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NVRH DENTAL, LIFE & DISABILITY PLAN 401k Plan overview

Plan NameNVRH DENTAL, LIFE & DISABILITY PLAN
Plan identification number 504

NVRH DENTAL, LIFE & DISABILITY PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

NORTHEASTERN VERMONT REGIONAL HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name:NORTHEASTERN VERMONT REGIONAL HOSPITAL
Employer identification number (EIN):036013761
NAIC Classification:622000
NAIC Description: Hospitals

Additional information about NORTHEASTERN VERMONT REGIONAL HOSPITAL

Jurisdiction of Incorporation: Vermont Secretary of State Corporations Division
Incorporation Date: 1964-06-01
Company Identification Number: 43838
Legal Registered Office Address: HOSPITAL DRIVE

ST. JOHNSBURY
United States of America (USA)
05819

More information about NORTHEASTERN VERMONT REGIONAL HOSPITAL

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NVRH DENTAL, LIFE & DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5042015-01-01ROBERT HERSEY ROBERT HERSEY2016-06-08
5042014-01-01ROBERT HERSEY ROBERT HERSEY2015-07-10
5042013-01-01ROBERT HERSEY ROBERT HERSEY2014-07-11
5042012-01-01ROBERT HERSEY
5042011-01-01ROBERT HERSEY
5042009-01-01ROBERT HERSEY ROBERT HERSEY2010-09-23

Plan Statistics for NVRH DENTAL, LIFE & DISABILITY PLAN

401k plan membership statisitcs for NVRH DENTAL, LIFE & DISABILITY PLAN

Measure Date Value
2015: NVRH DENTAL, LIFE & DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01454
Total number of active participants reported on line 7a of the Form 55002015-01-01443
Number of retired or separated participants receiving benefits2015-01-016
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01449
2014: NVRH DENTAL, LIFE & DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01449
Total number of active participants reported on line 7a of the Form 55002014-01-01450
Number of retired or separated participants receiving benefits2014-01-018
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01458
2013: NVRH DENTAL, LIFE & DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01429
Total number of active participants reported on line 7a of the Form 55002013-01-01443
Number of retired or separated participants receiving benefits2013-01-015
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01448
2012: NVRH DENTAL, LIFE & DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01363
Total number of active participants reported on line 7a of the Form 55002012-01-01429
Total of all active and inactive participants2012-01-01429
Total participants2012-01-010
2011: NVRH DENTAL, LIFE & DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01404
Total number of active participants reported on line 7a of the Form 55002011-01-01363
Number of retired or separated participants receiving benefits2011-01-011
Number of other retired or separated participants entitled to future benefits2011-01-011
Total of all active and inactive participants2011-01-01365
Total participants2011-01-01365
2009: NVRH DENTAL, LIFE & DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01377
Total number of active participants reported on line 7a of the Form 55002009-01-01390
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01390

Form 5500 Responses for NVRH DENTAL, LIFE & DISABILITY PLAN

2015: NVRH DENTAL, LIFE & DISABILITY PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: NVRH DENTAL, LIFE & DISABILITY PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: NVRH DENTAL, LIFE & DISABILITY PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: NVRH DENTAL, LIFE & DISABILITY PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: NVRH DENTAL, LIFE & DISABILITY PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: NVRH DENTAL, LIFE & DISABILITY PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number06216
Policy instance 1
Insurance contract or identification number06216
Number of Individuals Covered443
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $10,957
Total amount of fees paid to insurance companyUSD $159
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $295,707
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,957
Insurance broker organization code?3
Amount paid for insurance broker fees159
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATIVE FEES PAID
Insurance broker nameAXA ASSISTANCE, USA
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30037901
Policy instance 2
Insurance contract or identification number30037901
Number of Individuals Covered352
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,893
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $51,817
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,893
Insurance broker organization code?3
Insurance broker nameTHE RICHARDS GROUP
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number06216
Policy instance 1
Insurance contract or identification number06216
Number of Individuals Covered450
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $10,447
Total amount of fees paid to insurance companyUSD $160
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $244,713
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,447
Insurance broker organization code?3
Amount paid for insurance broker fees160
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker nameAXA ASSISTANCE, USA
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30037901
Policy instance 2
Insurance contract or identification number30037901
Number of Individuals Covered362
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,881
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,870
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,881
Insurance broker organization code?3
Insurance broker nameTHE RICHARDS GROUP
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number06216
Policy instance 1
Insurance contract or identification number06216
Number of Individuals Covered443
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $10,306
Total amount of fees paid to insurance companyUSD $158
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $230,588
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,306
Insurance broker organization code?3
Amount paid for insurance broker fees158
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker nameAXA ASSISTANCE, USA
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number06216
Policy instance 1
Insurance contract or identification number06216
Number of Individuals Covered113
Total amount of commissions paid to insurance brokerUSD $10,025
Total amount of fees paid to insurance companyUSD $151
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $409,473
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees151
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $3,665
Insurance broker nameHICKOK & BOARDMAN FINANCIAL
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number469814
Policy instance 2
Insurance contract or identification number469814
Number of Individuals Covered1006
Total amount of commissions paid to insurance brokerUSD $14,256
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $362,875
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,849
Insurance broker organization code?3
Insurance broker nameRICHARDS INC.
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number06216
Policy instance 1
Insurance contract or identification number06216
Number of Individuals Covered391
Total amount of commissions paid to insurance brokerUSD $9,323
Total amount of fees paid to insurance companyUSD $143
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $332,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number469814
Policy instance 2
Insurance contract or identification number469814
Number of Individuals Covered923
Total amount of commissions paid to insurance brokerUSD $11,985
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $300,064
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number06216
Policy instance 1
Insurance contract or identification number06216
Number of Individuals Covered403
Total amount of commissions paid to insurance brokerUSD $9,462
Total amount of fees paid to insurance companyUSD $129
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $346,246
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees129
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $9,462
Insurance broker nameSEGAL COMPANY
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number469814
Policy instance 2
Insurance contract or identification number469814
Number of Individuals Covered949
Total amount of commissions paid to insurance brokerUSD $10,351
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $282,082
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,351
Insurance broker organization code?3
Insurance broker nameSEGAL COMPANY

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