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| Plan Name | FAIRHAVEN CHRISTIAN RETIREMENT CENTER GROUP DENTAL INSURANCE PLAN |
| Plan identification number | 504 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | FAIRHAVEN CHRISTIAN RETIREMENT CENTER |
| Employer identification number (EIN): | 362606227 |
| NAIC Classification: | 623000 |
| NAIC Description: | Nursing and Residential Care Facilities |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 504 | 2015-12-01 | JEFF REIERSON | JEFF REIERSON | 2017-08-02 | |
| 504 | 2010-01-01 | JEFF REIERSON |
| Measure | Date | Value |
|---|---|---|
| 2015: FAIRHAVEN CHRISTIAN RETIREMENT CENTER GROUP DENTAL INSURANCE PLAN 2015 401k membership | ||
| Total participants, beginning-of-year | 2015-12-01 | 103 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-12-01 | 96 |
| Total of all active and inactive participants | 2015-12-01 | 96 |
| Total participants | 2015-12-01 | 96 |
| 2010: FAIRHAVEN CHRISTIAN RETIREMENT CENTER GROUP DENTAL INSURANCE PLAN 2010 401k membership | ||
| Total participants, beginning-of-year | 2010-01-01 | 108 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 94 |
| Total of all active and inactive participants | 2010-01-01 | 94 |
| Total participants | 2010-01-01 | 94 |
| 2015: FAIRHAVEN CHRISTIAN RETIREMENT CENTER GROUP DENTAL INSURANCE PLAN 2015 form 5500 responses | ||
|---|---|---|
| 2015-12-01 | Type of plan entity | Single employer plan |
| 2015-12-01 | Submission has been amended | No |
| 2015-12-01 | This submission is the final filing | No |
| 2015-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-12-01 | Plan is a collectively bargained plan | No |
| 2015-12-01 | Plan funding arrangement – Insurance | Yes |
| 2015-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: FAIRHAVEN CHRISTIAN RETIREMENT CENTER GROUP DENTAL INSURANCE PLAN 2010 form 5500 responses | ||
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | First time form 5500 has been submitted | Yes |
| 2010-01-01 | Submission has been amended | No |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | No |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
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