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NORTHERN OSWEGO COUNTY HEALTH SERVICES INC. HEALTH & WELFARE BENEFITS PLAN 401k Plan overview

Plan NameNORTHERN OSWEGO COUNTY HEALTH SERVICES INC. HEALTH & WELFARE BENEFITS PLAN
Plan identification number 501

NORTHERN OSWEGO COUNTY HEALTH SERVICES INC. HEALTH & WELFARE BENEFITS PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

NORTHERN OSWEGO COUNTY HEALTH SERVICES INC. has sponsored the creation of one or more 401k plans.

Company Name:NORTHERN OSWEGO COUNTY HEALTH SERVICES INC.
Employer identification number (EIN):207036393
NAIC Classification:621498
NAIC Description:All Other Outpatient Care Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTHERN OSWEGO COUNTY HEALTH SERVICES INC. HEALTH & WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012014-01-01KAREN T. PATERNITI
5012013-01-01KAREN T. PATERNITI

Plan Statistics for NORTHERN OSWEGO COUNTY HEALTH SERVICES INC. HEALTH & WELFARE BENEFITS PLAN

401k plan membership statisitcs for NORTHERN OSWEGO COUNTY HEALTH SERVICES INC. HEALTH & WELFARE BENEFITS PLAN

Measure Date Value
2014: NORTHERN OSWEGO COUNTY HEALTH SERVICES INC. HEALTH & WELFARE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01180
Total number of active participants reported on line 7a of the Form 55002014-01-01187
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01187
Total participants2014-01-01187
2013: NORTHERN OSWEGO COUNTY HEALTH SERVICES INC. HEALTH & WELFARE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01102
Total number of active participants reported on line 7a of the Form 55002013-01-01102
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01102
Total participants2013-01-01102

Form 5500 Responses for NORTHERN OSWEGO COUNTY HEALTH SERVICES INC. HEALTH & WELFARE BENEFITS PLAN

2014: NORTHERN OSWEGO COUNTY HEALTH SERVICES INC. HEALTH & WELFARE BENEFITS PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: NORTHERN OSWEGO COUNTY HEALTH SERVICES INC. HEALTH & WELFARE BENEFITS PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01First time form 5500 has been submittedYes
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )
Policy contract number00007747
Policy instance 1
Insurance contract or identification number00007747
Number of Individuals Covered124
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $64,507
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $64,507
Insurance broker organization code?3
Insurance broker nameTHE GEORGE L. WLADIS COMPANIES, INC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00314369
Policy instance 2
Insurance contract or identification number00314369
Number of Individuals Covered183
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $7,116
Total amount of fees paid to insurance companyUSD $3,885
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $105,861
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,116
Amount paid for insurance broker fees3885
Insurance broker organization code?3
Insurance broker nameTHE GEORGE L WLADIS CO
EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )
Policy contract number11117747
Policy instance 1
Insurance contract or identification number11117747
Number of Individuals Covered113
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $51,211
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $51,211
Insurance broker organization code?3
Insurance broker nameTHE GEORGE L. WLADIS COMPANIES, INC
THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 89009 )
Policy contract number445261
Policy instance 2
Insurance contract or identification number445261
Number of Individuals Covered178
Insurance policy start date2013-06-01
Insurance policy end date2013-11-30
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00314369
Policy instance 3
Insurance contract or identification number00314369
Number of Individuals Covered158
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $6,465
Total amount of fees paid to insurance companyUSD $2,974
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $74,881
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,406
Amount paid for insurance broker fees2974
Insurance broker organization code?3
Insurance broker nameELIAS HOWARD J INC

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