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ERB OPCO SAV, LLC DBA ST. ANDREWS VILLAGE 401k Plan overview

Plan NameERB OPCO SAV, LLC DBA ST. ANDREWS VILLAGE
Plan identification number 501

ERB OPCO SAV, LLC DBA ST. ANDREWS VILLAGE Benefits

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

401k Sponsoring company profile

ERB OPCO SAV, LLC has sponsored the creation of one or more 401k plans.

Company Name:ERB OPCO SAV, LLC
Employer identification number (EIN):453088464
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Additional information about ERB OPCO SAV, LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number: 5029682

More information about ERB OPCO SAV, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ERB OPCO SAV, LLC DBA ST. ANDREWS VILLAGE

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012016-05-01CINDY CLARK
5012015-05-01CINDY CLARK
5012014-05-01
5012013-05-01
5012012-05-01BRIAN E DOWD
5012011-05-01TERRY FRISBY

Plan Statistics for ERB OPCO SAV, LLC DBA ST. ANDREWS VILLAGE

401k plan membership statisitcs for ERB OPCO SAV, LLC DBA ST. ANDREWS VILLAGE

Measure Date Value
2016: ERB OPCO SAV, LLC DBA ST. ANDREWS VILLAGE 2016 401k membership
Total participants, beginning-of-year2016-05-01100
Total number of active participants reported on line 7a of the Form 55002016-05-0191
Number of retired or separated participants receiving benefits2016-05-010
Number of other retired or separated participants entitled to future benefits2016-05-010
Total of all active and inactive participants2016-05-0191
2015: ERB OPCO SAV, LLC DBA ST. ANDREWS VILLAGE 2015 401k membership
Total participants, beginning-of-year2015-05-01113
Total number of active participants reported on line 7a of the Form 55002015-05-01100
Number of retired or separated participants receiving benefits2015-05-010
Number of other retired or separated participants entitled to future benefits2015-05-010
Total of all active and inactive participants2015-05-01100
2014: ERB OPCO SAV, LLC DBA ST. ANDREWS VILLAGE 2014 401k membership
Total participants, beginning-of-year2014-05-01106
Total number of active participants reported on line 7a of the Form 55002014-05-01113
Total of all active and inactive participants2014-05-01113
2013: ERB OPCO SAV, LLC DBA ST. ANDREWS VILLAGE 2013 401k membership
Total participants, beginning-of-year2013-05-0192
Total number of active participants reported on line 7a of the Form 55002013-05-01106
Total of all active and inactive participants2013-05-01106
2012: ERB OPCO SAV, LLC DBA ST. ANDREWS VILLAGE 2012 401k membership
Total participants, beginning-of-year2012-05-0173
Total number of active participants reported on line 7a of the Form 55002012-05-0192
Total of all active and inactive participants2012-05-0192
2011: ERB OPCO SAV, LLC DBA ST. ANDREWS VILLAGE 2011 401k membership
Total participants, beginning-of-year2011-05-0178
Total number of active participants reported on line 7a of the Form 55002011-05-0175
Number of retired or separated participants receiving benefits2011-05-010
Number of other retired or separated participants entitled to future benefits2011-05-010
Total of all active and inactive participants2011-05-0175

Form 5500 Responses for ERB OPCO SAV, LLC DBA ST. ANDREWS VILLAGE

2016: ERB OPCO SAV, LLC DBA ST. ANDREWS VILLAGE 2016 form 5500 responses
2016-05-01Type of plan entitySingle employer plan
2016-05-01Plan funding arrangement – InsuranceYes
2016-05-01Plan benefit arrangement – InsuranceYes
2015: ERB OPCO SAV, LLC DBA ST. ANDREWS VILLAGE 2015 form 5500 responses
2015-05-01Type of plan entitySingle employer plan
2015-05-01Plan funding arrangement – InsuranceYes
2015-05-01Plan benefit arrangement – InsuranceYes
2014: ERB OPCO SAV, LLC DBA ST. ANDREWS VILLAGE 2014 form 5500 responses
2014-05-01Type of plan entitySingle employer plan
2014-05-01Plan funding arrangement – InsuranceYes
2014-05-01Plan benefit arrangement – InsuranceYes
2013: ERB OPCO SAV, LLC DBA ST. ANDREWS VILLAGE 2013 form 5500 responses
2013-05-01Type of plan entitySingle employer plan
2013-05-01Plan funding arrangement – InsuranceYes
2013-05-01Plan benefit arrangement – InsuranceYes
2012: ERB OPCO SAV, LLC DBA ST. ANDREWS VILLAGE 2012 form 5500 responses
2012-05-01Type of plan entitySingle employer plan
2012-05-01Plan funding arrangement – InsuranceYes
2012-05-01Plan benefit arrangement – InsuranceYes
2011: ERB OPCO SAV, LLC DBA ST. ANDREWS VILLAGE 2011 form 5500 responses
2011-05-01Type of plan entitySingle employer plan
2011-05-01Submission has been amendedNo
2011-05-01This submission is the final filingNo
2011-05-01This return/report is a short plan year return/report (less than 12 months)No
2011-05-01Plan is a collectively bargained planNo
2011-05-01Plan funding arrangement – InsuranceYes
2011-05-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number35555
Policy instance 1
Insurance contract or identification number35555
Number of Individuals Covered100
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $26,272
Welfare Benefit Premiums Paid to CarrierUSD $518,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,272
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Insurance broker nameBROWN & BROWN OF FLORIDA INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number632091
Policy instance 2
Insurance contract or identification number632091
Number of Individuals Covered17
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $3,524
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $76,845
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,524
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Insurance broker nameBROWN & BROWN OF FLORIDA, INC.
KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number35555
Policy instance 1
Insurance contract or identification number35555
Number of Individuals Covered113
Insurance policy start date2014-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $27,095
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $545,460
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,095
Insurance broker organization code?3
Insurance broker nameBROWN & BROWN OF FLORIDA
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number632091
Policy instance 2
Insurance contract or identification number632091
Number of Individuals Covered18
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $1,820
Total amount of fees paid to insurance companyUSD $1,068
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $71,672
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,820
Amount paid for insurance broker fees1068
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameBROWN & BROWN OF FLORIDA
KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 )
Policy contract number35555
Policy instance 1
Insurance contract or identification number35555
Number of Individuals Covered91
Insurance policy start date2013-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $22,137
Total amount of fees paid to insurance companyUSD $12,920
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $474,776
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,137
Amount paid for insurance broker fees12920
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameBROWN & BROWN OF FLORIDA
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number632091
Policy instance 2
Insurance contract or identification number632091
Number of Individuals Covered15
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $1,792
Total amount of fees paid to insurance companyUSD $322
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $59,715
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,792
Amount paid for insurance broker fees322
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameBROWN & BROWN OF FLORIDA
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number195851
Policy instance 2
Insurance contract or identification number195851
Number of Individuals Covered0
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $33
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
Insurance broker nameSUNCOAST & ASSOCIATES
ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 )
Policy contract number195851
Policy instance 1
Insurance contract or identification number195851
Number of Individuals Covered92
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $15,176
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $558,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,176
Insurance broker organization code?3
Insurance broker nameSUNCOAST & ASSOCIATES
ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 )
Policy contract number195851
Policy instance 1
Insurance contract or identification number195851
Number of Individuals Covered75
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Total amount of commissions paid to insurance brokerUSD $23,127
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $487,410
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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