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| Plan Name | GROUP LIFE AND DISABILITY BENEFIT PLAN FOR EMPLOYEES OF ARTESIA GENERAL HOSPITAL |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | ARTESIA GENERAL HOSPITAL |
| Employer identification number (EIN): | 742851819 |
| NAIC Classification: | 622000 |
| NAIC Description: | Hospitals |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2016-01-01 | CORINA YATES | |||
| 502 | 2015-01-01 | CORINA YATES |
| Measure | Date | Value |
|---|---|---|
| 2016: GROUP LIFE AND DISABILITY BENEFIT PLAN FOR EMPLOYEES OF ARTESIA GENERAL HOSPITAL 2016 401k membership | ||
| Total participants, beginning-of-year | 2016-01-01 | 313 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 0 |
| 2015: GROUP LIFE AND DISABILITY BENEFIT PLAN FOR EMPLOYEES OF ARTESIA GENERAL HOSPITAL 2015 401k membership | ||
| Total participants, beginning-of-year | 2015-01-01 | 244 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 313 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 313 |
| 2016: GROUP LIFE AND DISABILITY BENEFIT PLAN FOR EMPLOYEES OF ARTESIA GENERAL HOSPITAL 2016 form 5500 responses | ||
|---|---|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | Yes |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: GROUP LIFE AND DISABILITY BENEFIT PLAN FOR EMPLOYEES OF ARTESIA GENERAL HOSPITAL 2015 form 5500 responses | ||
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | First time form 5500 has been submitted | Yes |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | OK968031 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | VDT961773 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | VDT961772 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | FLX966507 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 4 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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