401k Plan data: ANNE ARUNDEL MEDICAL CENTER VOLUNTARY BENEFIT PLAN plan

ANNE ARUNDEL MEDICAL CENTER VOLUNTARY BENEFIT PLAN 401k Plan overview

Plan Name	ANNE ARUNDEL MEDICAL CENTER VOLUNTARY BENEFIT PLAN
Plan identification number	509

ANNE ARUNDEL MEDICAL CENTER VOLUNTARY BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Other welfare benefit cover

401k Sponsoring company profile

LUMINIS HEALTH ANNE ARUNDEL MEDICAL CENTER, INC. has sponsored the creation of one or more 401k plans.

Company Name: LUMINIS HEALTH ANNE ARUNDEL MEDICAL CENTER, INC.

Employer identification number (EIN): 521169362

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ANNE ARUNDEL MEDICAL CENTER VOLUNTARY BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
509 2016-07-01 NANCY LUTTRELL
509 2015-07-01 NANCY LUTTRELL
509 2014-07-01 NANCY LUTTRELL
509 2013-07-01 NANCY LUTTRELL
509 2012-07-01 NANCY LUTTRELL
509 2012-07-01

Plan Statistics for ANNE ARUNDEL MEDICAL CENTER VOLUNTARY BENEFIT PLAN

401k plan membership statisitcs for ANNE ARUNDEL MEDICAL CENTER VOLUNTARY BENEFIT PLAN

Measure Date Value
2016: ANNE ARUNDEL MEDICAL CENTER VOLUNTARY BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-07-01 387
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 0
Number of retired or separated participants receiving benefits 2016-07-01 0
Number of other retired or separated participants entitled to future benefits 2016-07-01 0
Total of all active and inactive participants 2016-07-01 0
2015: ANNE ARUNDEL MEDICAL CENTER VOLUNTARY BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-07-01 393
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 387
Number of retired or separated participants receiving benefits 2015-07-01 0
Number of other retired or separated participants entitled to future benefits 2015-07-01 0
Total of all active and inactive participants 2015-07-01 387
2014: ANNE ARUNDEL MEDICAL CENTER VOLUNTARY BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-07-01 377
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 393
Number of retired or separated participants receiving benefits 2014-07-01 0
Number of other retired or separated participants entitled to future benefits 2014-07-01 0
Total of all active and inactive participants 2014-07-01 393
2013: ANNE ARUNDEL MEDICAL CENTER VOLUNTARY BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-07-01 427
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 377
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 2013-07-01 377
2012: ANNE ARUNDEL MEDICAL CENTER VOLUNTARY BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 427
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 427
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 2012-07-01 427

Measure	Date	Value
2016: ANNE ARUNDEL MEDICAL CENTER VOLUNTARY BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-07-01	387
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	0
Number of retired or separated participants receiving benefits	2016-07-01	0
Number of other retired or separated participants entitled to future benefits	2016-07-01	0
Total of all active and inactive participants	2016-07-01	0
2015: ANNE ARUNDEL MEDICAL CENTER VOLUNTARY BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-07-01	393
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	387
Number of retired or separated participants receiving benefits	2015-07-01	0
Number of other retired or separated participants entitled to future benefits	2015-07-01	0
Total of all active and inactive participants	2015-07-01	387
2014: ANNE ARUNDEL MEDICAL CENTER VOLUNTARY BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-07-01	377
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	393
Number of retired or separated participants receiving benefits	2014-07-01	0
Number of other retired or separated participants entitled to future benefits	2014-07-01	0
Total of all active and inactive participants	2014-07-01	393
2013: ANNE ARUNDEL MEDICAL CENTER VOLUNTARY BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-07-01	427
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	377
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	377
2012: ANNE ARUNDEL MEDICAL CENTER VOLUNTARY BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	427
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	427
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	427

Form 5500 Responses for ANNE ARUNDEL MEDICAL CENTER VOLUNTARY BENEFIT PLAN

2016: ANNE ARUNDEL MEDICAL CENTER VOLUNTARY BENEFIT PLAN 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Submission has been amended	No
2016-07-01	This submission is the final filing	Yes
2016-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-07-01	Plan is a collectively bargained plan	No
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2015: ANNE ARUNDEL MEDICAL CENTER VOLUNTARY BENEFIT PLAN 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Submission has been amended	No
2015-07-01	This submission is the final filing	No
2015-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-07-01	Plan is a collectively bargained plan	No
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2014: ANNE ARUNDEL MEDICAL CENTER VOLUNTARY BENEFIT PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Submission has been amended	No
2014-07-01	This submission is the final filing	No
2014-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-07-01	Plan is a collectively bargained plan	No
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2013: ANNE ARUNDEL MEDICAL CENTER VOLUNTARY BENEFIT 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	No
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: ANNE ARUNDEL MEDICAL CENTER VOLUNTARY BENEFIT PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	First time form 5500 has been submitted	Yes
2012-07-01	Submission has been amended	Yes
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

Insurance Providers Used on plan

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

FKQ83

Policy instance

Insurance contract or identification number	FKQ83
Number of Individuals Covered	387
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $87,751
Total amount of fees paid to insurance company	USD $3,176
Are there contracts with allocated funds for individual policies?	No
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENT INDEMNITY, CANCER CARE, CRITICAL CARE & RECOVERY, HOSPITAL CONFINEMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $460,478
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,394
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	BRIAN G JAEGGI

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

FKQ83

Policy instance

Insurance contract or identification number	FKQ83
Number of Individuals Covered	393
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $81,103
Total amount of fees paid to insurance company	USD $3,423
Are there contracts with allocated funds for individual policies?	No
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENT INDEMNITY, CANCER CARE, CRITICAL CARE & RECOVERY, HOSPITAL CONFINEMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $439,303
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,469
Amount paid for insurance broker fees	1859
Additional information about fees paid to insurance broker	COMMISSIONS/FEES
Insurance broker organization code?	3
Insurance broker name	JAMES R HILL SR

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

FKQ83

Policy instance

Insurance contract or identification number	FKQ83
Number of Individuals Covered	377
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $97,874
Total amount of fees paid to insurance company	USD $506
Are there contracts with allocated funds for individual policies?	No
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENT INDEMNITY, CANCER CARE, CRITICAL CARE & RECOVERY, HOSPITAL CONFINEMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $455,152
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $30,158
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	RHONDA NEWMAN

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

FKQ83

Policy instance

Insurance contract or identification number	FKQ83
Number of Individuals Covered	427
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $264,971
Total amount of fees paid to insurance company	USD $1,799
Are there contracts with allocated funds for individual policies?	No
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENT INDEMNITY, CANCER CARE, CRITICAL CARE & RECOVERY, HOSPITAL CONFINEMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $491,032
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $88,864
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	WILLIAM M WARDLAW JR

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Company Name:	LUMINIS HEALTH ANNE ARUNDEL MEDICAL CENTER, INC.
Employer identification number (EIN):	521169362
NAIC Classification:	622000
NAIC Description:	Hospitals

Plan id#	Filing Submission Date	Name of Administrator
509	2016-07-01	NANCY LUTTRELL
509	2015-07-01	NANCY LUTTRELL
509	2014-07-01	NANCY LUTTRELL
509	2013-07-01	NANCY LUTTRELL
509	2012-07-01	NANCY LUTTRELL
509	2012-07-01