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GREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN 401k Plan overview

Plan NameGREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN
Plan identification number 502

GREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN Benefits

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

401k Sponsoring company profile

GREENVILLE RETIREMENT COMMUNITY, has sponsored the creation of one or more 401k plans.

Company Name:GREENVILLE RETIREMENT COMMUNITY,
Employer identification number (EIN):510267730
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022021-01-01
5022020-01-01
5022019-01-01
5022018-01-01
5022017-01-01MICHELLE JATKO
5022016-12-01MICHELLE JATKO
5022015-12-01MICHELLE JATKO

Plan Statistics for GREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN

401k plan membership statisitcs for GREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN

Measure Date Value
2021: GREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0165
Total number of active participants reported on line 7a of the Form 55002021-01-0159
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-0159
2020: GREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0167
Total number of active participants reported on line 7a of the Form 55002020-01-0165
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-0165
2019: GREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0167
Total number of active participants reported on line 7a of the Form 55002019-01-0167
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-0167
2018: GREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0173
Total number of active participants reported on line 7a of the Form 55002018-01-0167
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-0167
2017: GREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0177
Total number of active participants reported on line 7a of the Form 55002017-01-0173
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-0173
2016: GREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-12-0177
Total number of active participants reported on line 7a of the Form 55002016-12-0177
Number of retired or separated participants receiving benefits2016-12-010
Number of other retired or separated participants entitled to future benefits2016-12-010
Total of all active and inactive participants2016-12-0177
2015: GREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year2015-12-0181
Total number of active participants reported on line 7a of the Form 55002015-12-0177
Number of retired or separated participants receiving benefits2015-12-010
Number of other retired or separated participants entitled to future benefits2015-12-010
Total of all active and inactive participants2015-12-0177

Financial Data on GREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN

Measure Date Value
2021 : GREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN 2021 401k financial data
Total plan liabilities at end of year2021-12-31$63,124
Total plan liabilities at beginning of year2021-12-31$40,433
Total income from all sources2021-12-31$795,352
Expenses. Total of all expenses incurred2021-12-31$809,911
Benefits paid (including direct rollovers)2021-12-31$421,832
Total plan assets at end of year2021-12-31$614,654
Total plan assets at beginning of year2021-12-31$606,522
Value of fidelity bond covering the plan2021-12-31$500,000
Total contributions received or receivable from participants2021-12-31$99,729
Expenses. Other expenses not covered elsewhere2021-12-31$309,473
Other income received2021-12-31$1,652
Net income (gross income less expenses)2021-12-31$-14,559
Net plan assets at end of year (total assets less liabilities)2021-12-31$551,530
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$566,089
Total contributions received or receivable from employer(s)2021-12-31$693,971
Value of corrective distributions2021-12-31$40,000
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$38,606
2020 : GREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN 2020 401k financial data
Total plan liabilities at end of year2020-12-31$40,433
Total plan liabilities at beginning of year2020-12-31$57,116
Total income from all sources2020-12-31$742,412
Expenses. Total of all expenses incurred2020-12-31$582,760
Benefits paid (including direct rollovers)2020-12-31$236,476
Total plan assets at end of year2020-12-31$606,522
Total plan assets at beginning of year2020-12-31$463,553
Value of fidelity bond covering the plan2020-12-31$500,000
Total contributions received or receivable from participants2020-12-31$108,866
Expenses. Other expenses not covered elsewhere2020-12-31$297,941
Contributions received from other sources (not participants or employers)2020-12-31$0
Other income received2020-12-31$1,337
Net income (gross income less expenses)2020-12-31$159,652
Net plan assets at end of year (total assets less liabilities)2020-12-31$566,089
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$406,437
Total contributions received or receivable from employer(s)2020-12-31$632,209
Value of corrective distributions2020-12-31$7,000
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$41,343
2019 : GREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN 2019 401k financial data
Total plan liabilities at end of year2019-12-31$57,116
Total plan liabilities at beginning of year2019-12-31$42,445
Total income from all sources2019-12-31$883,887
Expenses. Total of all expenses incurred2019-12-31$658,495
Benefits paid (including direct rollovers)2019-12-31$338,156
Total plan assets at end of year2019-12-31$463,553
Total plan assets at beginning of year2019-12-31$223,490
Value of fidelity bond covering the plan2019-12-31$500,000
Total contributions received or receivable from participants2019-12-31$129,955
Expenses. Other expenses not covered elsewhere2019-12-31$276,915
Other income received2019-12-31$668
Net income (gross income less expenses)2019-12-31$225,392
Net plan assets at end of year (total assets less liabilities)2019-12-31$406,437
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$181,045
Total contributions received or receivable from employer(s)2019-12-31$753,264
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$43,424
2018 : GREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN 2018 401k financial data
Total plan liabilities at end of year2018-12-31$42,445
Total plan liabilities at beginning of year2018-12-31$43,390
Total income from all sources2018-12-31$793,559
Expenses. Total of all expenses incurred2018-12-31$665,193
Benefits paid (including direct rollovers)2018-12-31$349,815
Total plan assets at end of year2018-12-31$223,490
Total plan assets at beginning of year2018-12-31$96,069
Value of fidelity bond covering the plan2018-12-31$500,000
Total contributions received or receivable from participants2018-12-31$151,238
Expenses. Other expenses not covered elsewhere2018-12-31$270,511
Contributions received from other sources (not participants or employers)2018-12-31$0
Other income received2018-12-31$447
Net income (gross income less expenses)2018-12-31$128,366
Net plan assets at end of year (total assets less liabilities)2018-12-31$181,045
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$52,679
Total contributions received or receivable from employer(s)2018-12-31$641,874
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$44,867
2017 : GREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN 2017 401k financial data
Total plan liabilities at end of year2017-12-31$43,390
Total plan liabilities at beginning of year2017-12-31$103,508
Total income from all sources2017-12-31$754,322
Expenses. Total of all expenses incurred2017-12-31$611,756
Benefits paid (including direct rollovers)2017-12-31$324,876
Total plan assets at end of year2017-12-31$96,069
Total plan assets at beginning of year2017-12-31$13,621
Value of fidelity bond covering the plan2017-12-31$500,000
Total contributions received or receivable from participants2017-12-31$140,490
Expenses. Other expenses not covered elsewhere2017-12-31$233,946
Other income received2017-12-31$221
Net income (gross income less expenses)2017-12-31$142,566
Net plan assets at end of year (total assets less liabilities)2017-12-31$52,679
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$-89,887
Total contributions received or receivable from employer(s)2017-12-31$613,611
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$52,934
2016 : GREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN 2016 401k financial data
Total plan liabilities at end of year2016-12-31$103,508
Total plan liabilities at beginning of year2016-12-31$44,241
Total income from all sources2016-12-31$2
Expenses. Total of all expenses incurred2016-12-31$115,024
Benefits paid (including direct rollovers)2016-12-31$115,024
Total plan assets at end of year2016-12-31$13,621
Total plan assets at beginning of year2016-12-31$69,376
Value of fidelity bond covering the plan2016-12-31$500,000
Total contributions received or receivable from participants2016-12-31$0
Expenses. Other expenses not covered elsewhere2016-12-31$0
Contributions received from other sources (not participants or employers)2016-12-31$0
Other income received2016-12-31$2
Net income (gross income less expenses)2016-12-31$-115,022
Net plan assets at end of year (total assets less liabilities)2016-12-31$-89,887
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$25,135
Total contributions received or receivable from employer(s)2016-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$0
Total plan liabilities at end of year2016-11-30$44,241
Total plan liabilities at beginning of year2016-11-30$0
Total income from all sources2016-11-30$825,699
Expenses. Total of all expenses incurred2016-11-30$800,564
Benefits paid (including direct rollovers)2016-11-30$478,788
Total plan assets at end of year2016-11-30$69,376
Total plan assets at beginning of year2016-11-30$0
Value of fidelity bond covering the plan2016-11-30$500,000
Total contributions received or receivable from participants2016-11-30$65,379
Expenses. Other expenses not covered elsewhere2016-11-30$265,937
Contributions received from other sources (not participants or employers)2016-11-30$2,915
Other income received2016-11-30$65
Net income (gross income less expenses)2016-11-30$25,135
Net plan assets at end of year (total assets less liabilities)2016-11-30$25,135
Net plan assets at beginning of year (total assets less liabilities)2016-11-30$0
Total contributions received or receivable from employer(s)2016-11-30$757,340
Expenses. Administrative service providers (salaries,fees and commissions)2016-11-30$55,839

Form 5500 Responses for GREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN

2021: GREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: GREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: GREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: GREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle 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 – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: GREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: GREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN 2016 form 5500 responses
2016-12-01Type of plan entitySingle employer plan
2016-12-01Submission has been amendedNo
2016-12-01This submission is the final filingNo
2016-12-01This return/report is a short plan year return/report (less than 12 months)Yes
2016-12-01Plan is a collectively bargained planNo
2016-12-01Plan funding arrangement – InsuranceYes
2016-12-01Plan funding arrangement – TrustYes
2016-12-01Plan benefit arrangement – InsuranceYes
2016-12-01Plan benefit arrangement - TrustYes
2015: GREENVILLE RETIREMENT COMMUNITY LLC GROUP MEDICAL PLAN 2015 form 5500 responses
2015-12-01Type of plan entitySingle employer plan
2015-12-01First time form 5500 has been submittedYes
2015-12-01Submission has been amendedNo
2015-12-01This submission is the final filingNo
2015-12-01This return/report is a short plan year return/report (less than 12 months)No
2015-12-01Plan is a collectively bargained planNo
2015-12-01Plan funding arrangement – InsuranceYes
2015-12-01Plan funding arrangement – TrustYes
2015-12-01Plan benefit arrangement – InsuranceYes
2015-12-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number407414
Policy instance 1
Insurance contract or identification number407414
Number of Individuals Covered59
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
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
Welfare Benefit Premiums Paid to CarrierUSD $270,210
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number407414
Policy instance 1
Insurance contract or identification number407414
Number of Individuals Covered65
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
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
Welfare Benefit Premiums Paid to CarrierUSD $259,294
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberVERIS
Policy instance 1
Insurance contract or identification numberVERIS
Number of Individuals Covered73
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
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
Welfare Benefit Premiums Paid to CarrierUSD $237,955
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberVERIS
Policy instance 1
Insurance contract or identification numberVERIS
Number of Individuals Covered73
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
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
Welfare Benefit Premiums Paid to CarrierUSD $193,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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