401k Plan data: NORTHWEST COUNTRY PLACE HEALTH AND WELFARE PLAN plan

NORTHWEST COUNTRY PLACE HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	NORTHWEST COUNTRY PLACE HEALTH AND WELFARE PLAN
Plan identification number	501

NORTHWEST COUNTRY PLACE HEALTH AND WELFARE PLAN Benefits

401k Plan Type

Welfare Benefit

Plan Features/Benefits

Health (other than dental or vision)
Life insurance
Dental
Death benefits (include travel accident but not life insurance)
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.
Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

NORTHWEST COUNTRY PLACE, INC. has sponsored the creation of one or more 401k plans.

Company Name: NORTHWEST COUNTRY PLACE, INC.

Employer identification number (EIN): 931114329

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

Additional information about NORTHWEST COUNTRY PLACE, INC.

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division

Incorporation Date: 1993-05-21

Company Identification Number: 34723783

Legal Registered Office Address: 5300 MEADOWS ROAD STE 200

LAKE OSWEGO
United States of America (USA)
97035

More information about NORTHWEST COUNTRY PLACE, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTHWEST COUNTRY PLACE HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2012-08-01 DAVID HENDERSON
501 2011-08-01 DAWN HALL
501 2010-08-01 DAWN HALL
501 2009-08-01 DAWN HALL

Plan id#	Filing Submission Date	Name of Administrator
501	2012-08-01	DAVID HENDERSON
501	2011-08-01	DAWN HALL
501	2010-08-01	DAWN HALL
501	2009-08-01	DAWN HALL

Plan Statistics for NORTHWEST COUNTRY PLACE HEALTH AND WELFARE PLAN

401k plan membership statisitcs for NORTHWEST COUNTRY PLACE HEALTH AND WELFARE PLAN

Measure Date Value
2012: NORTHWEST COUNTRY PLACE HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-08-01 215
Total number of active participants reported on line 7a of the Form 5500 2012-08-01 186
Number of retired or separated participants receiving benefits 2012-08-01 0
Number of other retired or separated participants entitled to future benefits 2012-08-01 0
Total of all active and inactive participants 2012-08-01 186
2011: NORTHWEST COUNTRY PLACE HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-08-01 117
Total number of active participants reported on line 7a of the Form 5500 2011-08-01 215
Number of retired or separated participants receiving benefits 2011-08-01 0
Number of other retired or separated participants entitled to future benefits 2011-08-01 0
Total of all active and inactive participants 2011-08-01 215
2010: NORTHWEST COUNTRY PLACE HEALTH AND WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year 2010-08-01 117
Total number of active participants reported on line 7a of the Form 5500 2010-08-01 117
Number of retired or separated participants receiving benefits 2010-08-01 0
Number of other retired or separated participants entitled to future benefits 2010-08-01 0
Total of all active and inactive participants 2010-08-01 117
2009: NORTHWEST COUNTRY PLACE HEALTH AND WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-08-01 112
Total number of active participants reported on line 7a of the Form 5500 2009-08-01 94
Number of retired or separated participants receiving benefits 2009-08-01 0
Number of other retired or separated participants entitled to future benefits 2009-08-01 0
Total of all active and inactive participants 2009-08-01 94

Measure	Date	Value
2012: NORTHWEST COUNTRY PLACE HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-08-01	215
Total number of active participants reported on line 7a of the Form 5500	2012-08-01	186
Number of retired or separated participants receiving benefits	2012-08-01	0
Number of other retired or separated participants entitled to future benefits	2012-08-01	0
Total of all active and inactive participants	2012-08-01	186
2011: NORTHWEST COUNTRY PLACE HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-08-01	117
Total number of active participants reported on line 7a of the Form 5500	2011-08-01	215
Number of retired or separated participants receiving benefits	2011-08-01	0
Number of other retired or separated participants entitled to future benefits	2011-08-01	0
Total of all active and inactive participants	2011-08-01	215
2010: NORTHWEST COUNTRY PLACE HEALTH AND WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year	2010-08-01	117
Total number of active participants reported on line 7a of the Form 5500	2010-08-01	117
Number of retired or separated participants receiving benefits	2010-08-01	0
Number of other retired or separated participants entitled to future benefits	2010-08-01	0
Total of all active and inactive participants	2010-08-01	117
2009: NORTHWEST COUNTRY PLACE HEALTH AND WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-08-01	112
Total number of active participants reported on line 7a of the Form 5500	2009-08-01	94
Number of retired or separated participants receiving benefits	2009-08-01	0
Number of other retired or separated participants entitled to future benefits	2009-08-01	0
Total of all active and inactive participants	2009-08-01	94

Form 5500 Responses for NORTHWEST COUNTRY PLACE HEALTH AND WELFARE PLAN

2012: NORTHWEST COUNTRY PLACE HEALTH AND WELFARE PLAN 2012 form 5500 responses
2012-08-01	Type of plan entity	Single employer plan
2012-08-01	Submission has been amended	No
2012-08-01	This submission is the final filing	No
2012-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-08-01	Plan is a collectively bargained plan	No
2012-08-01	Plan funding arrangement – Insurance	Yes
2012-08-01	Plan benefit arrangement – Insurance	Yes
2011: NORTHWEST COUNTRY PLACE HEALTH AND WELFARE PLAN 2011 form 5500 responses
2011-08-01	Type of plan entity	Single employer plan
2011-08-01	Submission has been amended	No
2011-08-01	This submission is the final filing	No
2011-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-08-01	Plan is a collectively bargained plan	No
2011-08-01	Plan funding arrangement – Insurance	Yes
2011-08-01	Plan benefit arrangement – Insurance	Yes
2010: NORTHWEST COUNTRY PLACE HEALTH AND WELFARE PLAN 2010 form 5500 responses
2010-08-01	Type of plan entity	Single employer plan
2010-08-01	Submission has been amended	No
2010-08-01	This submission is the final filing	No
2010-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-08-01	Plan is a collectively bargained plan	No
2010-08-01	Plan funding arrangement – Insurance	Yes
2010-08-01	Plan benefit arrangement – Insurance	Yes
2009: NORTHWEST COUNTRY PLACE HEALTH AND WELFARE PLAN 2009 form 5500 responses
2009-08-01	Type of plan entity	Single employer plan
2009-08-01	Submission has been amended	No
2009-08-01	This submission is the final filing	No
2009-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-08-01	Plan is a collectively bargained plan	No
2009-08-01	Plan funding arrangement – Insurance	Yes
2009-08-01	Plan benefit arrangement – Insurance	Yes

Potentially related plans

NORTHWEST COUNTRY MANAGEMENT L 401(K) PROFIT SHARING PLAN & TRUST [EIN = 680626515]

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Company Name:	NORTHWEST COUNTRY PLACE, INC.
Employer identification number (EIN):	931114329
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities

Jurisdiction of Incorporation:	Oregon Secretary of State Corporations Division
Incorporation Date:	1993-05-21
Company Identification Number:	34723783
Legal Registered Office Address:	5300 MEADOWS ROAD STE 200 LAKE OSWEGO United States of America (USA) 97035