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OUR LADY OF LOURDES MEMORIAL HOSPITAL EMPLOYEE HEALTH AND GROUP INSURANCE PLAN 401k Plan overview

Plan NameOUR LADY OF LOURDES MEMORIAL HOSPITAL EMPLOYEE HEALTH AND GROUP INSURANCE PLAN
Plan identification number 501

OUR LADY OF LOURDES MEMORIAL HOSPITAL EMPLOYEE HEALTH AND GROUP INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Other welfare benefit cover

401k Sponsoring company profile

OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. has sponsored the creation of one or more 401k plans.

Company Name:OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC.
Employer identification number (EIN):150532221
NAIC Classification:622000
NAIC Description: Hospitals

Additional information about OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC.

Jurisdiction of Incorporation: New York Department of State
Incorporation Date: 1936-05-20
Company Identification Number: 38264
Legal Registered Office Address: 80 STATE STREET
Broome
ALBANY
United States of America (USA)
122072543

More information about OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OUR LADY OF LOURDES MEMORIAL HOSPITAL EMPLOYEE HEALTH AND GROUP INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012012-01-01MARY HUGHS DAVID PATAK2013-10-03
5012011-01-01MARY HUGHS DAVID PATAK2012-10-15
5012010-01-01MARY HUGHS DAVID PATAK2011-07-29
5012009-01-01MARY HUGHS DAVID PATAK2010-07-26

Plan Statistics for OUR LADY OF LOURDES MEMORIAL HOSPITAL EMPLOYEE HEALTH AND GROUP INSURANCE PLAN

401k plan membership statisitcs for OUR LADY OF LOURDES MEMORIAL HOSPITAL EMPLOYEE HEALTH AND GROUP INSURANCE PLAN

Measure Date Value
2012: OUR LADY OF LOURDES MEMORIAL HOSPITAL EMPLOYEE HEALTH AND GROUP INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-011,672
Total number of active participants reported on line 7a of the Form 55002012-01-011,639
Number of retired or separated participants receiving benefits2012-01-0110
Total of all active and inactive participants2012-01-011,649
Total participants2012-01-011,649
2011: OUR LADY OF LOURDES MEMORIAL HOSPITAL EMPLOYEE HEALTH AND GROUP INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-011,753
Total number of active participants reported on line 7a of the Form 55002011-01-011,721
Number of retired or separated participants receiving benefits2011-01-016
Total of all active and inactive participants2011-01-011,727
Total participants2011-01-011,727
2010: OUR LADY OF LOURDES MEMORIAL HOSPITAL EMPLOYEE HEALTH AND GROUP INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-011,535
Total number of active participants reported on line 7a of the Form 55002010-01-011,561
Number of retired or separated participants receiving benefits2010-01-0125
Total of all active and inactive participants2010-01-011,586
Total participants2010-01-011,586
2009: OUR LADY OF LOURDES MEMORIAL HOSPITAL EMPLOYEE HEALTH AND GROUP INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-011,537
Total number of active participants reported on line 7a of the Form 55002009-01-011,509
Number of retired or separated participants receiving benefits2009-01-0126
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-011,535
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-011,535
Number of participants with account balances2009-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Form 5500 Responses for OUR LADY OF LOURDES MEMORIAL HOSPITAL EMPLOYEE HEALTH AND GROUP INSURANCE PLAN

2012: OUR LADY OF LOURDES MEMORIAL HOSPITAL EMPLOYEE HEALTH AND GROUP INSURANCE PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01First time form 5500 has been submittedYes
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: OUR LADY OF LOURDES MEMORIAL HOSPITAL EMPLOYEE HEALTH AND GROUP INSURANCE PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01First time form 5500 has been submittedYes
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: OUR LADY OF LOURDES MEMORIAL HOSPITAL EMPLOYEE HEALTH AND GROUP INSURANCE PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: OUR LADY OF LOURDES MEMORIAL HOSPITAL EMPLOYEE HEALTH AND GROUP INSURANCE 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 funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )
Policy contract number510181
Policy instance 1
Insurance contract or identification number510181
Number of Individuals Covered1753
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberN9858
Policy instance 2
Insurance contract or identification numberN9858
Number of Individuals Covered183
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Other welfare benefits providedSPECIFIED DISEASE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $82,990
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberN9858
Policy instance 1
Insurance contract or identification numberN9858
Number of Individuals Covered187
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Health Insurance Welfare BenefitNo
Other welfare benefits providedSPECIFIED DISEASE INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $84,866
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )
Policy contract number510181
Policy instance 2
Insurance contract or identification number510181
Number of Individuals Covered1586
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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