| Plan Name | OUR LADY OF LOURDES MEMORIAL HOSPITAL EMPLOYEE HEALTH AND GROUP INSURANCE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| 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.
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2012-01-01 | MARY HUGHS | DAVID PATAK | 2013-10-03 | |
| 501 | 2011-01-01 | MARY HUGHS | DAVID PATAK | 2012-10-15 | |
| 501 | 2010-01-01 | MARY HUGHS | DAVID PATAK | 2011-07-29 | |
| 501 | 2009-01-01 | MARY HUGHS | DAVID PATAK | 2010-07-26 |
| 2012: OUR LADY OF LOURDES MEMORIAL HOSPITAL EMPLOYEE HEALTH AND GROUP INSURANCE PLAN 2012 form 5500 responses | ||
|---|---|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | First time form 5500 has been submitted | Yes |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: OUR LADY OF LOURDES MEMORIAL HOSPITAL EMPLOYEE HEALTH AND GROUP INSURANCE PLAN 2011 form 5500 responses | ||
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | First time form 5500 has been submitted | Yes |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: OUR LADY OF LOURDES MEMORIAL HOSPITAL EMPLOYEE HEALTH AND GROUP INSURANCE PLAN 2010 form 5500 responses | ||
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Submission has been amended | No |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | No |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: OUR LADY OF LOURDES MEMORIAL HOSPITAL EMPLOYEE HEALTH AND GROUP INSURANCE PLAN 2009 form 5500 responses | ||
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 ) | |
| Policy contract number | 510181 |
| Policy instance | 1 |
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) | |
| Policy contract number | N9858 |
| Policy instance | 2 |
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) | |
| Policy contract number | N9858 |
| Policy instance | 1 |
| EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 ) | |
| Policy contract number | 510181 |
| Policy instance | 2 |