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FSA - HILO MEDICAL INVESTORS, LTD. DBA LIFE CARE CENTER OF HILO AND HALE ANUENUE RESTORATIVE CARE CENTER 401k Plan overview

Plan NameFSA - HILO MEDICAL INVESTORS, LTD. DBA LIFE CARE CENTER OF HILO AND HALE ANUENUE RESTORATIVE CARE CENTER
Plan identification number 503

FSA - HILO MEDICAL INVESTORS, LTD. DBA LIFE CARE CENTER OF HILO AND HALE ANUENUE RESTORATIVE CARE CENTER Benefits

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

401k Sponsoring company profile

HILO MEDICAL INVESTORS, LTD DBA LIFE CARE CENTER OF HILO AND has sponsored the creation of one or more 401k plans.

Company Name:HILO MEDICAL INVESTORS, LTD DBA LIFE CARE CENTER OF HILO AND
Employer identification number (EIN):581339022
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FSA - HILO MEDICAL INVESTORS, LTD. DBA LIFE CARE CENTER OF HILO AND HALE ANUENUE RESTORATIVE CARE CENTER

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032022-01-01MARK MANN2023-10-13
5032021-01-01LORETA WHITNEY2022-10-12
5032020-01-01JAY BEAUDOIN2021-11-03
5032019-01-01BETH WILLIAMS2020-10-15
5032018-01-01BETH WILLIAMS2019-10-14
5032017-01-01
5032016-01-01
5032009-01-01TERRY HENRY

Plan Statistics for FSA - HILO MEDICAL INVESTORS, LTD. DBA LIFE CARE CENTER OF HILO AND HALE ANUENUE RESTORATIVE CARE CENTER

401k plan membership statisitcs for FSA - HILO MEDICAL INVESTORS, LTD. DBA LIFE CARE CENTER OF HILO AND HALE ANUENUE RESTORATIVE CARE CENTER

Measure Date Value
2022: FSA - HILO MEDICAL INVESTORS, LTD. DBA LIFE CARE CENTER OF HILO AND HALE ANUENUE RESTORATIVE CARE CENTER 2022 401k membership
Total participants, beginning-of-year2022-01-0167
Total number of active participants reported on line 7a of the Form 55002022-01-0159
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-0159
2021: FSA - HILO MEDICAL INVESTORS, LTD. DBA LIFE CARE CENTER OF HILO AND HALE ANUENUE RESTORATIVE CARE CENTER 2021 401k membership
Total participants, beginning-of-year2021-01-0198
Total number of active participants reported on line 7a of the Form 55002021-01-0167
Total of all active and inactive participants2021-01-0167
2020: FSA - HILO MEDICAL INVESTORS, LTD. DBA LIFE CARE CENTER OF HILO AND HALE ANUENUE RESTORATIVE CARE CENTER 2020 401k membership
Total participants, beginning-of-year2020-01-01149
Total number of active participants reported on line 7a of the Form 55002020-01-0198
Total of all active and inactive participants2020-01-0198
2019: FSA - HILO MEDICAL INVESTORS, LTD. DBA LIFE CARE CENTER OF HILO AND HALE ANUENUE RESTORATIVE CARE CENTER 2019 401k membership
Total participants, beginning-of-year2019-01-0199
Total number of active participants reported on line 7a of the Form 55002019-01-01149
Total of all active and inactive participants2019-01-01149
2018: FSA - HILO MEDICAL INVESTORS, LTD. DBA LIFE CARE CENTER OF HILO AND HALE ANUENUE RESTORATIVE CARE CENTER 2018 401k membership
Total participants, beginning-of-year2018-01-01104
Total number of active participants reported on line 7a of the Form 55002018-01-0199
Total of all active and inactive participants2018-01-0199
2017: FSA - HILO MEDICAL INVESTORS, LTD. DBA LIFE CARE CENTER OF HILO AND HALE ANUENUE RESTORATIVE CARE CENTER 2017 401k membership
Total participants, beginning-of-year2017-01-01112
Total number of active participants reported on line 7a of the Form 55002017-01-01104
Total of all active and inactive participants2017-01-01104
2016: FSA - HILO MEDICAL INVESTORS, LTD. DBA LIFE CARE CENTER OF HILO AND HALE ANUENUE RESTORATIVE CARE CENTER 2016 401k membership
Total participants, beginning-of-year2016-01-0199
Total number of active participants reported on line 7a of the Form 55002016-01-01112
Total of all active and inactive participants2016-01-01112
2009: FSA - HILO MEDICAL INVESTORS, LTD. DBA LIFE CARE CENTER OF HILO AND HALE ANUENUE RESTORATIVE CARE CENTER 2009 401k membership
Total participants, beginning-of-year2009-01-01180
Total number of active participants reported on line 7a of the Form 55002009-01-01180
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01180

Form 5500 Responses for FSA - HILO MEDICAL INVESTORS, LTD. DBA LIFE CARE CENTER OF HILO AND HALE ANUENUE RESTORATIVE CARE CENTER

