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BLAIR SENIOR SERVICES, INC. GROUP MEDICAL PLAN 401k Plan overview

Plan NameBLAIR SENIOR SERVICES, INC. GROUP MEDICAL PLAN
Plan identification number 502

BLAIR SENIOR SERVICES, INC. GROUP MEDICAL PLAN Benefits

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

401k Sponsoring company profile

BLAIR SENIOR SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name:BLAIR SENIOR SERVICES, INC.
Employer identification number (EIN):251259406
NAIC Classification:812990
NAIC Description:All Other Personal Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BLAIR SENIOR SERVICES, INC. GROUP MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-07-01
5022021-07-01
5022020-07-01
5022019-07-01
5022018-07-01

Plan Statistics for BLAIR SENIOR SERVICES, INC. GROUP MEDICAL PLAN

401k plan membership statisitcs for BLAIR SENIOR SERVICES, INC. GROUP MEDICAL PLAN

Measure Date Value
2022: BLAIR SENIOR SERVICES, INC. GROUP MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year2022-07-0168
Total number of active participants reported on line 7a of the Form 55002022-07-0189
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 participants2022-07-0189
2021: BLAIR SENIOR SERVICES, INC. GROUP MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-0158
Total number of active participants reported on line 7a of the Form 55002021-07-01125
Number of retired or separated participants receiving benefits2021-07-010
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-01125
2020: BLAIR SENIOR SERVICES, INC. GROUP MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-0161
Total number of active participants reported on line 7a of the Form 55002020-07-0156
Number of retired or separated participants receiving benefits2020-07-012
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-0158
2019: BLAIR SENIOR SERVICES, INC. GROUP MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-0164
Total number of active participants reported on line 7a of the Form 55002019-07-0159
Number of retired or separated participants receiving benefits2019-07-012
Number of other retired or separated participants entitled to future benefits2019-07-010
Total of all active and inactive participants2019-07-0161
2018: BLAIR SENIOR SERVICES, INC. GROUP MEDICAL PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-0166
Total number of active participants reported on line 7a of the Form 55002018-07-0164
Number of retired or separated participants receiving benefits2018-07-010
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-0164

Financial Data on BLAIR SENIOR SERVICES, INC. GROUP MEDICAL PLAN

Measure Date Value
2023 : BLAIR SENIOR SERVICES, INC. GROUP MEDICAL PLAN 2023 401k financial data
Total plan liabilities at end of year2023-06-30$61,449
Total plan liabilities at beginning of year2023-06-30$40,842
Total income from all sources2023-06-30$1,100,133
Expenses. Total of all expenses incurred2023-06-30$1,130,213
Benefits paid (including direct rollovers)2023-06-30$657,032
Total plan assets at end of year2023-06-30$30,106
Total plan assets at beginning of year2023-06-30$39,579
Value of fidelity bond covering the plan2023-06-30$500,000
Total contributions received or receivable from participants2023-06-30$168,295
Expenses. Other expenses not covered elsewhere2023-06-30$409,330
Contributions received from other sources (not participants or employers)2023-06-30$0
Other income received2023-06-30$1,445
Net income (gross income less expenses)2023-06-30$-30,080
Net plan assets at end of year (total assets less liabilities)2023-06-30$-31,343
Net plan assets at beginning of year (total assets less liabilities)2023-06-30$-1,263
Total contributions received or receivable from employer(s)2023-06-30$930,393
Value of corrective distributions2023-06-30$51,058
Expenses. Administrative service providers (salaries,fees and commissions)2023-06-30$12,793
2022 : BLAIR SENIOR SERVICES, INC. GROUP MEDICAL PLAN 2022 401k financial data
Total plan liabilities at end of year2022-06-30$40,842
Total plan liabilities at beginning of year2022-06-30$15,823
Total income from all sources2022-06-30$729,674
Expenses. Total of all expenses incurred2022-06-30$783,309
Benefits paid (including direct rollovers)2022-06-30$511,275
Total plan assets at end of year2022-06-30$39,579
Total plan assets at beginning of year2022-06-30$68,195
Value of fidelity bond covering the plan2022-06-30$500,000
Total contributions received or receivable from participants2022-06-30$115,162
Expenses. Other expenses not covered elsewhere2022-06-30$256,136
Contributions received from other sources (not participants or employers)2022-06-30$1,660
Other income received2022-06-30$636
Net income (gross income less expenses)2022-06-30$-53,635
Net plan assets at end of year (total assets less liabilities)2022-06-30$-1,263
Net plan assets at beginning of year (total assets less liabilities)2022-06-30$52,372
Total contributions received or receivable from employer(s)2022-06-30$612,216
Value of corrective distributions2022-06-30$6,008
Expenses. Administrative service providers (salaries,fees and commissions)2022-06-30$9,890
2021 : BLAIR SENIOR SERVICES, INC. GROUP MEDICAL PLAN 2021 401k financial data
Total plan liabilities at end of year2021-06-30$15,823
Total plan liabilities at beginning of year2021-06-30$47,061
Total income from all sources2021-06-30$650,179
Expenses. Total of all expenses incurred2021-06-30$571,333
Benefits paid (including direct rollovers)2021-06-30$293,751
Total plan assets at end of year2021-06-30$68,195
Total plan assets at beginning of year2021-06-30$20,587
Value of fidelity bond covering the plan2021-06-30$500,000
Total contributions received or receivable from participants2021-06-30$105,461
Expenses. Other expenses not covered elsewhere2021-06-30$227,565
Contributions received from other sources (not participants or employers)2021-06-30$15,722
Other income received2021-06-30$810
Net income (gross income less expenses)2021-06-30$78,846
Net plan assets at end of year (total assets less liabilities)2021-06-30$52,372
Net plan assets at beginning of year (total assets less liabilities)2021-06-30$-26,474
Total contributions received or receivable from employer(s)2021-06-30$528,186
Value of corrective distributions2021-06-30$37,550
Expenses. Administrative service providers (salaries,fees and commissions)2021-06-30$12,467
2020 : BLAIR SENIOR SERVICES, INC. GROUP MEDICAL PLAN 2020 401k financial data
Total plan liabilities at end of year2020-06-30$47,061
Total plan liabilities at beginning of year2020-06-30$69,253
Total income from all sources2020-06-30$688,287
Expenses. Total of all expenses incurred2020-06-30$653,523
Benefits paid (including direct rollovers)2020-06-30$377,693
Total plan assets at end of year2020-06-30$20,587
Total plan assets at beginning of year2020-06-30$8,015
Value of fidelity bond covering the plan2020-06-30$500,000
Total contributions received or receivable from participants2020-06-30$40,966
Expenses. Other expenses not covered elsewhere2020-06-30$243,158
Contributions received from other sources (not participants or employers)2020-06-30$13,267
Other income received2020-06-30$530
Net income (gross income less expenses)2020-06-30$34,764
Net plan assets at end of year (total assets less liabilities)2020-06-30$-26,474
Net plan assets at beginning of year (total assets less liabilities)2020-06-30$-61,238
Total contributions received or receivable from employer(s)2020-06-30$633,524
Value of corrective distributions2020-06-30$0
Expenses. Administrative service providers (salaries,fees and commissions)2020-06-30$32,672
2019 : BLAIR SENIOR SERVICES, INC. GROUP MEDICAL PLAN 2019 401k financial data
Total plan liabilities at end of year2019-06-30$69,253
Total plan liabilities at beginning of year2019-06-30$0
Total income from all sources2019-06-30$596,177
Expenses. Total of all expenses incurred2019-06-30$657,415
Benefits paid (including direct rollovers)2019-06-30$379,501
Total plan assets at end of year2019-06-30$8,015
Total plan assets at beginning of year2019-06-30$0
Value of fidelity bond covering the plan2019-06-30$500,000
Total contributions received or receivable from participants2019-06-30$62,190
Expenses. Other expenses not covered elsewhere2019-06-30$244,192
Other income received2019-06-30$227
Net income (gross income less expenses)2019-06-30$-61,238
Net plan assets at end of year (total assets less liabilities)2019-06-30$-61,238
Net plan assets at beginning of year (total assets less liabilities)2019-06-30$0
Total contributions received or receivable from employer(s)2019-06-30$533,760
Expenses. Administrative service providers (salaries,fees and commissions)2019-06-30$33,722

Form 5500 Responses for BLAIR SENIOR SERVICES, INC. GROUP MEDICAL PLAN

2022: BLAIR SENIOR SERVICES, INC. GROUP MEDICAL PLAN 2022 form 5500 responses
2022-07-01Type of plan entitySingle employer plan
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
2021: BLAIR SENIOR SERVICES, INC. GROUP MEDICAL PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Submission has been amendedNo
2021-07-01This submission is the final filingNo
2021-07-01This return/report is a short plan year return/report (less than 12 months)No
2021-07-01Plan is a collectively bargained planNo
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan funding arrangement – TrustYes
2021-07-01Plan benefit arrangement – InsuranceYes
2021-07-01Plan benefit arrangement - TrustYes
2020: BLAIR SENIOR SERVICES, INC. GROUP MEDICAL PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Submission has been amendedNo
2020-07-01This submission is the final filingNo
2020-07-01This return/report is a short plan year return/report (less than 12 months)No
2020-07-01Plan is a collectively bargained planNo
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan funding arrangement – TrustYes
2020-07-01Plan benefit arrangement – InsuranceYes
2020-07-01Plan benefit arrangement - TrustYes
2019: BLAIR SENIOR SERVICES, INC. GROUP MEDICAL PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Submission has been amendedNo
2019-07-01This submission is the final filingNo
2019-07-01This return/report is a short plan year return/report (less than 12 months)No
2019-07-01Plan is a collectively bargained planNo
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan funding arrangement – TrustYes
2019-07-01Plan benefit arrangement – InsuranceYes
2019-07-01Plan benefit arrangement - TrustYes
2018: BLAIR SENIOR SERVICES, INC. GROUP MEDICAL PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01First time form 5500 has been submittedYes
2018-07-01Submission has been amendedNo
2018-07-01This submission is the final filingNo
2018-07-01This return/report is a short plan year return/report (less than 12 months)No
2018-07-01Plan is a collectively bargained planNo
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan funding arrangement – TrustYes
2018-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30700014
Policy instance 1
Insurance contract or identification number30700014
Number of Individuals Covered89
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 $360,295
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30700014
Policy instance 1
Insurance contract or identification number30700014
Number of Individuals Covered65
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
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 $220,786
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30700014
Policy instance 1
Insurance contract or identification number30700014
Number of Individuals Covered58
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
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 $194,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30700014
Policy instance 1
Insurance contract or identification number30700014
Number of Individuals Covered61
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
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 $205,853
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberPCI
Policy instance 1
Insurance contract or identification numberPCI
Number of Individuals Covered64
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
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 $204,429
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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