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| Plan Name | BLUEGRASS HEALTH PARTNERS LIFE INSURANCE PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | VALLEY STREAM OPERATOR 1 LLC DBA BLUEGRASS HEALTH PARTNERS |
| Employer identification number (EIN): | 811010658 |
| NAIC Classification: | 623000 |
| NAIC Description: | Nursing and Residential Care Facilities |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2018-02-01 | VALERIE PATE | |||
| 502 | 2017-02-01 | VALERIE PATE | |||
| 502 | 2016-08-01 | JOHN DAILEY |
| Measure | Date | Value |
|---|---|---|
| 2018: BLUEGRASS HEALTH PARTNERS LIFE INSURANCE PLAN 2018 401k membership | ||
| Total participants, beginning-of-year | 2018-02-01 | 1,169 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-02-01 | 1,169 |
| Number of retired or separated participants receiving benefits | 2018-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-02-01 | 0 |
| Total of all active and inactive participants | 2018-02-01 | 1,169 |
| 2017: BLUEGRASS HEALTH PARTNERS LIFE INSURANCE PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-02-01 | 1,096 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-02-01 | 966 |
| Number of retired or separated participants receiving benefits | 2017-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-02-01 | 0 |
| Total of all active and inactive participants | 2017-02-01 | 966 |
| 2016: BLUEGRASS HEALTH PARTNERS LIFE INSURANCE PLAN 2016 401k membership | ||
| Total participants, beginning-of-year | 2016-08-01 | 1,004 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-08-01 | 1,028 |
| Number of retired or separated participants receiving benefits | 2016-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-08-01 | 0 |
| Total of all active and inactive participants | 2016-08-01 | 1,028 |
| 2018: BLUEGRASS HEALTH PARTNERS LIFE INSURANCE PLAN 2018 form 5500 responses | ||
|---|---|---|
| 2018-02-01 | Type of plan entity | Single employer plan |
| 2018-02-01 | Submission has been amended | No |
| 2018-02-01 | This submission is the final filing | No |
| 2018-02-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2018-02-01 | Plan is a collectively bargained plan | No |
| 2018-02-01 | Plan funding arrangement – Insurance | Yes |
| 2018-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: BLUEGRASS HEALTH PARTNERS LIFE INSURANCE PLAN 2017 form 5500 responses | ||
| 2017-02-01 | Type of plan entity | Single employer plan |
| 2017-02-01 | Submission has been amended | No |
| 2017-02-01 | This submission is the final filing | No |
| 2017-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-02-01 | Plan is a collectively bargained plan | No |
| 2017-02-01 | Plan funding arrangement – Insurance | Yes |
| 2017-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: BLUEGRASS HEALTH PARTNERS LIFE INSURANCE PLAN 2016 form 5500 responses | ||
| 2016-08-01 | Type of plan entity | Single employer plan |
| 2016-08-01 | Submission has been amended | No |
| 2016-08-01 | This submission is the final filing | No |
| 2016-08-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2016-08-01 | Plan is a collectively bargained plan | No |
| 2016-08-01 | Plan funding arrangement – Insurance | Yes |
| 2016-08-01 | Plan benefit arrangement – Insurance | Yes |
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | G 00615593 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | G 00615593 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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