2022: FSA - HILO MEDICAL INVESTORS, LTD. DBA LIFE CARE CENTER OF HILO AND HALE ANUENUE RESTORATIVE CARE CENTER 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: FSA - HILO MEDICAL INVESTORS, LTD. DBA LIFE CARE CENTER OF HILO AND HALE ANUENUE RESTORATIVE CARE CENTER 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: FSA - HILO MEDICAL INVESTORS, LTD. DBA LIFE CARE CENTER OF HILO AND HALE ANUENUE RESTORATIVE CARE CENTER 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: FSA - HILO MEDICAL INVESTORS, LTD. DBA LIFE CARE CENTER OF HILO AND HALE ANUENUE RESTORATIVE CARE CENTER 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: FSA - HILO MEDICAL INVESTORS, LTD. DBA LIFE CARE CENTER OF HILO AND HALE ANUENUE RESTORATIVE CARE CENTER 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: FSA - HILO MEDICAL INVESTORS, LTD. DBA LIFE CARE CENTER OF HILO AND HALE ANUENUE RESTORATIVE CARE CENTER 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: FSA - HILO MEDICAL INVESTORS, LTD. DBA LIFE CARE CENTER OF HILO AND HALE ANUENUE RESTORATIVE CARE CENTER 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: FSA - HILO MEDICAL INVESTORS, LTD. DBA LIFE CARE CENTER OF HILO AND HALE ANUENUE RESTORATIVE CARE CENTER 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

WAGE WORKS (National Association of Insurance Commissioners NAIC id number: 54161 )
Policy contract number2042173
Policy instance 1
Insurance contract or identification number2042173
Number of Individuals Covered59
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedDEPENDENT CARE
Welfare Benefit Premiums Paid to CarrierUSD $674,578
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WAGE WORKS (National Association of Insurance Commissioners NAIC id number: 54161 )
Policy contract number2042173
Policy instance 1
Insurance contract or identification number2042173
Number of Individuals Covered67
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedDEPENDENT CARE
Welfare Benefit Premiums Paid to CarrierUSD $685,290
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WAGE WORKS (National Association of Insurance Commissioners NAIC id number: 54161 )
Policy contract number2042173
Policy instance 3
Insurance contract or identification number2042173
Number of Individuals Covered76
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedDEPENDENT CARE
Welfare Benefit Premiums Paid to CarrierUSD $669,688
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number10166
Policy instance 2
Insurance contract or identification number10166
Number of Individuals Covered52
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $11,011
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $55,653
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,784
Amount paid for insurance broker fees0
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number12764
Policy instance 1
Insurance contract or identification number12764
Number of Individuals Covered36
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $10,669
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $35,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,858
Amount paid for insurance broker fees0
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number12764
Policy instance 1
Insurance contract or identification number12764
Number of Individuals Covered33
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $2,325
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $25,443
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,089
Amount paid for insurance broker fees0
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number10166
Policy instance 2
Insurance contract or identification number10166
Number of Individuals Covered49
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $4,574
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $52,543
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 fees0
Insurance broker organization code?3
WAGE WORKS (National Association of Insurance Commissioners NAIC id number: 54161 )
Policy contract number2042173
Policy instance 3
Insurance contract or identification number2042173
Number of Individuals Covered69
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedDEPENDENT CARE
Welfare Benefit Premiums Paid to CarrierUSD $718,163
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WAGE WORKS (National Association of Insurance Commissioners NAIC id number: 54161 )
Policy contract number2042173
Policy instance 3
Insurance contract or identification number2042173
Number of Individuals Covered76
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedDEPENDENT CARE
Welfare Benefit Premiums Paid to CarrierUSD $687,633
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number10166
Policy instance 2
Insurance contract or identification number10166
Number of Individuals Covered59
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $6,052
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT, CANCER
Welfare Benefit Premiums Paid to CarrierUSD $43,347
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,591
Amount paid for insurance broker fees0
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number12764
Policy instance 1
Insurance contract or identification number12764
Number of Individuals Covered56
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $4,187
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT, CANCER
Welfare Benefit Premiums Paid to CarrierUSD $28,120
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,871
Amount paid for insurance broker fees0
Insurance broker organization code?3
WAGE WORKS (National Association of Insurance Commissioners NAIC id number: 54161 )
Policy contract number2042173
Policy instance 3
Insurance contract or identification number2042173
Number of Individuals Covered84
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedDEPENDENT CARE
Welfare Benefit Premiums Paid to CarrierUSD $743,287
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number10166
Policy instance 2
Insurance contract or identification number10166
Number of Individuals Covered52
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $4,123
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT, CANCER & CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $37,506
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,799
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameCONSUMERS GROUP INS SVCS INC
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number12764
Policy instance 1
Insurance contract or identification number12764
Number of Individuals Covered42
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,112
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT, CANCER & CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $25,753
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,514
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameCONSUMERS GROUP INS SVCS INC AGENT

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