of year2017-12-31$375,410
Total plan assets at beginning of year2017-12-31$483,376
Value of fidelity bond covering the plan2017-12-31$100,000
Total contributions received or receivable from participants2017-12-31$133,094
Contributions received from other sources (not participants or employers)2017-12-31$4,334
Other income received2017-12-31$69,759
Net income (gross income less expenses)2017-12-31$-107,966
Net plan assets at end of year (total assets less liabilities)2017-12-31$375,410
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$483,376
Total contributions received or receivable from employer(s)2017-12-31$45,097
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$7,886
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : GOLDEN POND 401(K) PLAN 2016 401k financial data
Total income from all sources2016-12-31$569,581
Expenses. Total of all expenses incurred2016-12-31$86,205
Benefits paid (including direct rollovers)2016-12-31$78,217
Total plan assets at end of year2016-12-31$483,376
Total plan assets at beginning of year2016-12-31$0
Value of fidelity bond covering the plan2016-12-31$100,000
Total contributions received or receivable from participants2016-12-31$98,380
Contributions received from other sources (not participants or employers)2016-12-31$387,817
Other income received2016-12-31$44,276
Net income (gross income less expenses)2016-12-31$483,376
Net plan assets at end of year (total assets less liabilities)2016-12-31$483,376
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$0
Total contributions received or receivable from employer(s)2016-12-31$39,108
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$7,988
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0

Form 5500 Responses for GOLDEN POND 401(K) PLAN

2021: GOLDEN POND 401(K) PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: GOLDEN POND 401(K) PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: GOLDEN POND 401(K) PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: GOLDEN POND 401(K) PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: GOLDEN POND 401(K) PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: GOLDEN POND 401(K) PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01First time form 5500 has been submittedYes
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number121137
Policy instance 1
Insurance contract or identification number121137
Number of Individuals Covered152
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $469
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 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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
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 fees435
Additional information about fees paid to insurance brokerTPA COMPENSATION
Insurance broker organization code?5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number121137
Policy instance 1
Insurance contract or identification number121137
Number of Individuals Covered135
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,045
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 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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
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 fees675
Additional information about fees paid to insurance brokerTPA FEES PAID
Insurance broker organization code?5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number121137
Policy instance 1
Insurance contract or identification number121137
Number of Individuals Covered110
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $3,072
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 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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
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 fees2778
Additional information about fees paid to insurance brokerTPA FEES PAID
Insurance broker organization code?5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number121137
Policy instance 1
Insurance contract or identification number121137
Number of Individuals Covered30
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $468
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 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 BenefitNo
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 fees250
Additional information about fees paid to insurance brokerTPA FEES PAID
Insurance broker organization code?5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number121137
Policy instance 1
Insurance contract or identification number121137
Number of Individuals Covered32
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $714
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 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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
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 fees489
Additional information about fees paid to insurance brokerTPA COMPENSATION
Insurance broker organization code?5
Insurance broker nameSWERDLIN NORTHEAST LLC

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