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MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan NameMIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN
Plan identification number 501

MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

MIRABELLA RETIREMENT has sponsored the creation of one or more 401k plans.

Company Name:MIRABELLA RETIREMENT
Employer identification number (EIN):342030255
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012018-10-01LYNDELL SMITH2020-06-30
5012018-10-01EMILY PERRY2021-07-09
5012017-10-01
5012016-10-01
5012015-10-01LYNDELL SMITH
5012014-10-01TAMARA NORDIN
5012013-10-01TAMARA NORDIN
5012012-10-01TAMARA NORDIN
5012011-10-01TAMARA NORDIN

Plan Statistics for MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN

Measure Date Value
2018: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-10-01182
Total number of active participants reported on line 7a of the Form 55002018-10-01195
Number of retired or separated participants receiving benefits2018-10-010
Number of other retired or separated participants entitled to future benefits2018-10-010
Total of all active and inactive participants2018-10-01195
Number of employers contributing to the scheme2018-10-010
2017: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-10-01192
Total number of active participants reported on line 7a of the Form 55002017-10-01182
Number of retired or separated participants receiving benefits2017-10-010
Number of other retired or separated participants entitled to future benefits2017-10-010
Total of all active and inactive participants2017-10-01182
Number of employers contributing to the scheme2017-10-010
2016: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-10-01162
Total number of active participants reported on line 7a of the Form 55002016-10-01192
Number of retired or separated participants receiving benefits2016-10-010
Number of other retired or separated participants entitled to future benefits2016-10-010
Total of all active and inactive participants2016-10-01192
2015: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-10-01113
Total number of active participants reported on line 7a of the Form 55002015-10-01162
Number of retired or separated participants receiving benefits2015-10-010
Number of other retired or separated participants entitled to future benefits2015-10-010
Total of all active and inactive participants2015-10-01162
2014: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-10-01119
Total number of active participants reported on line 7a of the Form 55002014-10-01113
Number of retired or separated participants receiving benefits2014-10-010
Number of other retired or separated participants entitled to future benefits2014-10-010
Total of all active and inactive participants2014-10-01113
2013: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-10-01121
Total number of active participants reported on line 7a of the Form 55002013-10-01119
Number of retired or separated participants receiving benefits2013-10-010
Number of other retired or separated participants entitled to future benefits2013-10-010
Total of all active and inactive participants2013-10-01119
2012: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-10-01107
Total number of active participants reported on line 7a of the Form 55002012-10-01121
Number of retired or separated participants receiving benefits2012-10-010
Number of other retired or separated participants entitled to future benefits2012-10-010
Total of all active and inactive participants2012-10-01121
2011: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-10-01109
Total number of active participants reported on line 7a of the Form 55002011-10-01107
Number of retired or separated participants receiving benefits2011-10-010
Number of other retired or separated participants entitled to future benefits2011-10-010
Total of all active and inactive participants2011-10-01107

Form 5500 Responses for MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN

2018: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2018 form 5500 responses
2018-10-01Type of plan entitySingle employer plan
2018-10-01Submission has been amendedYes
2018-10-01This submission is the final filingYes
2018-10-01Plan funding arrangement – InsuranceYes
2018-10-01Plan funding arrangement – General assets of the sponsorYes
2018-10-01Plan benefit arrangement – InsuranceYes
2018-10-01Plan benefit arrangement – General assets of the sponsorYes
2017: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-10-01Type of plan entitySingle employer plan
2017-10-01Plan funding arrangement – InsuranceYes
2017-10-01Plan funding arrangement – General assets of the sponsorYes
2017-10-01Plan benefit arrangement – InsuranceYes
2017-10-01Plan benefit arrangement – General assets of the sponsorYes
2016: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-10-01Type of plan entitySingle employer plan
2016-10-01Plan funding arrangement – InsuranceYes
2016-10-01Plan funding arrangement – General assets of the sponsorYes
2016-10-01Plan benefit arrangement – InsuranceYes
2016-10-01Plan benefit arrangement – General assets of the sponsorYes
2015: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01Submission has been amendedNo
2015-10-01This submission is the final filingNo
2015-10-01This return/report is a short plan year return/report (less than 12 months)No
2015-10-01Plan is a collectively bargained planNo
2015-10-01Plan funding arrangement – InsuranceYes
2015-10-01Plan funding arrangement – General assets of the sponsorYes
2015-10-01Plan benefit arrangement – InsuranceYes
2015-10-01Plan benefit arrangement – General assets of the sponsorYes
2014: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2014 form 5500 responses
2014-10-01Type of plan entitySingle employer plan
2014-10-01Submission has been amendedNo
2014-10-01This submission is the final filingNo
2014-10-01This return/report is a short plan year return/report (less than 12 months)No
2014-10-01Plan is a collectively bargained planNo
2014-10-01Plan funding arrangement – InsuranceYes
2014-10-01Plan funding arrangement – General assets of the sponsorYes
2014-10-01Plan benefit arrangement – InsuranceYes
2014-10-01Plan benefit arrangement – General assets of the sponsorYes
2013: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2013 form 5500 responses
2013-10-01Type of plan entitySingle employer plan
2013-10-01Submission has been amendedNo
2013-10-01This submission is the final filingNo
2013-10-01This return/report is a short plan year return/report (less than 12 months)No
2013-10-01Plan is a collectively bargained planNo
2013-10-01Plan funding arrangement – InsuranceYes
2013-10-01Plan funding arrangement – General assets of the sponsorYes
2013-10-01Plan benefit arrangement – InsuranceYes
2013-10-01Plan benefit arrangement – General assets of the sponsorYes
2012: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2012 form 5500 responses
2012-10-01Type of plan entitySingle employer plan
2012-10-01Submission has been amendedNo
2012-10-01This submission is the final filingNo
2012-10-01This return/report is a short plan year return/report (less than 12 months)No
2012-10-01Plan is a collectively bargained planNo
2012-10-01Plan funding arrangement – InsuranceYes
2012-10-01Plan funding arrangement – General assets of the sponsorYes
2012-10-01Plan benefit arrangement – InsuranceYes
2012-10-01Plan benefit arrangement – General assets of the sponsorYes
2011: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2011 form 5500 responses
2011-10-01Type of plan entitySingle employer plan
2011-10-01Submission has been amendedNo
2011-10-01This submission is the final filingNo
2011-10-01This return/report is a short plan year return/report (less than 12 months)No
2011-10-01Plan is a collectively bargained planNo
2011-10-01Plan funding arrangement – InsuranceYes
2011-10-01Plan funding arrangement – General assets of the sponsorYes
2011-10-01Plan benefit arrangement – InsuranceYes
2011-10-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number6516800
Policy instance 1
Insurance contract or identification number6516800
Number of Individuals Covered238
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $110,529
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,491,260
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $110,529
Amount paid for insurance broker fees0
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number6516800
Policy instance 1
Insurance contract or identification number6516800
Number of Individuals Covered213
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $70,053
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,560,996
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes

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