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NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN 401k Plan overview

Plan NameNORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN
Plan identification number 503

NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

NORTH COUNTRY HEALTH SYSTEM, INC. has sponsored the creation of one or more 401k plans.

Company Name:NORTH COUNTRY HEALTH SYSTEM, INC.
Employer identification number (EIN):030185556
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032020-01-01
5032019-01-01
5032018-01-01
5032017-11-01WILLIAM PERKET WILLIAM PERKET2018-05-14
5032016-11-01WILLIAM PERKET WILLIAM PERKET2018-05-14
5032015-11-01WILLIAM PERKET WILLIAM PERKET2017-05-18
5032014-11-01WILLIAM PERKET WILLIAM PERKET2016-05-09
5032013-11-01WILLIAM PERKET WILLIAM PERKET2015-05-11
5032012-11-01WILLIAM PERKET WILLIAM PERKET2014-03-18
5032011-11-01WILLIAM PERKET WILLIAM PERKET2013-06-24
5032010-11-01WILLIAM PERKET WILLIAM PERKET2012-05-22
5032009-11-01WILLIAM PERKET WILLIAM PERKET2011-05-23

Plan Statistics for NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN

401k plan membership statisitcs for NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN

Measure Date Value
2020: NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01465
Total number of active participants reported on line 7a of the Form 55002020-01-01465
Number of retired or separated participants receiving benefits2020-01-017
Number of other retired or separated participants entitled to future benefits2020-01-017
Total of all active and inactive participants2020-01-01479
2019: NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01462
Total number of active participants reported on line 7a of the Form 55002019-01-01458
Number of retired or separated participants receiving benefits2019-01-012
Number of other retired or separated participants entitled to future benefits2019-01-012
Total of all active and inactive participants2019-01-01462
2018: NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01487
Total number of active participants reported on line 7a of the Form 55002018-01-01468
Number of retired or separated participants receiving benefits2018-01-012
Number of other retired or separated participants entitled to future benefits2018-01-012
Total of all active and inactive participants2018-01-01472
2017: NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year2017-11-01483
Total number of active participants reported on line 7a of the Form 55002017-11-01479
Number of retired or separated participants receiving benefits2017-11-012
Number of other retired or separated participants entitled to future benefits2017-11-016
Total of all active and inactive participants2017-11-01487
2016: NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year2016-11-01476
Total number of active participants reported on line 7a of the Form 55002016-11-01480
Number of retired or separated participants receiving benefits2016-11-012
Number of other retired or separated participants entitled to future benefits2016-11-012
Total of all active and inactive participants2016-11-01484
2015: NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year2015-11-01465
Total number of active participants reported on line 7a of the Form 55002015-11-01467
Number of retired or separated participants receiving benefits2015-11-016
Number of other retired or separated participants entitled to future benefits2015-11-013
Total of all active and inactive participants2015-11-01476
2014: NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year2014-11-01443
Total number of active participants reported on line 7a of the Form 55002014-11-01452
Number of retired or separated participants receiving benefits2014-11-015
Number of other retired or separated participants entitled to future benefits2014-11-018
Total of all active and inactive participants2014-11-01465
2013: NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year2013-11-01475
Total number of active participants reported on line 7a of the Form 55002013-11-01444
Number of retired or separated participants receiving benefits2013-11-015
Number of other retired or separated participants entitled to future benefits2013-11-016
Total of all active and inactive participants2013-11-01455
2012: NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year2012-11-01512
Total number of active participants reported on line 7a of the Form 55002012-11-01475
Number of retired or separated participants receiving benefits2012-11-018
Number of other retired or separated participants entitled to future benefits2012-11-018
Total of all active and inactive participants2012-11-01491
2011: NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year2011-11-01514
Total number of active participants reported on line 7a of the Form 55002011-11-01512
Number of retired or separated participants receiving benefits2011-11-014
Number of other retired or separated participants entitled to future benefits2011-11-012
Total of all active and inactive participants2011-11-01518
2010: NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN 2010 401k membership
Total participants, beginning-of-year2010-11-01512
Total number of active participants reported on line 7a of the Form 55002010-11-01514
Number of retired or separated participants receiving benefits2010-11-0110
Number of other retired or separated participants entitled to future benefits2010-11-013
Total of all active and inactive participants2010-11-01527
2009: NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year2009-11-01498
Total number of active participants reported on line 7a of the Form 55002009-11-01499
Number of retired or separated participants receiving benefits2009-11-0111
Number of other retired or separated participants entitled to future benefits2009-11-012
Total of all active and inactive participants2009-11-01512
Total participants2009-11-010

Form 5500 Responses for NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN

2020: NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN 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 benefit arrangement – InsuranceYes
2019: NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN 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 benefit arrangement – InsuranceYes
2018: NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN 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 benefit arrangement – InsuranceYes
2017: NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN 2017 form 5500 responses
2017-11-01Type of plan entitySingle employer plan
2017-11-01Submission has been amendedNo
2017-11-01This submission is the final filingNo
2017-11-01This return/report is a short plan year return/report (less than 12 months)Yes
2017-11-01Plan is a collectively bargained planNo
2017-11-01Plan funding arrangement – InsuranceYes
2017-11-01Plan benefit arrangement – InsuranceYes
2016: NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN 2016 form 5500 responses
2016-11-01Type of plan entitySingle employer plan
2016-11-01Submission has been amendedNo
2016-11-01This submission is the final filingNo
2016-11-01This return/report is a short plan year return/report (less than 12 months)No
2016-11-01Plan is a collectively bargained planNo
2016-11-01Plan funding arrangement – InsuranceYes
2016-11-01Plan benefit arrangement – InsuranceYes
2015: NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN 2015 form 5500 responses
2015-11-01Type of plan entitySingle employer plan
2015-11-01Submission has been amendedNo
2015-11-01This submission is the final filingNo
2015-11-01This return/report is a short plan year return/report (less than 12 months)No
2015-11-01Plan is a collectively bargained planNo
2015-11-01Plan funding arrangement – InsuranceYes
2015-11-01Plan benefit arrangement – InsuranceYes
2014: NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN 2014 form 5500 responses
2014-11-01Type of plan entitySingle employer plan
2014-11-01Submission has been amendedNo
2014-11-01This submission is the final filingNo
2014-11-01This return/report is a short plan year return/report (less than 12 months)No
2014-11-01Plan is a collectively bargained planNo
2014-11-01Plan funding arrangement – InsuranceYes
2014-11-01Plan benefit arrangement – InsuranceYes
2013: NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN 2013 form 5500 responses
2013-11-01Type of plan entitySingle employer plan
2013-11-01Submission has been amendedNo
2013-11-01This submission is the final filingNo
2013-11-01This return/report is a short plan year return/report (less than 12 months)No
2013-11-01Plan is a collectively bargained planNo
2013-11-01Plan funding arrangement – InsuranceYes
2013-11-01Plan benefit arrangement – InsuranceYes
2012: NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN 2012 form 5500 responses
2012-11-01Type of plan entitySingle employer plan
2012-11-01Submission has been amendedNo
2012-11-01This submission is the final filingNo
2012-11-01This return/report is a short plan year return/report (less than 12 months)No
2012-11-01Plan is a collectively bargained planNo
2012-11-01Plan funding arrangement – InsuranceYes
2012-11-01Plan benefit arrangement – InsuranceYes
2011: NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN 2011 form 5500 responses
2011-11-01Type of plan entitySingle employer plan
2011-11-01Submission has been amendedNo
2011-11-01This submission is the final filingNo
2011-11-01This return/report is a short plan year return/report (less than 12 months)No
2011-11-01Plan is a collectively bargained planNo
2011-11-01Plan funding arrangement – InsuranceYes
2011-11-01Plan benefit arrangement – InsuranceYes
2010: NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN 2010 form 5500 responses
2010-11-01Type of plan entitySingle employer plan
2010-11-01Submission has been amendedNo
2010-11-01This submission is the final filingNo
2010-11-01This return/report is a short plan year return/report (less than 12 months)No
2010-11-01Plan is a collectively bargained planNo
2010-11-01Plan funding arrangement – InsuranceYes
2010-11-01Plan benefit arrangement – InsuranceYes
2009: NORTH COUNTRY HOSPITAL & HEALTH CENTER, INC. LONG-TERM DISABILITY PLAN 2009 form 5500 responses
2009-11-01Type of plan entitySingle employer plan
2009-11-01Submission has been amendedNo
2009-11-01This submission is the final filingNo
2009-11-01This return/report is a short plan year return/report (less than 12 months)No
2009-11-01Plan is a collectively bargained planNo
2009-11-01Plan funding arrangement – InsuranceYes
2009-11-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberGF3810B6360401
Policy instance 1
Insurance contract or identification numberGF3810B6360401
Number of Individuals Covered465
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $11,047
Total amount of fees paid to insurance companyUSD $4,629
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $220,938
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 fees4629
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number69893-8
Policy instance 2
Insurance contract or identification number69893-8
Number of Individuals Covered465
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $8,228
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $77,527
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,389
Amount paid for insurance broker fees0
Insurance broker organization code?3
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberGF3810B6360401
Policy instance 1
Insurance contract or identification numberGF3810B6360401
Number of Individuals Covered462
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $19,415
Total amount of fees paid to insurance companyUSD $3,540
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $178,136
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,708
Amount paid for insurance broker fees3540
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number69893-8
Policy instance 2
Insurance contract or identification number69893-8
Number of Individuals Covered458
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $8,329
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $58,629
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,358
Amount paid for insurance broker fees0
Insurance broker organization code?3
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberGF3810B6360401
Policy instance 1
Insurance contract or identification numberGF3810B6360401
Number of Individuals Covered468
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $17,319
Total amount of fees paid to insurance companyUSD $3,592
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $189,209
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $-809
Amount paid for insurance broker fees3592
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number69893-8
Policy instance 2
Insurance contract or identification number69893-8
Number of Individuals Covered467
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $6,820
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $79,367
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,852
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerWRITING AGENT
Insurance broker organization code?3
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberGF3810B6360401
Policy instance 1
Insurance contract or identification numberGF3810B6360401
Number of Individuals Covered480
Insurance policy start date2017-11-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,117
Total amount of fees paid to insurance companyUSD $1,396
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,117
Amount paid for insurance broker fees1396
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameBROWN & BROWN OF MASSACHUSETTS LLC
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number69893-8
Policy instance 2
Insurance contract or identification number69893-8
Number of Individuals Covered479
Insurance policy start date2017-11-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,152
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $13,629
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $471
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameACADIA BENEFITS INC

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