401k Plan data: MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT plan

MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT 401k Plan overview

Plan Name	MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT
Plan identification number	501

MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision

401k Sponsoring company profile

MEDILODGE GROUP, INC. has sponsored the creation of one or more 401k plans.

Company Name: MEDILODGE GROUP, INC.

Employer identification number (EIN): 382791039

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-01-01 BILL GRAY
501 2014-01-01 BILL GRAY
501 2014-01-01 BILL GRAY
501 2013-01-01 FRANK WRONSKI FRANK WRONSKI 2014-07-18
501 2012-01-01 FRANK WRONSKI FRANK WRONSKI 2013-07-01
501 2011-01-01 FRANK WRONSKI FRANK WRONSKI 2012-10-15
501 2010-01-01 FRANK WRONSKI FRANK WRONSKI 2011-10-17
501 2009-01-01
501 2009-01-01 FRANK WRONSKI FRANK WRONSKI 2010-12-01
501 2009-01-01 FRANK WRONSKI FRANK WRONSKI 2010-10-14
501 2009-01-01 SUZANNE LEWANDOWSKI

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2015-01-01	BILL GRAY
501	2014-01-01	BILL GRAY
501	2014-01-01	BILL GRAY
501	2013-01-01	FRANK WRONSKI	FRANK WRONSKI	2014-07-18
501	2012-01-01	FRANK WRONSKI	FRANK WRONSKI	2013-07-01
501	2011-01-01	FRANK WRONSKI	FRANK WRONSKI	2012-10-15
501	2010-01-01	FRANK WRONSKI	FRANK WRONSKI	2011-10-17
501	2009-01-01
501	2009-01-01	FRANK WRONSKI	FRANK WRONSKI	2010-12-01
501	2009-01-01	FRANK WRONSKI	FRANK WRONSKI	2010-10-14
501	2009-01-01	SUZANNE LEWANDOWSKI

Plan Statistics for MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT

401k plan membership statisitcs for MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT

Measure Date Value
2015: MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT 2015 401k membership
Total participants, beginning-of-year 2015-01-01 179
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 185
Total of all active and inactive participants 2015-01-01 185
2014: MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT 2014 401k membership
Total participants, beginning-of-year 2014-01-01 216
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 168
Total of all active and inactive participants 2014-01-01 168
2013: MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT 2013 401k membership
Total participants, beginning-of-year 2013-01-01 418
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 397
Total of all active and inactive participants 2013-01-01 397
2012: MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT 2012 401k membership
Total participants, beginning-of-year 2012-01-01 433
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 390
Total of all active and inactive participants 2012-01-01 390
2011: MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,346
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1,374
Total of all active and inactive participants 2011-01-01 1,374
2010: MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT 2010 401k membership
Total participants, beginning-of-year 2010-01-01 1,372
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 1,346
Total of all active and inactive participants 2010-01-01 1,346
2009: MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT 2009 401k membership
Total participants, beginning-of-year 2009-01-01 279
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 250
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 250
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0

Measure	Date	Value
2015: MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT 2015 401k membership
Total participants, beginning-of-year	2015-01-01	179
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	185
Total of all active and inactive participants	2015-01-01	185
2014: MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT 2014 401k membership
Total participants, beginning-of-year	2014-01-01	216
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	168
Total of all active and inactive participants	2014-01-01	168
2013: MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT 2013 401k membership
Total participants, beginning-of-year	2013-01-01	418
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	397
Total of all active and inactive participants	2013-01-01	397
2012: MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT 2012 401k membership
Total participants, beginning-of-year	2012-01-01	433
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	390
Total of all active and inactive participants	2012-01-01	390
2011: MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,346
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1,374
Total of all active and inactive participants	2011-01-01	1,374
2010: MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT 2010 401k membership
Total participants, beginning-of-year	2010-01-01	1,372
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	1,346
Total of all active and inactive participants	2010-01-01	1,346
2009: MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT 2009 401k membership
Total participants, beginning-of-year	2009-01-01	279
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	250
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	250
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0

Form 5500 Responses for MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT

2015: MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT 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)	Yes
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT 2011 form 5500 responses
2011-01-01	Type of plan entity	Multi-employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Section 412(e)(3) insurance Contracts	Yes
2010: MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT 2010 form 5500 responses
2010-01-01	Type of plan entity	Multi-employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Section 412(e)(3) insurance Contracts	Yes
2009: MEDILODGE GROUP, INC. FLEXIBLE SPENDING ACCOUNT 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
Policy contract number	778672 S001
Policy instance	10
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
Policy contract number	778672S002
Policy instance	9
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )
Policy contract number	E3441458
Policy instance	8
TOTAL HEALTH CARE USA INC (National Association of Insurance Commissioners NAIC id number: 12326 )
Policy contract number	M60050COBR
Policy instance	7
TOTAL HEALTH CARE USA INC (National Association of Insurance Commissioners NAIC id number: 12326 )
Policy contract number	M60050
Policy instance	6
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	TM05731803
Policy instance	5
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	40000200000520
Policy instance	4
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	40000300100077
Policy instance	3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	40000100003591
Policy instance	2
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number	46851
Policy instance	1
TOTAL HEALTH CARE USA, INC. (National Association of Insurance Commissioners NAIC id number: )
Policy contract number	M60050
Policy instance	6
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	TM05731803
Policy instance	5
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	40000200000520
Policy instance	4
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	400000300100077
Policy instance	3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	400000100003591
Policy instance	2
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number	46851
Policy instance	1

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Company Name:	MEDILODGE GROUP, INC.
Employer identification number (EIN):	382791039
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities