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EDEN SENIOR CARE LLC 401(K) PROFIT SHARING PLAN & TRUST 401k Plan overview

Plan NameEDEN SENIOR CARE LLC 401(K) PROFIT SHARING PLAN & TRUST
Plan identification number 001

EDEN SENIOR CARE LLC 401(K) PROFIT SHARING PLAN & TRUST 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.
  • 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.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

EDEN SENIOR CARE LLC has sponsored the creation of one or more 401k plans.

Company Name:EDEN SENIOR CARE LLC
Employer identification number (EIN):813209892
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EDEN SENIOR CARE LLC 401(K) PROFIT SHARING PLAN & TRUST

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
0012018-01-01
0012017-07-04MAXIM STESEL

Plan Statistics for EDEN SENIOR CARE LLC 401(K) PROFIT SHARING PLAN & TRUST

401k plan membership statisitcs for EDEN SENIOR CARE LLC 401(K) PROFIT SHARING PLAN & TRUST

Measure Date Value
2022: EDEN SENIOR CARE LLC 401(K) PROFIT SHARING PLAN & TRUST 2022 401k membership
Total participants, beginning-of-year2022-01-012,143
Total number of active participants reported on line 7a of the Form 55002022-01-011,909
Number of retired or separated participants receiving benefits2022-01-011
Number of other retired or separated participants entitled to future benefits2022-01-01181
Total of all active and inactive participants2022-01-012,091
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-012,091
Number of participants with account balances2022-01-01516
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-0131
2021: EDEN SENIOR CARE LLC 401(K) PROFIT SHARING PLAN & TRUST 2021 401k membership
Total participants, beginning-of-year2021-01-011,864
Total number of active participants reported on line 7a of the Form 55002021-01-011,693
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-01118
Total of all active and inactive participants2021-01-011,811
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-011,811
Number of participants with account balances2021-01-01367
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: EDEN SENIOR CARE LLC 401(K) PROFIT SHARING PLAN & TRUST 2020 401k membership
Total participants, beginning-of-year2020-01-011,727
Total number of active participants reported on line 7a of the Form 55002020-01-011,602
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0138
Total of all active and inactive participants2020-01-011,640
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-011,640
Number of participants with account balances2020-01-01199
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: EDEN SENIOR CARE LLC 401(K) PROFIT SHARING PLAN & TRUST 2019 401k membership
Total participants, beginning-of-year2019-01-011,475
Total number of active participants reported on line 7a of the Form 55002019-01-011,425
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-0126
Total of all active and inactive participants2019-01-011,451
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-011,451
Number of participants with account balances2019-01-01114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: EDEN SENIOR CARE LLC 401(K) PROFIT SHARING PLAN & TRUST 2018 401k membership
Total participants, beginning-of-year2018-01-011,236
Total number of active participants reported on line 7a of the Form 55002018-01-011,310
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-019
Total of all active and inactive participants2018-01-011,319
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-011,319
Number of participants with account balances2018-01-0158
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: EDEN SENIOR CARE LLC 401(K) PROFIT SHARING PLAN & TRUST 2017 401k membership
Total participants, beginning-of-year2017-07-04141
Total number of active participants reported on line 7a of the Form 55002017-07-04602
Number of retired or separated participants receiving benefits2017-07-040
Number of other retired or separated participants entitled to future benefits2017-07-040
Total of all active and inactive participants2017-07-04602
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-07-040
Total participants2017-07-04602
Number of participants with account balances2017-07-0424
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-07-040

Financial Data on EDEN SENIOR CARE LLC 401(K) PROFIT SHARING PLAN & TRUST

Measure Date Value
2022 : EDEN SENIOR CARE LLC 401(K) PROFIT SHARING PLAN & TRUST 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$902,531
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$228,108
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$207,355
Expenses. Certain deemed distributions of participant loans2022-12-31$0
Value of total corrective distributions2022-12-31$1,034
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$1,471,285
Value of total assets at end of year2022-12-31$3,858,468
Value of total assets at beginning of year2022-12-31$3,184,045
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$19,719
Total interest from all sources2022-12-31$2,832
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$166,293
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$166,293
Administrative expenses professional fees incurred2022-12-31$0
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$318,404
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$1,234,213
Participant contributions at end of year2022-12-31$80,608
Participant contributions at beginning of year2022-12-31$65,618
Participant contributions at end of year2022-12-31$0
Participant contributions at beginning of year2022-12-31$0
Assets. Other investments not covered elsewhere at end of year2022-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2022-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$25,517
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$0
Administrative expenses (other) incurred2022-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$674,423
Value of net assets at end of year (total assets less liabilities)2022-12-31$3,858,468
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$3,184,045
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$9,643
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$3,543,517
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$3,026,590
Value of interest in pooled separate accounts at end of year2022-12-31$0
Value of interest in pooled separate accounts at beginning of year2022-12-31$0
Interest on participant loans2022-12-31$2,832
Value of interest in master investment trust accounts at end of year2022-12-31$0
Value of interest in master investment trust accounts at beginning of year2022-12-31$0
Value of interest in common/collective trusts at end of year2022-12-31$110,138
Value of interest in common/collective trusts at beginning of year2022-12-31$91,837
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2022-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2022-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-737,879
Net investment gain/loss from pooled separate accounts2022-12-31$0
Net investment gain or loss from common/collective trusts2022-12-31$0
Net gain/loss from 103.12 investment entities2022-12-31$0
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 contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$211,555
Employer contributions (assets) at end of year2022-12-31$124,205
Employer contributions (assets) at beginning of year2022-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$207,355
Contract administrator fees2022-12-31$10,076
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32022-12-31No
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 name2022-12-31JMM CPA
Accountancy firm EIN2022-12-31472940358
2021 : EDEN SENIOR CARE LLC 401(K) PROFIT SHARING PLAN & TRUST 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$1,593,243
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$321,890
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$310,126
Expenses. Certain deemed distributions of participant loans2021-12-31$0
Value of total corrective distributions2021-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$1,250,254
Value of total assets at end of year2021-12-31$3,184,045
Value of total assets at beginning of year2021-12-31$1,912,692
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$11,764
Total interest from all sources2021-12-31$2,001
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$143,169
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$143,169
Assets. Real estate other than employer real property at beginning of year2021-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2021-12-31$0
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$191,269
If this is an individual account plan, was there a blackout period2021-12-31No
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$856,647
Participant contributions at end of year2021-12-31$65,618
Participant contributions at beginning of year2021-12-31$16,379
Participant contributions at end of year2021-12-31$0
Participant contributions at beginning of year2021-12-31$0
Assets. Other investments not covered elsewhere at end of year2021-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2021-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$393,607
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$0
Assets. Loans (other than to participants) at beginning of year2021-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-12-31$0
Administrative expenses (other) incurred2021-12-31$0
Liabilities. Value of operating payables at beginning of year2021-12-31$0
Total non interest bearing cash at beginning of year2021-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$1,271,353
Value of net assets at end of year (total assets less liabilities)2021-12-31$3,184,045
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$1,912,692
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
Assets. partnership/joint venture interests at beginning of year2021-12-31$0
Investment advisory and management fees2021-12-31$7,442
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$3,026,590
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$1,896,297
Value of interest in pooled separate accounts at end of year2021-12-31$0
Value of interest in pooled separate accounts at beginning of year2021-12-31$0
Interest on participant loans2021-12-31$2,001
Value of interest in master investment trust accounts at end of year2021-12-31$0
Value of interest in master investment trust accounts at beginning of year2021-12-31$0
Value of interest in common/collective trusts at end of year2021-12-31$91,837
Value of interest in common/collective trusts at beginning of year2021-12-31$16
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2021-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2021-12-31$0
Asset value of US Government securities at beginning of year2021-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$196,298
Net investment gain/loss from pooled separate accounts2021-12-31$0
Net investment gain or loss from common/collective trusts2021-12-31$1,521
Net gain/loss from 103.12 investment entities2021-12-31$0
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 contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Assets. Invements in employer securities at beginning of year2021-12-31$0
Assets. Value of employer real property at beginning of year2021-12-31$0
Contributions received in cash from employer2021-12-31$0
Employer contributions (assets) at end of year2021-12-31$0
Employer contributions (assets) at beginning of year2021-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$310,126
Asset. Corporate debt instrument preferred debt at beginning of year2021-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2021-12-31$0
Contract administrator fees2021-12-31$4,322
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32021-12-31No
Assets. Corporate common stocks other than exployer securities at beginning of year2021-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2021-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2021-12-31$0
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
Liabilities. Value of acquisition indebtedness at beginning of year2021-12-31$0
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31JMM CPA
Accountancy firm EIN2021-12-31472940358
2020 : EDEN SENIOR CARE LLC 401(K) PROFIT SHARING PLAN & TRUST 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$778,785
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$88,928
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$81,160
Expenses. Certain deemed distributions of participant loans2020-12-31$0
Value of total corrective distributions2020-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$557,657
Value of total assets at end of year2020-12-31$1,912,692
Value of total assets at beginning of year2020-12-31$1,222,835
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$7,768
Total interest from all sources2020-12-31$891
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$64,751
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$64,751
Assets. Real estate other than employer real property at beginning of year2020-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2020-12-31$0
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$122,283
If this is an individual account plan, was there a blackout period2020-12-31Yes
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$419,897
Participant contributions at end of year2020-12-31$16,379
Participant contributions at beginning of year2020-12-31$7,511
Participant contributions at end of year2020-12-31$0
Participant contributions at beginning of year2020-12-31$0
Assets. Other investments not covered elsewhere at end of year2020-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2020-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$137,760
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$0
Assets. Loans (other than to participants) at beginning of year2020-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$0
Administrative expenses (other) incurred2020-12-31$0
Liabilities. Value of operating payables at beginning of year2020-12-31$0
Total non interest bearing cash at beginning of year2020-12-31$952
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$689,857
Value of net assets at end of year (total assets less liabilities)2020-12-31$1,912,692
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$1,222,835
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
Assets. partnership/joint venture interests at beginning of year2020-12-31$0
Investment advisory and management fees2020-12-31$3,268
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$1,896,297
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$0
Value of interest in pooled separate accounts at end of year2020-12-31$0
Value of interest in pooled separate accounts at beginning of year2020-12-31$1,214,372
Interest on participant loans2020-12-31$538
Interest earned on other investments2020-12-31$84
Value of interest in master investment trust accounts at end of year2020-12-31$0
Value of interest in master investment trust accounts at beginning of year2020-12-31$0
Value of interest in common/collective trusts at end of year2020-12-31$16
Value of interest in common/collective trusts at beginning of year2020-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-12-31$269
Assets. Value of investments in 103.12 investment entities at end of year2020-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2020-12-31$0
Asset value of US Government securities at beginning of year2020-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$101,493
Net investment gain/loss from pooled separate accounts2020-12-31$53,993
Net investment gain or loss from common/collective trusts2020-12-31$0
Net gain/loss from 103.12 investment entities2020-12-31$0
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
Assets. Invements in employer securities at beginning of year2020-12-31$0
Assets. Value of employer real property at beginning of year2020-12-31$0
Contributions received in cash from employer2020-12-31$0
Employer contributions (assets) at end of year2020-12-31$0
Employer contributions (assets) at beginning of year2020-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$81,160
Asset. Corporate debt instrument preferred debt at beginning of year2020-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2020-12-31$0
Contract administrator fees2020-12-31$4,500
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-12-31Yes
Assets. Corporate common stocks other than exployer securities at beginning of year2020-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2020-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2020-12-31$0
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
Liabilities. Value of acquisition indebtedness at beginning of year2020-12-31$0
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31JMM CPA
Accountancy firm EIN2020-12-31472940358
2019 : EDEN SENIOR CARE LLC 401(K) PROFIT SHARING PLAN & TRUST 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$874,165
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$201,620
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$200,158
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$729,131
Value of total assets at end of year2019-12-31$1,222,835
Value of total assets at beginning of year2019-12-31$550,290
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$1,462
Total interest from all sources2019-12-31$347
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Assets. Real estate other than employer real property at beginning of year2019-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2019-12-31$0
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$110,057
If this is an individual account plan, was there a blackout period2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$264,403
Participant contributions at end of year2019-12-31$7,511
Participant contributions at beginning of year2019-12-31$3,076
Participant contributions at beginning of year2019-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2019-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$464,728
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$0
Assets. Loans (other than to participants) at beginning of year2019-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$0
Liabilities. Value of operating payables at beginning of year2019-12-31$0
Total non interest bearing cash at end of year2019-12-31$952
Total non interest bearing cash at beginning of year2019-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$672,545
Value of net assets at end of year (total assets less liabilities)2019-12-31$1,222,835
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$550,290
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 leases to which the plan was party in default or uncollectible2019-12-31No
Assets. partnership/joint venture interests at beginning of year2019-12-31$0
Investment advisory and management fees2019-12-31$1,462
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$0
Value of interest in pooled separate accounts at end of year2019-12-31$1,214,372
Value of interest in pooled separate accounts at beginning of year2019-12-31$547,214
Interest on participant loans2019-12-31$347
Value of interest in master investment trust accounts at beginning of year2019-12-31$0
Value of interest in common/collective trusts at beginning of year2019-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2019-12-31$0
Asset value of US Government securities at beginning of year2019-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$0
Net investment gain/loss from pooled separate accounts2019-12-31$144,687
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 contributions2019-12-31Yes
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Assets. Invements in employer securities at beginning of year2019-12-31$0
Assets. Value of employer real property at beginning of year2019-12-31$0
Contributions received in cash from employer2019-12-31$0
Employer contributions (assets) at beginning of year2019-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$200,158
Asset. Corporate debt instrument preferred debt at beginning of year2019-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2019-12-31$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-12-31No
Assets. Corporate common stocks other than exployer securities at beginning of year2019-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2019-12-31$0
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
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Liabilities. Value of acquisition indebtedness at beginning of year2019-12-31$0
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
Accountancy firm name2019-12-31JMM CPA
Accountancy firm EIN2019-12-31472940358
2018 : EDEN SENIOR CARE LLC 401(K) PROFIT SHARING PLAN & TRUST 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$97,297
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$3,337
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$741
Expenses. Certain deemed distributions of participant loans2018-12-31$0
Value of total corrective distributions2018-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$131,875
Value of total assets at end of year2018-12-31$550,290
Value of total assets at beginning of year2018-12-31$456,330
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$2,596
Total interest from all sources2018-12-31$155
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
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$45,633
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$111,328
Participant contributions at end of year2018-12-31$3,076
Participant contributions at beginning of year2018-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$20,547
Administrative expenses (other) incurred2018-12-31$125
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
Value of net income/loss2018-12-31$93,960
Value of net assets at end of year (total assets less liabilities)2018-12-31$550,290
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$456,330
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 pooled separate accounts at end of year2018-12-31$547,214
Value of interest in pooled separate accounts at beginning of year2018-12-31$456,330
Interest on participant loans2018-12-31$155
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$1
Net investment gain/loss from pooled separate accounts2018-12-31$-34,734
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$741
Contract administrator fees2018-12-31$2,471
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 name2018-12-31JMM CPA
Accountancy firm EIN2018-12-31472940358
2017 : EDEN SENIOR CARE LLC 401(K) PROFIT SHARING PLAN & TRUST 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total income from all sources (including contributions)2017-12-31$456,858
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$528
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$0
Expenses. Certain deemed distributions of participant loans2017-12-31$0
Value of total corrective distributions2017-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$449,882
Value of total assets at end of year2017-12-31$456,330
Value of total assets at beginning of year2017-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$528
Total interest from all sources2017-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Assets. Real estate other than employer real property at beginning of year2017-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2017-12-31$0
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$20,000
If this is an individual account plan, was there a blackout period2017-12-31No
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$6,035
Participant contributions at end of year2017-12-31$0
Participant contributions at beginning of year2017-12-31$0
Participant contributions at beginning of year2017-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2017-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$443,847
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-12-31$0
Assets. Loans (other than to participants) at beginning of year2017-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-12-31$0
Liabilities. Value of operating payables at beginning of year2017-12-31$0
Total non interest bearing cash at beginning of year2017-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$456,330
Value of net assets at end of year (total assets less liabilities)2017-12-31$456,330
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Assets. partnership/joint venture interests at beginning of year2017-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$0
Value of interest in pooled separate accounts at end of year2017-12-31$456,330
Value of interest in master investment trust accounts at beginning of year2017-12-31$0
Value of interest in common/collective trusts at beginning of year2017-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2017-12-31$0
Asset value of US Government securities at beginning of year2017-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$33
Net investment gain/loss from pooled separate accounts2017-12-31$6,943
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Assets. Invements in employer securities at beginning of year2017-12-31$0
Assets. Value of employer real property at beginning of year2017-12-31$0
Contributions received in cash from employer2017-12-31$0
Employer contributions (assets) at beginning of year2017-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2017-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2017-12-31$0
Contract administrator fees2017-12-31$528
Assets. Corporate common stocks other than exployer securities at beginning of year2017-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2017-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2017-12-31$0
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Liabilities. Value of acquisition indebtedness at beginning of year2017-12-31$0

Form 5500 Responses for EDEN SENIOR CARE LLC 401(K) PROFIT SHARING PLAN & TRUST

2022: EDEN SENIOR CARE LLC 401(K) PROFIT SHARING PLAN & TRUST 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement - TrustYes
2021: EDEN SENIOR CARE LLC 401(K) PROFIT SHARING PLAN & TRUST 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 – TrustYes
2021-01-01Plan benefit arrangement - TrustYes
2020: EDEN SENIOR CARE LLC 401(K) PROFIT SHARING PLAN & TRUST 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: EDEN SENIOR CARE LLC 401(K) PROFIT SHARING PLAN & TRUST 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: EDEN SENIOR CARE LLC 401(K) PROFIT SHARING PLAN & TRUST 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: EDEN SENIOR CARE LLC 401(K) PROFIT SHARING PLAN & TRUST 2017 form 5500 responses
2017-07-04Type of plan entitySingle employer plan
2017-07-04First time form 5500 has been submittedYes
2017-07-04Submission has been amendedNo
2017-07-04This submission is the final filingNo
2017-07-04This return/report is a short plan year return/report (less than 12 months)Yes
2017-07-04Plan is a collectively bargained planNo
2017-07-04Plan funding arrangement – InsuranceYes
2017-07-04Plan funding arrangement – TrustYes
2017-07-04Plan benefit arrangement – InsuranceYes
2017-07-04Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number129954
Policy instance 1
Insurance contract or identification number129954
Number of Individuals Covered0
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,520
Total amount of fees paid to insurance companyUSD $709
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 fees709
Additional information about fees paid to insurance brokerTPA COMPENSATION
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number129954
Policy instance 1
Insurance contract or identification number129954
Number of Individuals Covered123
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $4,311
Total amount of fees paid to insurance companyUSD $1,485
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 $4,311
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?3
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number129954
Policy instance 1
Insurance contract or identification number129954
Number of Individuals Covered71
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $2,522
Total amount of fees paid to insurance companyUSD $1,316
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 $896
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER COMISSION
Insurance broker organization code?3

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