401k Plan data: JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN plan

JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN 401k Plan overview

Plan Name	JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN
Plan identification number	501

JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

JERSEY SHORE HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name: JERSEY SHORE HOSPITAL

Employer identification number (EIN): 240792115

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about JERSEY SHORE HOSPITAL

Jurisdiction of Incorporation: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF STATE

Incorporation Date:

Company Identification Number: 179361

More information about JERSEY SHORE HOSPITAL

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-07-01 WENDY M. MARSHALL
501 2016-07-01 JOAN ROUNSLEY
501 2015-07-01 JOAN ROUNSLEY
501 2014-07-01 JOAN ROUNSLEY
501 2014-01-01 JOAN ROUNSLEY
501 2013-01-01 JOAN ROUNSLEY
501 2012-01-01 MEGAN SWITZER
501 2011-01-01 MEGAN SWITZER
501 2009-01-01 TRUDI ALEXANDER

Plan id#	Filing Submission Date	Name of Administrator
501	2017-07-01	WENDY M. MARSHALL
501	2016-07-01	JOAN ROUNSLEY
501	2015-07-01	JOAN ROUNSLEY
501	2014-07-01	JOAN ROUNSLEY
501	2014-01-01	JOAN ROUNSLEY
501	2013-01-01	JOAN ROUNSLEY
501	2012-01-01	MEGAN SWITZER
501	2011-01-01	MEGAN SWITZER
501	2009-01-01	TRUDI ALEXANDER

Plan Statistics for JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN

401k plan membership statisitcs for JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN

Measure Date Value
2017: JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN 2017 401k membership
Total participants, beginning-of-year 2017-07-01 167
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 0
Number of retired or separated participants receiving benefits 2017-07-01 0
Number of other retired or separated participants entitled to future benefits 2017-07-01 0
Total of all active and inactive participants 2017-07-01 0
2016: JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN 2016 401k membership
Total participants, beginning-of-year 2016-07-01 234
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 173
Number of retired or separated participants receiving benefits 2016-07-01 6
Number of other retired or separated participants entitled to future benefits 2016-07-01 0
Total of all active and inactive participants 2016-07-01 179
2015: JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN 2015 401k membership
Total participants, beginning-of-year 2015-07-01 237
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 231
Number of retired or separated participants receiving benefits 2015-07-01 3
Number of other retired or separated participants entitled to future benefits 2015-07-01 0
Total of all active and inactive participants 2015-07-01 234
2014: JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN 2014 401k membership
Total participants, beginning-of-year 2014-07-01 223
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 236
Number of retired or separated participants receiving benefits 2014-07-01 1
Number of other retired or separated participants entitled to future benefits 2014-07-01 0
Total of all active and inactive participants 2014-07-01 237
Total participants, beginning-of-year 2014-01-01 227
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 222
Number of retired or separated participants receiving benefits 2014-01-01 1
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 223
2013: JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 196
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 227
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 227
2012: JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 187
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 196
Total of all active and inactive participants 2012-01-01 196
Total participants 2012-01-01 196
2011: JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 172
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 187
Total of all active and inactive participants 2011-01-01 187
Total participants 2011-01-01 187
2009: JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 160
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 168
Total of all active and inactive participants 2009-01-01 168
Total participants 2009-01-01 168

Measure	Date	Value
2017: JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN 2017 401k membership
Total participants, beginning-of-year	2017-07-01	167
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	0
Number of retired or separated participants receiving benefits	2017-07-01	0
Number of other retired or separated participants entitled to future benefits	2017-07-01	0
Total of all active and inactive participants	2017-07-01	0
2016: JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN 2016 401k membership
Total participants, beginning-of-year	2016-07-01	234
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	173
Number of retired or separated participants receiving benefits	2016-07-01	6
Number of other retired or separated participants entitled to future benefits	2016-07-01	0
Total of all active and inactive participants	2016-07-01	179
2015: JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN 2015 401k membership
Total participants, beginning-of-year	2015-07-01	237
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	231
Number of retired or separated participants receiving benefits	2015-07-01	3
Number of other retired or separated participants entitled to future benefits	2015-07-01	0
Total of all active and inactive participants	2015-07-01	234
2014: JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN 2014 401k membership
Total participants, beginning-of-year	2014-07-01	223
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	236
Number of retired or separated participants receiving benefits	2014-07-01	1
Number of other retired or separated participants entitled to future benefits	2014-07-01	0
Total of all active and inactive participants	2014-07-01	237
Total participants, beginning-of-year	2014-01-01	227
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	222
Number of retired or separated participants receiving benefits	2014-01-01	1
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	223
2013: JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	196
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	227
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	227
2012: JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	187
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	196
Total of all active and inactive participants	2012-01-01	196
Total participants	2012-01-01	196
2011: JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	172
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	187
Total of all active and inactive participants	2011-01-01	187
Total participants	2011-01-01	187
2009: JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	160
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	168
Total of all active and inactive participants	2009-01-01	168
Total participants	2009-01-01	168

Form 5500 Responses for JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN

2017: JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	This submission is the final filing	Yes
2017-07-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2016: JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2015: JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2014: JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
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 benefit arrangement – Insurance	Yes
2011: JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
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 benefit arrangement – Insurance	Yes
2009: JERSEY SHORE HOSPITAL BLUECROSS AND BLUESHIELD 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 benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 )

Policy contract number

117998

Policy instance

Insurance contract or identification number	117998
Insurance policy start date	2017-07-01
Insurance policy end date	2018-03-17
Total amount of commissions paid to insurance broker	USD $37,698
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,256,601
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,698
Insurance broker organization code?	3
Insurance broker name	FIRST NATIONAL INSURANCE AGENCY

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Company Name:	JERSEY SHORE HOSPITAL
Employer identification number (EIN):	240792115
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF STATE
Incorporation Date:
Company Identification Number:	179361