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CIVITAS SENIOR HEALTHCARE 401(K) PLAN 401k Plan overview

Plan NameCIVITAS SENIOR HEALTHCARE 401(K) PLAN
Plan identification number 001

CIVITAS SENIOR HEALTHCARE 401(K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

CIVITAS SENIOR HEALTHCARE, LLC has sponsored the creation of one or more 401k plans.

Company Name:CIVITAS SENIOR HEALTHCARE, LLC
Employer identification number (EIN):455284618
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Additional information about CIVITAS SENIOR HEALTHCARE, LLC

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2012-05-14
Company Identification Number: 0801595930
Legal Registered Office Address: 930 W 1ST ST STE 303

FORT WORTH
United States of America (USA)
76102

More information about CIVITAS SENIOR HEALTHCARE, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CIVITAS SENIOR HEALTHCARE 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01
0012021-01-01
0012020-01-01
0012019-01-01
0012018-01-01JASON DUPONT2020-02-20
0012017-01-01
0012016-01-01JASON DUPONT2017-07-07
0012015-01-01JASON DUPONT2016-05-26
0012014-01-01JASON DUPONT2015-10-07
0012013-01-01JASON DUPONT2014-10-03

Plan Statistics for CIVITAS SENIOR HEALTHCARE 401(K) PLAN

401k plan membership statisitcs for CIVITAS SENIOR HEALTHCARE 401(K) PLAN

Measure Date Value
2022: CIVITAS SENIOR HEALTHCARE 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-011,867
Total number of active participants reported on line 7a of the Form 55002022-01-01636
Number of retired or separated participants receiving benefits2022-01-016
Number of other retired or separated participants entitled to future benefits2022-01-011,171
Total of all active and inactive participants2022-01-011,813
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-011,813
Number of participants with account balances2022-01-011,599
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: CIVITAS SENIOR HEALTHCARE 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-011,724
Total number of active participants reported on line 7a of the Form 55002021-01-01696
Number of retired or separated participants receiving benefits2021-01-0122
Number of other retired or separated participants entitled to future benefits2021-01-011,012
Total of all active and inactive participants2021-01-011,730
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-011,730
Number of participants with account balances2021-01-011,502
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: CIVITAS SENIOR HEALTHCARE 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-011,338
Total number of active participants reported on line 7a of the Form 55002020-01-01961
Number of other retired or separated participants entitled to future benefits2020-01-01666
Total of all active and inactive participants2020-01-011,627
Total participants2020-01-011,627
Number of participants with account balances2020-01-011,290
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: CIVITAS SENIOR HEALTHCARE 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01774
Total number of active participants reported on line 7a of the Form 55002019-01-011,091
Number of other retired or separated participants entitled to future benefits2019-01-01247
Total of all active and inactive participants2019-01-011,338
Total participants2019-01-011,338
Number of participants with account balances2019-01-01971
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: CIVITAS SENIOR HEALTHCARE 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01735
Total number of active participants reported on line 7a of the Form 55002018-01-01769
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-015
Total of all active and inactive participants2018-01-01774
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01774
Number of participants with account balances2018-01-0142
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010

