401k Plan data: CONCORDIA HEALTH PARTNERS WORKPLACE BENEFITS PLAN plan

CONCORDIA HEALTH PARTNERS WORKPLACE BENEFITS PLAN 401k Plan overview

Plan Name	CONCORDIA HEALTH PARTNERS WORKPLACE BENEFITS PLAN
Plan identification number	503

CONCORDIA HEALTH PARTNERS WORKPLACE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Temporary disability (accident and sickness) Other welfare benefit cover Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

CONCORDIA HEALTH PARTNERS, LLC has sponsored the creation of one or more 401k plans.

Company Name: CONCORDIA HEALTH PARTNERS, LLC

Employer identification number (EIN): 822325415

NAIC Classification: 623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CONCORDIA HEALTH PARTNERS WORKPLACE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2018-10-01
503 2017-10-01 VALERIE PATE

Plan Statistics for CONCORDIA HEALTH PARTNERS WORKPLACE BENEFITS PLAN

401k plan membership statisitcs for CONCORDIA HEALTH PARTNERS WORKPLACE BENEFITS PLAN

Measure Date Value
2018: CONCORDIA HEALTH PARTNERS WORKPLACE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year 2018-10-01 519
Total number of active participants reported on line 7a of the Form 5500 2018-10-01 28
Number of retired or separated participants receiving benefits 2018-10-01 0
Number of other retired or separated participants entitled to future benefits 2018-10-01 0
Total of all active and inactive participants 2018-10-01 28
2017: CONCORDIA HEALTH PARTNERS WORKPLACE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year 2017-10-01 495
Total number of active participants reported on line 7a of the Form 5500 2017-10-01 540
Number of retired or separated participants receiving benefits 2017-10-01 0
Number of other retired or separated participants entitled to future benefits 2017-10-01 0
Total of all active and inactive participants 2017-10-01 540

Measure	Date	Value
2018: CONCORDIA HEALTH PARTNERS WORKPLACE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-10-01	519
Total number of active participants reported on line 7a of the Form 5500	2018-10-01	28
Number of retired or separated participants receiving benefits	2018-10-01	0
Number of other retired or separated participants entitled to future benefits	2018-10-01	0
Total of all active and inactive participants	2018-10-01	28
2017: CONCORDIA HEALTH PARTNERS WORKPLACE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-10-01	495
Total number of active participants reported on line 7a of the Form 5500	2017-10-01	540
Number of retired or separated participants receiving benefits	2017-10-01	0
Number of other retired or separated participants entitled to future benefits	2017-10-01	0
Total of all active and inactive participants	2017-10-01	540

Form 5500 Responses for CONCORDIA HEALTH PARTNERS WORKPLACE BENEFITS PLAN

2018: CONCORDIA HEALTH PARTNERS WORKPLACE BENEFITS PLAN 2018 form 5500 responses
2018-10-01	Type of plan entity	Mulitple employer plan
2018-10-01	Submission has been amended	No
2018-10-01	This submission is the final filing	No
2018-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-10-01	Plan is a collectively bargained plan	No
2018-10-01	Plan funding arrangement – Insurance	Yes
2018-10-01	Plan benefit arrangement – Insurance	Yes
2017: CONCORDIA HEALTH PARTNERS WORKPLACE BENEFITS PLAN 2017 form 5500 responses
2017-10-01	Type of plan entity	Mulitple employer plan
2017-10-01	First time form 5500 has been submitted	Yes
2017-10-01	Submission has been amended	No
2017-10-01	This submission is the final filing	No
2017-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-10-01	Plan is a collectively bargained plan	No
2017-10-01	Plan funding arrangement – Insurance	Yes
2017-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

23830

Policy instance

Insurance contract or identification number	23830
Number of Individuals Covered	1044
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $81,283
Total amount of fees paid to insurance company	USD $0
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL
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 Carrier	USD $268,145
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $81,283
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

23830

Policy instance

Insurance contract or identification number	23830
Number of Individuals Covered	933
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $126,385
Total amount of fees paid to insurance company	USD $0
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL
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 Carrier	USD $284,189
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	CONCORDIA HEALTH PARTNERS, LLC
Employer identification number (EIN):	822325415
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities