401k Plan data: GROUP ACCIDENTAL DEATH INSURANCE PLAN plan

GROUP ACCIDENTAL DEATH INSURANCE PLAN 401k Plan overview

Plan Name	GROUP ACCIDENTAL DEATH INSURANCE PLAN
Plan identification number	504

GROUP ACCIDENTAL DEATH INSURANCE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance

401k Sponsoring company profile

SUSQUEHANNA HEALTH SYSTEM has sponsored the creation of one or more 401k plans.

Company Name: SUSQUEHANNA HEALTH SYSTEM

Employer identification number (EIN): 232751183

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GROUP ACCIDENTAL DEATH INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2013-07-01 ELIZABETH BRUBAKER CHRISTINE BALLARD 2015-01-19
504 2012-07-01 ELIZABETH BRUBAKER CHRISTINE BALLARD 2014-01-27
504 2011-07-01 ELIZABETH BRUBAKER CHRISTINE BALLARD 2013-01-10
504 2010-07-01 ELIZABETH BRUBAKER GLENN MECHLING 2012-01-25
504 2009-07-01 M CLARE KIEHART GLENN MECHLING 2011-01-07

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
504	2013-07-01	ELIZABETH BRUBAKER	CHRISTINE BALLARD	2015-01-19
504	2012-07-01	ELIZABETH BRUBAKER	CHRISTINE BALLARD	2014-01-27
504	2011-07-01	ELIZABETH BRUBAKER	CHRISTINE BALLARD	2013-01-10
504	2010-07-01	ELIZABETH BRUBAKER	GLENN MECHLING	2012-01-25
504	2009-07-01	M CLARE KIEHART	GLENN MECHLING	2011-01-07

Plan Statistics for GROUP ACCIDENTAL DEATH INSURANCE PLAN

401k plan membership statisitcs for GROUP ACCIDENTAL DEATH INSURANCE PLAN

Measure Date Value
2013: GROUP ACCIDENTAL DEATH INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-07-01 2,404
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 0
Number of retired or separated participants receiving benefits 2013-07-01 0
Number of other retired or separated participants entitled to future benefits 2013-07-01 0
Total of all active and inactive participants 2013-07-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-07-01 0
Total participants 2013-07-01 0
Number of participants with account balances 2013-07-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-07-01 0
Number of employers contributing to the scheme 2013-07-01 0
2012: GROUP ACCIDENTAL DEATH INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 2,476
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 2,404
Number of retired or separated participants receiving benefits 2012-07-01 0
Number of other retired or separated participants entitled to future benefits 2012-07-01 0
Total of all active and inactive participants 2012-07-01 2,404
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-07-01 0
Total participants 2012-07-01 2,404
Number of participants with account balances 2012-07-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-07-01 0
Number of employers contributing to the scheme 2012-07-01 0
2011: GROUP ACCIDENTAL DEATH INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-07-01 2,426
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 2,476
Number of retired or separated participants receiving benefits 2011-07-01 0
Number of other retired or separated participants entitled to future benefits 2011-07-01 0
Total of all active and inactive participants 2011-07-01 2,476
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-07-01 0
Total participants 2011-07-01 2,476
Number of participants with account balances 2011-07-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-07-01 0
2010: GROUP ACCIDENTAL DEATH INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year 2010-07-01 2,475
Total number of active participants reported on line 7a of the Form 5500 2010-07-01 2,426
Number of retired or separated participants receiving benefits 2010-07-01 0
Number of other retired or separated participants entitled to future benefits 2010-07-01 0
Total of all active and inactive participants 2010-07-01 2,426
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-07-01 0
Total participants 2010-07-01 2,426
Number of participants with account balances 2010-07-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-07-01 0
2009: GROUP ACCIDENTAL DEATH INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-07-01 2,481
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 2,475
Number of retired or separated participants receiving benefits 2009-07-01 0
Number of other retired or separated participants entitled to future benefits 2009-07-01 0
Total of all active and inactive participants 2009-07-01 2,475
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-07-01 0
Total participants 2009-07-01 2,475
Number of participants with account balances 2009-07-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-07-01 0

Measure	Date	Value
2013: GROUP ACCIDENTAL DEATH INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-07-01	2,404
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	0
Number of retired or separated participants receiving benefits	2013-07-01	0
Number of other retired or separated participants entitled to future benefits	2013-07-01	0
Total of all active and inactive participants	2013-07-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-07-01	0
Total participants	2013-07-01	0
Number of participants with account balances	2013-07-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-07-01	0
Number of employers contributing to the scheme	2013-07-01	0
2012: GROUP ACCIDENTAL DEATH INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	2,476
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	2,404
Number of retired or separated participants receiving benefits	2012-07-01	0
Number of other retired or separated participants entitled to future benefits	2012-07-01	0
Total of all active and inactive participants	2012-07-01	2,404
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-07-01	0
Total participants	2012-07-01	2,404
Number of participants with account balances	2012-07-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-07-01	0
Number of employers contributing to the scheme	2012-07-01	0
2011: GROUP ACCIDENTAL DEATH INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-07-01	2,426
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	2,476
Number of retired or separated participants receiving benefits	2011-07-01	0
Number of other retired or separated participants entitled to future benefits	2011-07-01	0
Total of all active and inactive participants	2011-07-01	2,476
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-07-01	0
Total participants	2011-07-01	2,476
Number of participants with account balances	2011-07-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-07-01	0
2010: GROUP ACCIDENTAL DEATH INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year	2010-07-01	2,475
Total number of active participants reported on line 7a of the Form 5500	2010-07-01	2,426
Number of retired or separated participants receiving benefits	2010-07-01	0
Number of other retired or separated participants entitled to future benefits	2010-07-01	0
Total of all active and inactive participants	2010-07-01	2,426
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-07-01	0
Total participants	2010-07-01	2,426
Number of participants with account balances	2010-07-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-07-01	0
2009: GROUP ACCIDENTAL DEATH INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-07-01	2,481
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	2,475
Number of retired or separated participants receiving benefits	2009-07-01	0
Number of other retired or separated participants entitled to future benefits	2009-07-01	0
Total of all active and inactive participants	2009-07-01	2,475
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-07-01	0
Total participants	2009-07-01	2,475
Number of participants with account balances	2009-07-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-07-01	0

Form 5500 Responses for GROUP ACCIDENTAL DEATH INSURANCE PLAN

2013: GROUP ACCIDENTAL DEATH INSURANCE PLAN 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Submission has been amended	No
2013-07-01	This submission is the final filing	Yes
2013-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-07-01	Plan is a collectively bargained plan	No
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2012: GROUP ACCIDENTAL DEATH INSURANCE PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Submission has been amended	No
2012-07-01	This submission is the final filing	No
2012-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-07-01	Plan is a collectively bargained plan	No
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2011: GROUP ACCIDENTAL DEATH INSURANCE PLAN 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Submission has been amended	No
2011-07-01	This submission is the final filing	No
2011-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-07-01	Plan is a collectively bargained plan	No
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2010: GROUP ACCIDENTAL DEATH INSURANCE PLAN 2010 form 5500 responses
2010-07-01	Type of plan entity	Single employer plan
2010-07-01	Submission has been amended	No
2010-07-01	This submission is the final filing	No
2010-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-07-01	Plan is a collectively bargained plan	No
2010-07-01	Plan funding arrangement – Insurance	Yes
2010-07-01	Plan benefit arrangement – Insurance	Yes
2009: GROUP ACCIDENTAL DEATH INSURANCE PLAN 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	Submission has been amended	No
2009-07-01	This submission is the final filing	No
2009-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-07-01	Plan is a collectively bargained plan	No
2009-07-01	Plan funding arrangement – Insurance	Yes
2009-07-01	Plan benefit arrangement – Insurance	Yes

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Company Name:	SUSQUEHANNA HEALTH SYSTEM
Employer identification number (EIN):	232751183
NAIC Classification:	622000
NAIC Description:	Hospitals