401k Plan data: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN plan

MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN
Plan identification number	501

MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN Benefits

401k Plan Type	Welfare 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 Signed Name of Company Sponsor Date Sponsor Signed
501 2018-10-01 LYNDELL SMITH 2020-06-30
501 2018-10-01 EMILY PERRY 2021-07-09
501 2017-10-01
501 2016-10-01
501 2015-10-01 LYNDELL SMITH
501 2014-10-01 TAMARA NORDIN
501 2013-10-01 TAMARA NORDIN
501 2012-10-01 TAMARA NORDIN
501 2011-10-01 TAMARA NORDIN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2018-10-01	LYNDELL SMITH	2020-06-30
501	2018-10-01	EMILY PERRY	2021-07-09
501	2017-10-01
501	2016-10-01
501	2015-10-01	LYNDELL SMITH
501	2014-10-01	TAMARA NORDIN
501	2013-10-01	TAMARA NORDIN
501	2012-10-01	TAMARA NORDIN
501	2011-10-01	TAMARA 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-year 2018-10-01 182
Total number of active participants reported on line 7a of the Form 5500 2018-10-01 195
Number of retired or separated participants receiving benefits 2018-10-01 0
Number of other retired or separated participants entitled to future benefits 2018-10-01 0
Total of all active and inactive participants 2018-10-01 195
Number of employers contributing to the scheme 2018-10-01 0
2017: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-10-01 192
Total number of active participants reported on line 7a of the Form 5500 2017-10-01 182
Number of retired or separated participants receiving benefits 2017-10-01 0
Number of other retired or separated participants entitled to future benefits 2017-10-01 0
Total of all active and inactive participants 2017-10-01 182
Number of employers contributing to the scheme 2017-10-01 0
2016: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-10-01 162
Total number of active participants reported on line 7a of the Form 5500 2016-10-01 192
Number of retired or separated participants receiving benefits 2016-10-01 0
Number of other retired or separated participants entitled to future benefits 2016-10-01 0
Total of all active and inactive participants 2016-10-01 192
2015: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-10-01 113
Total number of active participants reported on line 7a of the Form 5500 2015-10-01 162
Number of retired or separated participants receiving benefits 2015-10-01 0
Number of other retired or separated participants entitled to future benefits 2015-10-01 0
Total of all active and inactive participants 2015-10-01 162
2014: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-10-01 119
Total number of active participants reported on line 7a of the Form 5500 2014-10-01 113
Number of retired or separated participants receiving benefits 2014-10-01 0
Number of other retired or separated participants entitled to future benefits 2014-10-01 0
Total of all active and inactive participants 2014-10-01 113
2013: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-10-01 121
Total number of active participants reported on line 7a of the Form 5500 2013-10-01 119
Number of retired or separated participants receiving benefits 2013-10-01 0
Number of other retired or separated participants entitled to future benefits 2013-10-01 0
Total of all active and inactive participants 2013-10-01 119
2012: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-10-01 107
Total number of active participants reported on line 7a of the Form 5500 2012-10-01 121
Number of retired or separated participants receiving benefits 2012-10-01 0
Number of other retired or separated participants entitled to future benefits 2012-10-01 0
Total of all active and inactive participants 2012-10-01 121
2011: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-10-01 109
Total number of active participants reported on line 7a of the Form 5500 2011-10-01 107
Number of retired or separated participants receiving benefits 2011-10-01 0
Number of other retired or separated participants entitled to future benefits 2011-10-01 0
Total of all active and inactive participants 2011-10-01 107

Measure	Date	Value
2018: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-10-01	182
Total number of active participants reported on line 7a of the Form 5500	2018-10-01	195
Number of retired or separated participants receiving benefits	2018-10-01	0
Number of other retired or separated participants entitled to future benefits	2018-10-01	0
Total of all active and inactive participants	2018-10-01	195
Number of employers contributing to the scheme	2018-10-01	0
2017: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-10-01	192
Total number of active participants reported on line 7a of the Form 5500	2017-10-01	182
Number of retired or separated participants receiving benefits	2017-10-01	0
Number of other retired or separated participants entitled to future benefits	2017-10-01	0
Total of all active and inactive participants	2017-10-01	182
Number of employers contributing to the scheme	2017-10-01	0
2016: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-10-01	162
Total number of active participants reported on line 7a of the Form 5500	2016-10-01	192
Number of retired or separated participants receiving benefits	2016-10-01	0
Number of other retired or separated participants entitled to future benefits	2016-10-01	0
Total of all active and inactive participants	2016-10-01	192
2015: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-10-01	113
Total number of active participants reported on line 7a of the Form 5500	2015-10-01	162
Number of retired or separated participants receiving benefits	2015-10-01	0
Number of other retired or separated participants entitled to future benefits	2015-10-01	0
Total of all active and inactive participants	2015-10-01	162
2014: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-10-01	119
Total number of active participants reported on line 7a of the Form 5500	2014-10-01	113
Number of retired or separated participants receiving benefits	2014-10-01	0
Number of other retired or separated participants entitled to future benefits	2014-10-01	0
Total of all active and inactive participants	2014-10-01	113
2013: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-10-01	121
Total number of active participants reported on line 7a of the Form 5500	2013-10-01	119
Number of retired or separated participants receiving benefits	2013-10-01	0
Number of other retired or separated participants entitled to future benefits	2013-10-01	0
Total of all active and inactive participants	2013-10-01	119
2012: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-10-01	107
Total number of active participants reported on line 7a of the Form 5500	2012-10-01	121
Number of retired or separated participants receiving benefits	2012-10-01	0
Number of other retired or separated participants entitled to future benefits	2012-10-01	0
Total of all active and inactive participants	2012-10-01	121
2011: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-10-01	109
Total number of active participants reported on line 7a of the Form 5500	2011-10-01	107
Number of retired or separated participants receiving benefits	2011-10-01	0
Number of other retired or separated participants entitled to future benefits	2011-10-01	0
Total of all active and inactive participants	2011-10-01	107

Form 5500 Responses for MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN

2018: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2018 form 5500 responses
2018-10-01	Type of plan entity	Single employer plan
2018-10-01	Submission has been amended	Yes
2018-10-01	This submission is the final filing	Yes
2018-10-01	Plan funding arrangement – Insurance	Yes
2018-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-10-01	Plan benefit arrangement – Insurance	Yes
2018-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-10-01	Type of plan entity	Single employer plan
2017-10-01	Plan funding arrangement – Insurance	Yes
2017-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-10-01	Plan benefit arrangement – Insurance	Yes
2017-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-10-01	Type of plan entity	Single employer plan
2016-10-01	Plan funding arrangement – Insurance	Yes
2016-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-10-01	Plan benefit arrangement – Insurance	Yes
2016-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-10-01	Type of plan entity	Single employer plan
2015-10-01	Submission has been amended	No
2015-10-01	This submission is the final filing	No
2015-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-10-01	Plan is a collectively bargained plan	No
2015-10-01	Plan funding arrangement – Insurance	Yes
2015-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-10-01	Plan benefit arrangement – Insurance	Yes
2015-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2014 form 5500 responses
2014-10-01	Type of plan entity	Single employer plan
2014-10-01	Submission has been amended	No
2014-10-01	This submission is the final filing	No
2014-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-10-01	Plan is a collectively bargained plan	No
2014-10-01	Plan funding arrangement – Insurance	Yes
2014-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-10-01	Plan benefit arrangement – Insurance	Yes
2014-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2013 form 5500 responses
2013-10-01	Type of plan entity	Single employer plan
2013-10-01	Submission has been amended	No
2013-10-01	This submission is the final filing	No
2013-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-10-01	Plan is a collectively bargained plan	No
2013-10-01	Plan funding arrangement – Insurance	Yes
2013-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-10-01	Plan benefit arrangement – Insurance	Yes
2013-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2012 form 5500 responses
2012-10-01	Type of plan entity	Single employer plan
2012-10-01	Submission has been amended	No
2012-10-01	This submission is the final filing	No
2012-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-10-01	Plan is a collectively bargained plan	No
2012-10-01	Plan funding arrangement – Insurance	Yes
2012-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-10-01	Plan benefit arrangement – Insurance	Yes
2012-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: MIRABELLA RETIREMENT EMPLOYEE BENEFIT PLAN 2011 form 5500 responses
2011-10-01	Type of plan entity	Single employer plan
2011-10-01	Submission has been amended	No
2011-10-01	This submission is the final filing	No
2011-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-10-01	Plan is a collectively bargained plan	No
2011-10-01	Plan funding arrangement – Insurance	Yes
2011-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-10-01	Plan benefit arrangement – Insurance	Yes
2011-10-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number	6516800
Policy instance	1
GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )
Policy contract number	6516800
Policy instance	1

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