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SHADOW HEALTH INC. 401(K) PROFIT SHARING PLAN AND TRUST 401k Plan overview

Plan NameSHADOW HEALTH INC. 401(K) PROFIT SHARING PLAN AND TRUST
Plan identification number 001

SHADOW HEALTH INC. 401(K) PROFIT SHARING PLAN AND TRUST Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
  • 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.

401k Sponsoring company profile

SHADOW HEALTH INC. has sponsored the creation of one or more 401k plans.

Company Name:SHADOW HEALTH INC.
Employer identification number (EIN):900728777
NAIC Classification:621399
NAIC Description:Offices of All Other Miscellaneous Health Practitioners

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SHADOW HEALTH INC. 401(K) PROFIT SHARING PLAN AND TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012021-01-01
0012020-01-01PATRICK BIZUB2021-06-23

Plan Statistics for SHADOW HEALTH INC. 401(K) PROFIT SHARING PLAN AND TRUST

401k plan membership statisitcs for SHADOW HEALTH INC. 401(K) PROFIT SHARING PLAN AND TRUST

Measure Date Value
2021: SHADOW HEALTH INC. 401(K) PROFIT SHARING PLAN AND TRUST 2021 401k membership
Total participants, beginning-of-year2021-01-01141
Total number of active participants reported on line 7a of the Form 55002021-01-010
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 participants2021-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-010
Number of participants with account balances2021-01-010

Financial Data on SHADOW HEALTH INC. 401(K) PROFIT SHARING PLAN AND TRUST

Measure Date Value
2021 : SHADOW HEALTH INC. 401(K) PROFIT SHARING PLAN AND TRUST 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-07-19$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-07-19$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-07-19$0
Total income from all sources (including contributions)2021-07-19$42,465
Total loss/gain on sale of assets2021-07-19$0
Total of all expenses incurred2021-07-19$1,594,969
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-07-19$1,594,969
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-07-19$0
Value of total assets at end of year2021-07-19$0
Value of total assets at beginning of year2021-07-19$1,552,504
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-07-19$0
Total interest from all sources2021-07-19$908
Total dividends received (eg from common stock, registered investment company shares)2021-07-19$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-07-19Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2021-07-19$0
Was this plan covered by a fidelity bond2021-07-19Yes
Value of fidelity bond cover2021-07-19$156,000
If this is an individual account plan, was there a blackout period2021-07-19No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-07-19$0
Were there any nonexempt tranactions with any party-in-interest2021-07-19No
Participant contributions at end of year2021-07-19$0
Participant contributions at beginning of year2021-07-19$1,311
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-07-19No
Value of net income/loss2021-07-19$-1,552,504
Value of net assets at end of year (total assets less liabilities)2021-07-19$0
Value of net assets at beginning of year (total assets less liabilities)2021-07-19$1,552,504
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-07-19No
Were any loans by the plan or fixed income obligations due to the plan in default2021-07-19No
Were any leases to which the plan was party in default or uncollectible2021-07-19No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-07-19$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-07-19$1,515,242
Interest earned on other investments2021-07-19$908
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-07-19$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-07-19$29,376
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-07-19$41,557
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-07-19No
Was there a failure to transmit to the plan any participant contributions2021-07-19No
Has the plan failed to provide any benefit when due under the plan2021-07-19No
Employer contributions (assets) at end of year2021-07-19$0
Employer contributions (assets) at beginning of year2021-07-19$6,575
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-07-19$1,594,969
Did the plan have assets held for investment2021-07-19No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-07-19No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-07-19Yes
Opinion of an independent qualified public accountant for this plan2021-07-19Unqualified
Accountancy firm name2021-07-19PURVIS GRAY & COMPANY, LLP
Accountancy firm EIN2021-07-19590548468

Form 5500 Responses for SHADOW HEALTH INC. 401(K) PROFIT SHARING PLAN AND TRUST

2021: SHADOW HEALTH INC. 401(K) PROFIT SHARING PLAN AND 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 filingYes
2021-01-01This return/report is a short plan year return/report (less than 12 months)Yes
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

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-CP-LX2K
Policy instance 1
Insurance contract or identification numberGAP-CP-LX2K
Number of Individuals Covered0
Insurance policy start date2021-01-01
Insurance policy end date2021-07-19
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?Yes
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

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