Financial Data on CIVITAS SENIOR HEALTHCARE 401(K) PLAN

Measure Date Value
2022 : CIVITAS SENIOR HEALTHCARE 401(K) PLAN 2022 401k financial data
Total income from all sources (including contributions)2022-12-31$586,239
Total of all expenses incurred2022-12-31$367,833
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$254,810
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$977,382
Value of total assets at end of year2022-12-31$2,330,718
Value of total assets at beginning of year2022-12-31$2,112,312
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$113,023
Total interest from all sources2022-12-31$471
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$211,231
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$834,732
Participant contributions at end of year2022-12-31$36,662
Participant contributions at beginning of year2022-12-31$2,102
Participant contributions at end of year2022-12-31$0
Participant contributions at beginning of year2022-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$142,650
Total non interest bearing cash at beginning of year2022-12-31$529
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$218,406
Value of net assets at end of year (total assets less liabilities)2022-12-31$2,330,718
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$2,112,312
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Investment advisory and management fees2022-12-31$113,023
Value of interest in pooled separate accounts at end of year2022-12-31$2,268,750
Value of interest in pooled separate accounts at beginning of year2022-12-31$2,101,561
Interest on participant loans2022-12-31$471
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$25,306
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$8,120
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-391,614
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31Yes
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$254,810
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31KREISCHER MILLER
Accountancy firm EIN2022-12-31231980475
2021 : CIVITAS SENIOR HEALTHCARE 401(K) PLAN 2021 401k financial data
Total transfer of assets to this plan2021-12-31$46,988
Total income from all sources (including contributions)2021-12-31$1,029,827
Total of all expenses incurred2021-12-31$350,015
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$266,599
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$762,268
Value of total assets at end of year2021-12-31$2,112,312
Value of total assets at beginning of year2021-12-31$1,385,512
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$83,416
Total interest from all sources2021-12-31$114
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$138,551
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$748,956
Participant contributions at end of year2021-12-31$2,102
Participant contributions at beginning of year2021-12-31$2,398
Participant contributions at end of year2021-12-31$0
Participant contributions at beginning of year2021-12-31$3,543
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$13,312
Total non interest bearing cash at end of year2021-12-31$529
Total non interest bearing cash at beginning of year2021-12-31$501
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$679,812
Value of net assets at end of year (total assets less liabilities)2021-12-31$2,112,312
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$1,385,512
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest in pooled separate accounts at end of year2021-12-31$2,101,561
Value of interest in pooled separate accounts at beginning of year2021-12-31$1,370,640
Interest on participant loans2021-12-31$91
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-12-31$23
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$8,120
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$8,430
Net investment gain/loss from pooled separate accounts2021-12-31$267,445
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31Yes
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$266,599
Contract administrator fees2021-12-31$83,416
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31KREISCHER MILLER
Accountancy firm EIN2021-12-31231980475
2020 : CIVITAS SENIOR HEALTHCARE 401(K) PLAN 2020 401k financial data
Total transfer of assets to this plan2020-12-31$9,455
Total income from all sources (including contributions)2020-12-31$932,937
Total of all expenses incurred2020-12-31$170,194
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$113,032
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$741,183
Value of total assets at end of year2020-12-31$1,385,512
Value of total assets at beginning of year2020-12-31$613,314
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$57,162
Total interest from all sources2020-12-31$193
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$61,331
If this is an individual account plan, was there a blackout period2020-12-31No
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$741,183
Participant contributions at end of year2020-12-31$2,398
Participant contributions at beginning of year2020-12-31$1,492
Participant contributions at end of year2020-12-31$3,543
Total non interest bearing cash at end of year2020-12-31$501
Total non interest bearing cash at beginning of year2020-12-31$452
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$762,743
Value of net assets at end of year (total assets less liabilities)2020-12-31$1,385,512
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$613,314
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest in pooled separate accounts at end of year2020-12-31$1,370,640
Value of interest in pooled separate accounts at beginning of year2020-12-31$606,869
Interest on participant loans2020-12-31$49
Interest earned on other investments2020-12-31$137
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-12-31$7
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$8,430
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$4,501
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$110
Net investment gain/loss from pooled separate accounts2020-12-31$191,451
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31Yes
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$113,032
Contract administrator fees2020-12-31$57,162
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31KREISCHER MILLER
Accountancy firm EIN2020-12-31231980475
2019 : CIVITAS SENIOR HEALTHCARE 401(K) PLAN 2019 401k financial data
Total transfer of assets to this plan2019-12-31$2,179
Total transfer of assets to this plan2019-12-31$2,179
Total transfer of assets from this plan2019-12-31$224,455
Total transfer of assets from this plan2019-12-31$224,455
Total income from all sources (including contributions)2019-12-31$534,607
Total income from all sources (including contributions)2019-12-31$534,607
Total of all expenses incurred2019-12-31$46,058
Total of all expenses incurred2019-12-31$46,058
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$22,410
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$22,410
Value of total corrective distributions2019-12-31$2,309
Value of total corrective distributions2019-12-31$2,309
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$455,732
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$455,732
Value of total assets at end of year2019-12-31$613,314
Value of total assets at end of year2019-12-31$613,314
Value of total assets at beginning of year2019-12-31$347,041
Value of total assets at beginning of year2019-12-31$347,041
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$21,339
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$21,339
Total interest from all sources2019-12-31$568
Total interest from all sources2019-12-31$568
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Administrative expenses professional fees incurred2019-12-31$660
Administrative expenses professional fees incurred2019-12-31$660
Was this plan covered by a fidelity bond2019-12-31Yes
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$34,704
Value of fidelity bond cover2019-12-31$34,704
If this is an individual account plan, was there a blackout period2019-12-31Yes
If this is an individual account plan, was there a blackout period2019-12-31Yes
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$448,777
Contributions received from participants2019-12-31$448,777
Participant contributions at end of year2019-12-31$1,492
Participant contributions at end of year2019-12-31$1,492
Participant contributions at beginning of year2019-12-31$24,275
Participant contributions at beginning of year2019-12-31$24,275
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$6,955
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$6,955
Total non interest bearing cash at end of year2019-12-31$452
Total non interest bearing cash at end of year2019-12-31$452
Total non interest bearing cash at beginning of year2019-12-31$981
Total non interest bearing cash at beginning of year2019-12-31$981
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$488,549
Value of net income/loss2019-12-31$488,549
Value of net assets at end of year (total assets less liabilities)2019-12-31$613,314
Value of net assets at end of year (total assets less liabilities)2019-12-31$613,314
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$347,041
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$347,041
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in pooled separate accounts at end of year2019-12-31$606,869
Value of interest in pooled separate accounts at end of year2019-12-31$606,869
Value of interest in pooled separate accounts at beginning of year2019-12-31$321,785
Value of interest in pooled separate accounts at beginning of year2019-12-31$321,785
Interest on participant loans2019-12-31$546
Interest on participant loans2019-12-31$546
Interest earned on other investments2019-12-31$19
Interest earned on other investments2019-12-31$19
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-12-31$3
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-12-31$3
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$4,501
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$4,501
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$33
Net investment gain/loss from pooled separate accounts2019-12-31$78,274
Net investment gain/loss from pooled separate accounts2019-12-31$78,274
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$22,410
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$22,410
Contract administrator fees2019-12-31$20,679
Contract administrator fees2019-12-31$20,679
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-12-31Yes
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-12-31Yes
Did the plan have assets held for investment2019-12-31Yes
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31KREISCHER MILLER
Accountancy firm name2019-12-31KREISCHER MILLER
Accountancy firm EIN2019-12-31231980475
Accountancy firm EIN2019-12-31231980475
2018 : CIVITAS SENIOR HEALTHCARE 401(K) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total income from all sources (including contributions)2018-12-31$176,633
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$25,775
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$17,360
Value of total corrective distributions2018-12-31$6,305
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$201,336
Value of total assets at end of year2018-12-31$347,041
Value of total assets at beginning of year2018-12-31$196,183
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$2,110
Total interest from all sources2018-12-31$1,211
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Administrative expenses professional fees incurred2018-12-31$1,899
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$50,000
If this is an individual account plan, was there a blackout period2018-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$138,272
Participant contributions at end of year2018-12-31$24,275
Participant contributions at beginning of year2018-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$63,064
Other income not declared elsewhere2018-12-31$981
Total non interest bearing cash at end of year2018-12-31$981
Total non interest bearing cash at beginning of year2018-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Income. Non cash contributions2018-12-31$0
Value of net income/loss2018-12-31$150,858
Value of net assets at end of year (total assets less liabilities)2018-12-31$347,041
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$196,183
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$321,785
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$196,183
Interest on participant loans2018-12-31$1,211
Net investment gain/loss from pooled separate accounts2018-12-31$-26,895
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31Yes
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$17,360
Contract administrator fees2018-12-31$211
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31CLIFTONLARSONALLEN LLP
Accountancy firm EIN2018-12-31410746749

Form 5500 Responses for CIVITAS SENIOR HEALTHCARE 401(K) PLAN

2022: CIVITAS SENIOR HEALTHCARE 401(K) PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement - TrustYes
2021: CIVITAS SENIOR HEALTHCARE 401(K) PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement - TrustYes
2020: CIVITAS SENIOR HEALTHCARE 401(K) PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement - TrustYes
2019: CIVITAS SENIOR HEALTHCARE 401(K) PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement - TrustYes
2018: CIVITAS SENIOR HEALTHCARE 401(K) PLAN 2018 form 5500 responses
2018-01-01Type of plan entityMulitple employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract number932475-056
Policy instance 1
Insurance contract or identification number932475-056
Total amount of fees paid to insurance companyUSD $2,115
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2115
Insurance broker organization code?5
TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract number932475-056
Policy instance 1
Insurance contract or identification number932475-056
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,795
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees1795
Insurance broker organization code?5
TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract number932475-056
Policy instance 1
Insurance contract or identification number932475-056
Total amount of fees paid to insurance companyUSD $937
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees489
Insurance broker organization code?5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number110727
Policy instance 1
Insurance contract or identification number110727
Total amount of commissions paid to insurance brokerUSD $942
Total amount of fees paid to insurance companyUSD $942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $942
Amount paid for insurance broker fees34
Insurance broker organization code?4
TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract number932475-056
Policy instance 2
Insurance contract or identification number932475-056
Total amount of fees paid to insurance companyUSD $230
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees230
Insurance broker organization code?5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number110727
Policy instance 1
Insurance contract or identification number110727
Number of Individuals Covered44
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,306
Total amount of fees paid to insurance companyUSD $2,002
Are there contracts with allocated funds for individual policies?0
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 BenefitNo
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees1899
Additional information about fees paid to insurance brokerTPA FEES
Insurance broker organization code?5

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