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FAIRMOUNT HOMES RETIREMENT COMMUNITY GROUP MEDICAL PLAN 401k Plan overview

Plan NameFAIRMOUNT HOMES RETIREMENT COMMUNITY GROUP MEDICAL PLAN
Plan identification number 502

FAIRMOUNT HOMES RETIREMENT COMMUNITY GROUP MEDICAL PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

401k Sponsoring company profile

FAIRMOUNT HOMES has sponsored the creation of one or more 401k plans.

Company Name:FAIRMOUNT HOMES
Employer identification number (EIN):231680874
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FAIRMOUNT HOMES RETIREMENT COMMUNITY GROUP MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-07-01

Plan Statistics for FAIRMOUNT HOMES RETIREMENT COMMUNITY GROUP MEDICAL PLAN

401k plan membership statisitcs for FAIRMOUNT HOMES RETIREMENT COMMUNITY GROUP MEDICAL PLAN

Measure Date Value
2022: FAIRMOUNT HOMES RETIREMENT COMMUNITY GROUP MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year2022-07-01106
Total number of active participants reported on line 7a of the Form 55002022-07-01122
Number of retired or separated participants receiving benefits2022-07-010
Number of other retired or separated participants entitled to future benefits2022-07-010
Total of all active and inactive participants2022-07-01122

Financial Data on FAIRMOUNT HOMES RETIREMENT COMMUNITY GROUP MEDICAL PLAN

Measure Date Value
2023 : FAIRMOUNT HOMES RETIREMENT COMMUNITY GROUP MEDICAL PLAN 2023 401k financial data
Total unrealized appreciation/depreciation of assets2023-06-30$0
Total transfer of assets to this plan2023-06-30$646,980
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-06-30$100,834
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-06-30$0
Total income from all sources (including contributions)2023-06-30$1,246,440
Total loss/gain on sale of assets2023-06-30$0
Total of all expenses incurred2023-06-30$1,701,330
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2023-06-30$1,312,691
Total contributions o plan (from employers,participants, others, non cash contrinutions)2023-06-30$1,242,087
Value of total assets at end of year2023-06-30$292,924
Value of total assets at beginning of year2023-06-30$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2023-06-30$388,639
Total interest from all sources2023-06-30$4,353
Total dividends received (eg from common stock, registered investment company shares)2023-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2023-06-30No
Was this plan covered by a fidelity bond2023-06-30Yes
Value of fidelity bond cover2023-06-30$500,000
If this is an individual account plan, was there a blackout period2023-06-30No
Were there any nonexempt tranactions with any party-in-interest2023-06-30No
Contributions received from participants2023-06-30$269,303
Value of other receiveables (less allowance for doubtful accounts) at end of year2023-06-30$882
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2023-06-30$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2023-06-30$91,747
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2023-06-30$0
Administrative expenses (other) incurred2023-06-30$344,760
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2023-06-30No
Value of net income/loss2023-06-30$-454,890
Value of net assets at end of year (total assets less liabilities)2023-06-30$192,090
Value of net assets at beginning of year (total assets less liabilities)2023-06-30$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2023-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2023-06-30No
Were any leases to which the plan was party in default or uncollectible2023-06-30No
Investment advisory and management fees2023-06-30$27,587
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2023-06-30$292,042
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2023-06-30$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2023-06-30$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2023-06-30$4,353
Expenses. Payments to insurance carriers foe the provision of benefits2023-06-30$1,312,691
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2023-06-30No
Was there a failure to transmit to the plan any participant contributions2023-06-30No
Has the plan failed to provide any benefit when due under the plan2023-06-30No
Contributions received in cash from employer2023-06-30$972,784
Contract administrator fees2023-06-30$16,292
Liabilities. Value of benefit claims payable at end of year2023-06-30$9,087
Liabilities. Value of benefit claims payable at beginning of year2023-06-30$0
Did the plan have assets held for investment2023-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2023-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2023-06-30No
Opinion of an independent qualified public accountant for this plan2023-06-30Unqualified
Accountancy firm name2023-06-30YOUNG, OAKES, BROWN & CO., P.C.
Accountancy firm EIN2023-06-30251589048

Form 5500 Responses for FAIRMOUNT HOMES RETIREMENT COMMUNITY GROUP MEDICAL PLAN

2022: FAIRMOUNT HOMES RETIREMENT COMMUNITY GROUP MEDICAL PLAN 2022 form 5500 responses
2022-07-01Type of plan entitySingle employer plan
2022-07-01First time form 5500 has been submittedYes
2022-07-01Submission has been amendedNo
2022-07-01This submission is the final filingNo
2022-07-01This return/report is a short plan year return/report (less than 12 months)No
2022-07-01Plan is a collectively bargained planNo
2022-07-01Plan funding arrangement – InsuranceYes
2022-07-01Plan funding arrangement – TrustYes
2022-07-01Plan benefit arrangement – InsuranceYes
2022-07-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 )
Policy contract numberUNI-202785
Policy instance 1
Insurance contract or identification numberUNI-202785
Number of Individuals Covered122
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
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
Welfare Benefit Premiums Paid to CarrierUSD $340,913
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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