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| Plan Name | SUSQUEHANNA HEALTH SYSTEM SUPPLEMENTAL LTD INSURANCE |
| Plan identification number | 511 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | SUSQUEHANNA HEALTH SYSTEM |
| Employer identification number (EIN): | 232751183 |
| NAIC Classification: | 622000 |
| NAIC Description: | Hospitals |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 511 | 2018-01-01 | ELIZABETH BRUBAKER | |||
| 511 | 2017-10-01 | ELIZABETH BRUBAKER | |||
| 511 | 2016-10-01 | ELIZABETH BRUBAKER |
| Measure | Date | Value |
|---|---|---|
| 2018: SUSQUEHANNA HEALTH SYSTEM SUPPLEMENTAL LTD INSURANCE 2018 401k membership | ||
| Total participants, beginning-of-year | 2018-01-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 0 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2018-01-01 | 0 |
| Total participants | 2018-01-01 | 0 |
| Number of participants with account balances | 2018-01-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2018-01-01 | 0 |
| Number of employers contributing to the scheme | 2018-01-01 | 0 |
| 2017: SUSQUEHANNA HEALTH SYSTEM SUPPLEMENTAL LTD INSURANCE 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-10-01 | 105 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-10-01 | 94 |
| Number of retired or separated participants receiving benefits | 2017-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-10-01 | 0 |
| Total of all active and inactive participants | 2017-10-01 | 94 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2017-10-01 | 0 |
| Total participants | 2017-10-01 | 94 |
| Number of participants with account balances | 2017-10-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2017-10-01 | 0 |
| 2016: SUSQUEHANNA HEALTH SYSTEM SUPPLEMENTAL LTD INSURANCE 2016 401k membership | ||
| Total participants, beginning-of-year | 2016-10-01 | 105 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-10-01 | 105 |
| Number of retired or separated participants receiving benefits | 2016-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-10-01 | 0 |
| Total of all active and inactive participants | 2016-10-01 | 105 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2016-10-01 | 0 |
| Total participants | 2016-10-01 | 105 |
| Number of participants with account balances | 2016-10-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2016-10-01 | 0 |
| 2018: SUSQUEHANNA HEALTH SYSTEM SUPPLEMENTAL LTD INSURANCE 2018 form 5500 responses | ||
|---|---|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | Yes |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: SUSQUEHANNA HEALTH SYSTEM SUPPLEMENTAL LTD INSURANCE 2017 form 5500 responses | ||
| 2017-10-01 | Type of plan entity | Single employer plan |
| 2017-10-01 | Submission has been amended | No |
| 2017-10-01 | This submission is the final filing | No |
| 2017-10-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2017-10-01 | Plan is a collectively bargained plan | No |
| 2017-10-01 | Plan funding arrangement – Insurance | Yes |
| 2017-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: SUSQUEHANNA HEALTH SYSTEM SUPPLEMENTAL LTD INSURANCE 2016 form 5500 responses | ||
| 2016-10-01 | Type of plan entity | Single employer plan |
| 2016-10-01 | First time form 5500 has been submitted | Yes |
| 2016-10-01 | Submission has been amended | No |
| 2016-10-01 | This submission is the final filing | No |
| 2016-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-10-01 | Plan is a collectively bargained plan | No |
| 2016-10-01 | Plan funding arrangement – Insurance | Yes |
| 2016-10-01 | Plan benefit arrangement – Insurance | Yes |
| MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | D2869 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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