401k Plan data: WEXNER HERITAGE VILLAGE 403(B) PLAN plan

WEXNER HERITAGE VILLAGE 403(B) PLAN 401k Plan overview

Plan Name	WEXNER HERITAGE VILLAGE 403(B) PLAN
Plan identification number	001

WEXNER HERITAGE VILLAGE 403(B) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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(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.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
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

WEXCO SENIOR SERVICES has sponsored the creation of one or more 401k plans.

Company Name: WEXCO SENIOR SERVICES

Employer identification number (EIN): 311804673

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WEXNER HERITAGE VILLAGE 403(B) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2022-01-01
001 2021-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01 THOMAS MCDERMOTT
001 2017-01-01 THOMAS MCDERMOTT
001 2015-01-01 ADRIAN SOLOMONIDES

Plan Statistics for WEXNER HERITAGE VILLAGE 403(B) PLAN

401k plan membership statisitcs for WEXNER HERITAGE VILLAGE 403(B) PLAN

Measure Date Value
2022: WEXNER HERITAGE VILLAGE 403(B) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 268
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 223
Number of retired or separated participants receiving benefits 2022-01-01 3
Number of other retired or separated participants entitled to future benefits 2022-01-01 34
Total of all active and inactive participants 2022-01-01 260
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 260
Number of participants with account balances 2022-01-01 86
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 2
2021: WEXNER HERITAGE VILLAGE 403(B) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 264
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 218
Number of retired or separated participants receiving benefits 2021-01-01 2
Number of other retired or separated participants entitled to future benefits 2021-01-01 42
Total of all active and inactive participants 2021-01-01 262
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 262
Number of participants with account balances 2021-01-01 102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 4
2020: WEXNER HERITAGE VILLAGE 403(B) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 290
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 216
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 47
Total of all active and inactive participants 2020-01-01 263
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 263
Number of participants with account balances 2020-01-01 116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 8
2019: WEXNER HERITAGE VILLAGE 403(B) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 342
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 242
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 47
Total of all active and inactive participants 2019-01-01 289
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 289
Number of participants with account balances 2019-01-01 123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 3
2018: WEXNER HERITAGE VILLAGE 403(B) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 423
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 282
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 60
Total of all active and inactive participants 2018-01-01 342
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 342
Number of participants with account balances 2018-01-01 140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 8
2017: WEXNER HERITAGE VILLAGE 403(B) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 540
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 353
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 70
Total of all active and inactive participants 2017-01-01 423
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 423
Number of participants with account balances 2017-01-01 195
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 23
2015: WEXNER HERITAGE VILLAGE 403(B) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 632
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 515
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 139
Total of all active and inactive participants 2015-01-01 654
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 654
Number of participants with account balances 2015-01-01 371
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 37

Measure	Date	Value
2022: WEXNER HERITAGE VILLAGE 403(B) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	268
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	223
Number of retired or separated participants receiving benefits	2022-01-01	3
Number of other retired or separated participants entitled to future benefits	2022-01-01	34
Total of all active and inactive participants	2022-01-01	260
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	260
Number of participants with account balances	2022-01-01	86
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	2
2021: WEXNER HERITAGE VILLAGE 403(B) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	264
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	218
Number of retired or separated participants receiving benefits	2021-01-01	2
Number of other retired or separated participants entitled to future benefits	2021-01-01	42
Total of all active and inactive participants	2021-01-01	262
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	262
Number of participants with account balances	2021-01-01	102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	4
2020: WEXNER HERITAGE VILLAGE 403(B) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	290
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	216
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	47
Total of all active and inactive participants	2020-01-01	263
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	263
Number of participants with account balances	2020-01-01	116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	8
2019: WEXNER HERITAGE VILLAGE 403(B) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	342
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	242
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	47
Total of all active and inactive participants	2019-01-01	289
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	289
Number of participants with account balances	2019-01-01	123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	3
2018: WEXNER HERITAGE VILLAGE 403(B) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	423
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	282
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	60
Total of all active and inactive participants	2018-01-01	342
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	342
Number of participants with account balances	2018-01-01	140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	8
2017: WEXNER HERITAGE VILLAGE 403(B) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	540
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	353
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	70
Total of all active and inactive participants	2017-01-01	423
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	423
Number of participants with account balances	2017-01-01	195
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	23
2015: WEXNER HERITAGE VILLAGE 403(B) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	632
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	515
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	139
Total of all active and inactive participants	2015-01-01	654
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	654
Number of participants with account balances	2015-01-01	371
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	37

Financial Data on WEXNER HERITAGE VILLAGE 403(B) PLAN

Measure	Date	Value
2022 : WEXNER HERITAGE VILLAGE 403(B) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-518,517
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$830,955
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$830,955
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$267,726
Value of total assets at end of year	2022-12-31	$3,049,487
Value of total assets at beginning of year	2022-12-31	$4,398,959
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$0
Total interest from all sources	2022-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$42,531
Participant contributions at end of year	2022-12-31	$0
Participant contributions at beginning of year	2022-12-31	$8,059
Administrative expenses (other) incurred	2022-12-31	$2,880
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-1,349,472
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$3,049,487
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$4,398,959
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$3,014,500
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$4,247,558
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-12-31	$101,127
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-12-31	$101,127
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$34,987
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$40,452
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-786,243
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Assets. Invements in employer securities at end of year	2022-12-31	$0
Assets. Invements in employer securities at beginning of year	2022-12-31	$0
Contributions received in cash from employer	2022-12-31	$225,195
Employer contributions (assets) at end of year	2022-12-31	$0
Employer contributions (assets) at beginning of year	2022-12-31	$1,763
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$830,955
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2022-12-31	381357951
2021 : WEXNER HERITAGE VILLAGE 403(B) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$982,826
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$949,601
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$947,351
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$279,619
Value of total assets at end of year	2021-12-31	$4,398,959
Value of total assets at beginning of year	2021-12-31	$4,365,734
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$2,250
Total interest from all sources	2021-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Administrative expenses professional fees incurred	2021-12-31	$2,250
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$233,194
Participant contributions at end of year	2021-12-31	$8,059
Participant contributions at beginning of year	2021-12-31	$8,162
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$33,225
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$4,398,959
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$4,365,734
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$4,247,558
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$4,151,525
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2021-12-31	$101,127
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2021-12-31	$95,289
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2021-12-31	$95,289
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$40,452
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$108,970
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$703,207
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Assets. Invements in employer securities at end of year	2021-12-31	$0
Assets. Invements in employer securities at beginning of year	2021-12-31	$0
Contributions received in cash from employer	2021-12-31	$46,425
Employer contributions (assets) at end of year	2021-12-31	$1,763
Employer contributions (assets) at beginning of year	2021-12-31	$1,788
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$947,351
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Disclaimer
Accountancy firm name	2021-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2021-12-31	381357951
2020 : WEXNER HERITAGE VILLAGE 403(B) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$875,774
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$198,023
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$196,403
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$273,038
Value of total assets at end of year	2020-12-31	$4,365,734
Value of total assets at beginning of year	2020-12-31	$3,687,983
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$1,620
Total interest from all sources	2020-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Administrative expenses professional fees incurred	2020-12-31	$1,620
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$224,265
Participant contributions at end of year	2020-12-31	$8,162
Participant contributions at beginning of year	2020-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$677,751
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$4,365,734
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$3,687,983
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$4,151,525
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$3,485,085
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-12-31	$95,289
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-12-31	$91,473
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-12-31	$91,473
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$108,970
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$111,425
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$602,736
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Assets. Invements in employer securities at end of year	2020-12-31	$0
Assets. Invements in employer securities at beginning of year	2020-12-31	$0
Contributions received in cash from employer	2020-12-31	$48,773
Employer contributions (assets) at end of year	2020-12-31	$1,788
Employer contributions (assets) at beginning of year	2020-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$196,403
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2020-12-31	381357951
2019 : WEXNER HERITAGE VILLAGE 403(B) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$963,277
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$580,625
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$576,724
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$196,896
Value of total assets at end of year	2019-12-31	$3,687,983
Value of total assets at beginning of year	2019-12-31	$3,305,331
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$3,901
Total interest from all sources	2019-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Administrative expenses professional fees incurred	2019-12-31	$3,901
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$163,380
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$7,692
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$4,784
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$382,652
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$3,687,983
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$3,305,331
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$3,485,085
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$3,053,865
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$91,473
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$124,685
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$124,685
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$111,425
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$117,188
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$766,381
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Assets. Invements in employer securities at end of year	2019-12-31	$0
Assets. Invements in employer securities at beginning of year	2019-12-31	$0
Contributions received in cash from employer	2019-12-31	$28,732
Employer contributions (assets) at end of year	2019-12-31	$0
Employer contributions (assets) at beginning of year	2019-12-31	$1,901
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$576,724
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2019-12-31	381357951
2018 : WEXNER HERITAGE VILLAGE 403(B) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$42,959
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$1,539,695
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$1,514,569
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$269,350
Value of total assets at end of year	2018-12-31	$3,305,331
Value of total assets at beginning of year	2018-12-31	$4,802,067
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$25,126
Total interest from all sources	2018-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Administrative expenses professional fees incurred	2018-12-31	$25,126
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$232,506
Participant contributions at end of year	2018-12-31	$7,692
Participant contributions at beginning of year	2018-12-31	$10,512
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$-1,496,736
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$3,305,331
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$4,802,067
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$3,053,865
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$4,484,064
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-12-31	$124,685
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-12-31	$186,074
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-12-31	$186,074
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$117,188
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$118,760
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-226,391
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Assets. Invements in employer securities at end of year	2018-12-31	$0
Assets. Invements in employer securities at beginning of year	2018-12-31	$0
Contributions received in cash from employer	2018-12-31	$36,844
Employer contributions (assets) at end of year	2018-12-31	$1,901
Employer contributions (assets) at beginning of year	2018-12-31	$2,657
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$1,514,569
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2018-12-31	No
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2018-12-31	381357951
2017 : WEXNER HERITAGE VILLAGE 403(B) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$1,041,885
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$709,700
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$709,439
Value of total corrective distributions	2017-12-31	$261
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$366,362
Value of total assets at end of year	2017-12-31	$4,802,067
Value of total assets at beginning of year	2017-12-31	$4,469,882
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$0
Total interest from all sources	2017-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$276,402
Participant contributions at end of year	2017-12-31	$10,512
Participant contributions at beginning of year	2017-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$14,901
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$332,185
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$4,802,067
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$4,469,882
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$4,484,064
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$4,179,054
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-12-31	$186,074
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-12-31	$180,914
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-12-31	$180,914
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$118,760
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$109,914
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$675,523
Net investment gain/loss from pooled separate accounts	2017-12-31	$675,523
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$75,059
Employer contributions (assets) at end of year	2017-12-31	$2,657
Employer contributions (assets) at beginning of year	2017-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$709,439
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2017-12-31	No
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2017-12-31	381357951
2015 : WEXNER HERITAGE VILLAGE 403(B) PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$525,524
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$877,938
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$877,938
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$632,286
Value of total assets at end of year	2015-12-31	$4,178,426
Value of total assets at beginning of year	2015-12-31	$4,530,840
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$0
Total interest from all sources	2015-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$127,759
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$17,471
Other income not declared elsewhere	2015-12-31	$-108,064
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-352,414
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$4,178,426
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$4,530,840
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$3,858,958
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$4,196,942
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$210,874
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$230,391
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$230,391
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$108,594
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$103,507
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$1,302
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$487,056
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$877,938
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2015-12-31	No
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2015-12-31	381357951

Form 5500 Responses for WEXNER HERITAGE VILLAGE 403(B) PLAN

2022: WEXNER HERITAGE VILLAGE 403(B) PLAN 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 funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: WEXNER HERITAGE VILLAGE 403(B) PLAN 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 funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: WEXNER HERITAGE VILLAGE 403(B) PLAN 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 funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: WEXNER HERITAGE VILLAGE 403(B) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: WEXNER HERITAGE VILLAGE 403(B) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: WEXNER HERITAGE VILLAGE 403(B) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	Yes
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2015: WEXNER HERITAGE VILLAGE 403(B) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

696-84040

Policy instance

Insurance contract or identification number	696-84040
Number of Individuals Covered	260
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $274
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	Yes
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 fees	274
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	4

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

696-84040

Policy instance

Insurance contract or identification number	696-84040
Number of Individuals Covered	102
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $687
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	Yes
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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
Commission paid to Insurance Broker	USD $687
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	4

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

696-84040

Policy instance

Insurance contract or identification number	696-84040
Number of Individuals Covered	216
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $772
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	Yes
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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
Commission paid to Insurance Broker	USD $772
Insurance broker organization code?	4

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

696-84040

Policy instance

Insurance contract or identification number	696-84040
Number of Individuals Covered	123
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $823
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	Yes
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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
Commission paid to Insurance Broker	USD $823
Insurance broker organization code?	4

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

696-84040

Policy instance

Insurance contract or identification number	696-84040
Number of Individuals Covered	140
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $872
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	Yes
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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
Commission paid to Insurance Broker	USD $872
Insurance broker organization code?	4

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

696-84040

Policy instance

Insurance contract or identification number	696-84040
Number of Individuals Covered	195
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $855
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	Yes
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 fees	855
Additional information about fees paid to insurance broker	FEES OR COMMISSIONS
Insurance broker organization code?	4
Insurance broker name	RAYMOND JAMES & ASSOCIATES INC.

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

696-84040

Policy instance

Insurance contract or identification number	696-84040
Number of Individuals Covered	371
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $768
Total amount of fees paid to insurance company	USD $70
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	Yes
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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
Commission paid to Insurance Broker	USD $336
Insurance broker organization code?	4
Amount paid for insurance broker fees	70
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker name	RAYMOND JAMES & ASSOCIATES INC.

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Company Name:	WEXCO SENIOR SERVICES
Employer identification number (EIN):	311804673
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities