2017-08-16T19:38:37-05:00 2016-11-30 430765316 RubinBrown LLP 7881 W CHARLESTON BLVD STE 250 LAS VEGAS NV 89117 990 2015-12-01 466536400 GREEN FOREST TRUST GREE 9492402423 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 VICTOR LUNDQUIST TRUSTEE 9492402423 2017-08-16 1 MICHAEL B PATCHETT CPA P01369879 7025797000 2017-08-15 2015 2021-01-29 14:40:06Z VICTOR LUNDQUIST 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 8647833 0 X N/A X 2013 CA TO PROVIDE HEALTH, DENTAL AND VISION BENEFITS FOR PARTICIPANTS AND THEIR ELIGIBLE DEPENDENTS. 1 0 0 0 0 0 0 0 5058147 8647833 0 0 0 0 5058147 8647833 0 0 4396091 4657439 0 0 0 0 0 1434568 1799241 5830659 6456680 -772512 2191153 136112 2327265 0 0 136112 2327265 TO PROVIDE WELFARE BENEFITS FOR THOSE EMPLOYEES AND THEIR ELIGILBLE DEPENDENTS COVERED BY THE PLAN OF NORTH AMERICAN HEALTH CARE, INC AND RELATED ENTITIES. 0 0 6456680 8647833 HEALTH, VISION, DENTAL INSURANCE COVERAGE PROVIDED TO PARTICIPANTS. 6456680 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 1 0 0 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 CA X SPENCER OLSEN - NORTH AMERICAN HEALTH CARE INC 9492402423 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 VICTOR LUNDQUIST TRUSTEE 0.10 40.00 X 0 352292 0 0 352292 0 0 0 1 0 CIGNA HEALTH AND LIFE INSURANCE COMPANY 25500 N NORTERRA DRIVE BLDG B PHOENIX AZ 85085 THIRD PARTY ADMINISTRATOR 119147 1 EMPLOYER AND EMPLOYER 900099 8647833 8647833 8647833 8647833 8647833 0 0 4657439 4657439 1768431 1768431 A&G BUSINESS TAXES 29473 29473 Accounting fees 1337 1337 6456680 6456680 0 0 136112 2327265 136112 2327265 0 0 X 0 0 0 0 136112 2327265 136112 2327265 136112 2327265 2191153 0 X 0 0 0 0 0 0 VICTOR LUNDQUIST TRUSTEE 0 352292 0 0 0 0 0 0 0 0 0 352292 0 0 Form 990, Part VI, Section A, line 3 CIGNA HANDLES ALL THE PROCESSING AND PAYMENT OF THE HEALTH AND WELFARE CLAIMS, ETC . Form 990, Part VI, Section A, line 8b THERE WAS NO COMMITTEE WITH AUTORITY TO ACT ON BEHALF OF THE GOVERNING BODY. Form 990, Part VI, Section B, line 11 THE TRUSTEE IS GIVEN A COPY OF THE RETURN TO REVIEW BEFORE THE TAX RETURN IS EFILED. Form 990, Part VI, Section C, line 19 THE ORGANIZATION MADE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC BY PROVIDING COPIES ON REQUEST DURING THE TAX YEAR. NORTH AMERICAN HEALTH CARE INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 880252963 PLAN SPONSOR CA S 0 LOMITA VERDE INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 330376540 CONTRIBUTING EMPLOYER CA S 0 RAMONA CARE INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 880253407 CONTRIBUTING EMPLOYER CA S 0 BP CARE INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 880253408 CONTRIBUTING EMPLOYER CA S 0 CHATSWORTH HOLDING LLC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 710916266 CONTRIBUTING EMPLOYER CA S 0 SCCH INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 880302193 CONTRIBUTING EMPLOYER CA S 0 FCH INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 880319648 CONTRIBUTING EMPLOYER CA S 0 VSNF INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 880334959 CONTRIBUTING EMPLOYER CA S 0 AVCH INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 880337360 CONTRIBUTING EMPLOYER CA S 0 WOODLAND SKILLED NURSING FACILITY INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 880350425 CONTRIBUTING EMPLOYER CA S 0 CCHC INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 880361567 CONTRIBUTING EMPLOYER CA S 0 PTCH INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 330725679 CONTRIBUTING EMPLOYER CA S 0 PACIFICA CARE CENTER 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 943255399 CONTRIBUTING EMPLOYER CA S 0 SUN HAVEN CARE INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 330743732 CONTRIBUTING EMPLOYER CA S 0 DANVILLE LONG-TERM CARE INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 943274729 CONTRIBUTING EMPLOYER CA S 0 VILLA CONVALESCENT HOSPITAL INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 952687468 CONTRIBUTING EMPLOYER CA S 0 ABRH INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 880395825 CONTRIBUTING EMPLOYER CA S 0 HACIENDA CH INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 880395836 CONTRIBUTING EMPLOYER CA S 0 PETALUMA CC INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 880422961 CONTRIBUTING EMPLOYER CA S 0 PACIFICA LINDA MAR INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 880426888 CONTRIBUTING EMPLOYER CA S 0 COTTONWOOD HC INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 880430406 CONTRIBUTING EMPLOYER CA S 0 CARMICHAEL CARE INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 880484955 CONTRIBUTING EMPLOYER CA S 0 MONTEREY CARE INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 880404123 CONTRIBUTING EMPLOYER AZ S 0 LBHC HOLDING LLC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 753088252 CONTRIBUTING EMPLOYER CA S 0 COSTAL HEALTH CARE INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 450509267 CONTRIBUTING EMPLOYER CA S 0 SEA BREEZE HEALTH CARE INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 680547791 CONTRIBUTING EMPLOYER CA S 0 FAIRFIELD HELATH CARE INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 510460208 CONTRIBUTING EMPLOYER CA S 0 GRAND TERRACE HEALTH CARE INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 582673168 CONTRIBUTING EMPLOYER CA S 0 NORTHWEST CARE - WEST SEATTLE INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 510475021 CONTRIBUTING EMPLOYER WA S 0 NORTHWEST CARE - SHORELINE INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 510475023 CONTRIBUTING EMPLOYER WA S 0 EDGEWATER HEALTH CARE INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 202742835 CONTRIBUTING EMPLOYER CA S 0 LODI SKILLED CURISNIG SERVICES 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 204524548 CONTRIBUTING EMPLOYER CA S 0 NORTHWEST CARE - ISSAQUAH INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 260895231 CONTRIBUTING EMPLOYER WA S 0 BURIEN POST-ACUTE SERVICES INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 261809683 CONTRIBUTING EMPLOYER WA S 0 STOCKTON HEALTHCARE SERVICES 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 264215679 CONTRIBUTING EMPLOYER CA S 0 NORTH COAST REHAB INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 462617469 CONTRIBUTING EMPLOYER CA S 0 RIVERSIDE CARE INC 3 MONARCH BAY PLAZA STE 203 DANA POINT CA 92629 472196291 CONTRIBUTING EMPLOYER CA S 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0