401k Plan data: AVON HEALTH CENTER AND WEST HARTFORD HEALTH AND REHABILITATION CENTER EMPLOYEE DENTAL PLAN plan

AVON HEALTH CENTER AND WEST HARTFORD HEALTH AND REHABILITATION CENTER EMPLOYEE DENTAL PLAN 401k Plan overview

Plan Name	AVON HEALTH CENTER AND WEST HARTFORD HEALTH AND REHABILITATION CENTER EMPLOYEE DENTAL PLAN
Plan identification number	503

AVON HEALTH CENTER AND WEST HARTFORD HEALTH AND REHABILITATION CENTER EMPLOYEE DENTAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental 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. Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

AVON CONVALESCENT HOME, INC. has sponsored the creation of one or more 401k plans.

Company Name: AVON CONVALESCENT HOME, INC.

Employer identification number (EIN): 060917232

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AVON HEALTH CENTER AND WEST HARTFORD HEALTH AND REHABILITATION CENTER EMPLOYEE DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2021-11-01 RUSSELL SCHWARTZ 2023-08-08
503 2020-11-01 RUSSELL SCHWARTZ 2022-02-25
503 2019-11-01 RUSSELL SCHWARTZ 2021-02-13
503 2018-11-01 RUSSELL SCHWARTZ 2020-04-15
503 2014-11-01 RUSSELL SCHWARTZ
503 2014-11-01
503 2013-11-01 RUSSELL SCHWARTZ

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
503	2021-11-01	RUSSELL SCHWARTZ	2023-08-08
503	2020-11-01	RUSSELL SCHWARTZ	2022-02-25
503	2019-11-01	RUSSELL SCHWARTZ	2021-02-13
503	2018-11-01	RUSSELL SCHWARTZ	2020-04-15
503	2014-11-01	RUSSELL SCHWARTZ
503	2014-11-01
503	2013-11-01	RUSSELL SCHWARTZ

Plan Statistics for AVON HEALTH CENTER AND WEST HARTFORD HEALTH AND REHABILITATION CENTER EMPLOYEE DENTAL PLAN

401k plan membership statisitcs for AVON HEALTH CENTER AND WEST HARTFORD HEALTH AND REHABILITATION CENTER EMPLOYEE DENTAL PLAN

Measure Date Value
2021: AVON HEALTH CENTER AND WEST HARTFORD HEALTH AND REHABILITATION CENTER EMPLOYEE DENTAL PLAN 2021 401k membership
Total participants, beginning-of-year 2021-11-01 146
Total number of active participants reported on line 7a of the Form 5500 2021-11-01 146
Number of retired or separated participants receiving benefits 2021-11-01 0
Number of other retired or separated participants entitled to future benefits 2021-11-01 0
Total of all active and inactive participants 2021-11-01 146
Number of employers contributing to the scheme 2021-11-01 0
2020: AVON HEALTH CENTER AND WEST HARTFORD HEALTH AND REHABILITATION CENTER EMPLOYEE DENTAL PLAN 2020 401k membership
Total participants, beginning-of-year 2020-11-01 176
Total number of active participants reported on line 7a of the Form 5500 2020-11-01 146
Number of retired or separated participants receiving benefits 2020-11-01 0
Number of other retired or separated participants entitled to future benefits 2020-11-01 0
Total of all active and inactive participants 2020-11-01 146
Number of employers contributing to the scheme 2020-11-01 0
2019: AVON HEALTH CENTER AND WEST HARTFORD HEALTH AND REHABILITATION CENTER EMPLOYEE DENTAL PLAN 2019 401k membership
Total participants, beginning-of-year 2019-11-01 176
Total number of active participants reported on line 7a of the Form 5500 2019-11-01 176
Number of retired or separated participants receiving benefits 2019-11-01 0
Number of other retired or separated participants entitled to future benefits 2019-11-01 0
Total of all active and inactive participants 2019-11-01 176
Number of employers contributing to the scheme 2019-11-01 0
2018: AVON HEALTH CENTER AND WEST HARTFORD HEALTH AND REHABILITATION CENTER EMPLOYEE DENTAL PLAN 2018 401k membership
Total participants, beginning-of-year 2018-11-01 180
Total number of active participants reported on line 7a of the Form 5500 2018-11-01 176
Number of retired or separated participants receiving benefits 2018-11-01 0
Number of other retired or separated participants entitled to future benefits 2018-11-01 0
Total of all active and inactive participants 2018-11-01 176
Number of employers contributing to the scheme 2018-11-01 0
2014: AVON HEALTH CENTER AND WEST HARTFORD HEALTH AND REHABILITATION CENTER EMPLOYEE DENTAL PLAN 2014 401k membership
Total participants, beginning-of-year 2014-11-01 188
Total number of active participants reported on line 7a of the Form 5500 2014-11-01 162
Number of retired or separated participants receiving benefits 2014-11-01 0
Number of other retired or separated participants entitled to future benefits 2014-11-01 0
Total of all active and inactive participants 2014-11-01 162
Number of employers contributing to the scheme 2014-11-01 0
2013: AVON HEALTH CENTER AND WEST HARTFORD HEALTH AND REHABILITATION CENTER EMPLOYEE DENTAL PLAN 2013 401k membership
Total participants, beginning-of-year 2013-11-01 100
Total number of active participants reported on line 7a of the Form 5500 2013-11-01 184
Number of retired or separated participants receiving benefits 2013-11-01 0
Number of other retired or separated participants entitled to future benefits 2013-11-01 0
Total of all active and inactive participants 2013-11-01 184

Measure	Date	Value
2021: AVON HEALTH CENTER AND WEST HARTFORD HEALTH AND REHABILITATION CENTER EMPLOYEE DENTAL PLAN 2021 401k membership
Total participants, beginning-of-year	2021-11-01	146
Total number of active participants reported on line 7a of the Form 5500	2021-11-01	146
Number of retired or separated participants receiving benefits	2021-11-01	0
Number of other retired or separated participants entitled to future benefits	2021-11-01	0
Total of all active and inactive participants	2021-11-01	146
Number of employers contributing to the scheme	2021-11-01	0
2020: AVON HEALTH CENTER AND WEST HARTFORD HEALTH AND REHABILITATION CENTER EMPLOYEE DENTAL PLAN 2020 401k membership
Total participants, beginning-of-year	2020-11-01	176
Total number of active participants reported on line 7a of the Form 5500	2020-11-01	146
Number of retired or separated participants receiving benefits	2020-11-01	0
Number of other retired or separated participants entitled to future benefits	2020-11-01	0
Total of all active and inactive participants	2020-11-01	146
Number of employers contributing to the scheme	2020-11-01	0
2019: AVON HEALTH CENTER AND WEST HARTFORD HEALTH AND REHABILITATION CENTER EMPLOYEE DENTAL PLAN 2019 401k membership
Total participants, beginning-of-year	2019-11-01	176
Total number of active participants reported on line 7a of the Form 5500	2019-11-01	176
Number of retired or separated participants receiving benefits	2019-11-01	0
Number of other retired or separated participants entitled to future benefits	2019-11-01	0
Total of all active and inactive participants	2019-11-01	176
Number of employers contributing to the scheme	2019-11-01	0
2018: AVON HEALTH CENTER AND WEST HARTFORD HEALTH AND REHABILITATION CENTER EMPLOYEE DENTAL PLAN 2018 401k membership
Total participants, beginning-of-year	2018-11-01	180
Total number of active participants reported on line 7a of the Form 5500	2018-11-01	176
Number of retired or separated participants receiving benefits	2018-11-01	0
Number of other retired or separated participants entitled to future benefits	2018-11-01	0
Total of all active and inactive participants	2018-11-01	176
Number of employers contributing to the scheme	2018-11-01	0
2014: AVON HEALTH CENTER AND WEST HARTFORD HEALTH AND REHABILITATION CENTER EMPLOYEE DENTAL PLAN 2014 401k membership
Total participants, beginning-of-year	2014-11-01	188
Total number of active participants reported on line 7a of the Form 5500	2014-11-01	162
Number of retired or separated participants receiving benefits	2014-11-01	0
Number of other retired or separated participants entitled to future benefits	2014-11-01	0
Total of all active and inactive participants	2014-11-01	162
Number of employers contributing to the scheme	2014-11-01	0
2013: AVON HEALTH CENTER AND WEST HARTFORD HEALTH AND REHABILITATION CENTER EMPLOYEE DENTAL PLAN 2013 401k membership
Total participants, beginning-of-year	2013-11-01	100
Total number of active participants reported on line 7a of the Form 5500	2013-11-01	184
Number of retired or separated participants receiving benefits	2013-11-01	0
Number of other retired or separated participants entitled to future benefits	2013-11-01	0
Total of all active and inactive participants	2013-11-01	184

Form 5500 Responses for AVON HEALTH CENTER AND WEST HARTFORD HEALTH AND REHABILITATION CENTER EMPLOYEE DENTAL PLAN

2021: AVON HEALTH CENTER AND WEST HARTFORD HEALTH AND REHABILITATION CENTER EMPLOYEE DENTAL PLAN 2021 form 5500 responses
2021-11-01	Type of plan entity	Single employer plan
2021-11-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-11-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: AVON HEALTH CENTER AND WEST HARTFORD HEALTH AND REHABILITATION CENTER EMPLOYEE DENTAL PLAN 2020 form 5500 responses
2020-11-01	Type of plan entity	Single employer plan
2020-11-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-11-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: AVON HEALTH CENTER AND WEST HARTFORD HEALTH AND REHABILITATION CENTER EMPLOYEE DENTAL PLAN 2019 form 5500 responses
2019-11-01	Type of plan entity	Single employer plan
2019-11-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-11-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: AVON HEALTH CENTER AND WEST HARTFORD HEALTH AND REHABILITATION CENTER EMPLOYEE DENTAL PLAN 2018 form 5500 responses
2018-11-01	Type of plan entity	Single employer plan
2018-11-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-11-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: AVON HEALTH CENTER AND WEST HARTFORD HEALTH AND REHABILITATION CENTER EMPLOYEE DENTAL PLAN 2014 form 5500 responses
2014-11-01	Type of plan entity	Single employer plan
2014-11-01	Submission has been amended	No
2014-11-01	This submission is the final filing	No
2014-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-11-01	Plan is a collectively bargained plan	No
2014-11-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-11-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: AVON HEALTH CENTER AND WEST HARTFORD HEALTH AND REHABILITATION CENTER EMPLOYEE DENTAL PLAN 2013 form 5500 responses
2013-11-01	Type of plan entity	Single employer plan
2013-11-01	First time form 5500 has been submitted	Yes
2013-11-01	Submission has been amended	No
2013-11-01	This submission is the final filing	No
2013-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-11-01	Plan is a collectively bargained plan	No
2013-11-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-11-01	Plan benefit arrangement – General assets of the sponsor	Yes

Potentially related plans

AVON HEALTH CARE TRUST [EIN = 130544597]

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Company Name:	AVON CONVALESCENT HOME, INC.
Employer identification number (EIN):	060917232
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities