401k Plan data: DEACONESS WOMENS HOSPITAL STD PLAN plan

DEACONESS WOMENS HOSPITAL STD PLAN 401k Plan overview

Plan Name	DEACONESS WOMENS HOSPITAL STD PLAN
Plan identification number	504

DEACONESS WOMENS HOSPITAL STD PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Temporary disability (accident and sickness) Long-term disability cover

401k Sponsoring company profile

DEACONESS WOMENS HOSPITAL OF SOUTHERN INDIANA, LLC has sponsored the creation of one or more 401k plans.

Company Name: DEACONESS WOMENS HOSPITAL OF SOUTHERN INDIANA, LLC

Employer identification number (EIN): 352062016

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DEACONESS WOMENS HOSPITAL STD PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2022-01-01 CHRISTINA M. CADY 2023-06-20
504 2021-01-01 CHRISTINEA M. CADY 2022-05-25 CHRISTINEA M. CADY 2022-05-25
504 2020-01-01 CHRISTINA M. CADY 2021-06-14 CHRISTINA M. CADY 2021-06-14
504 2019-01-01 CHRISTINA M. CADY 2020-06-10 CHRISTINA M. CADY 2020-06-10
504 2018-01-01 CHRISTINA M. CADY
504 2017-01-01 CHRISTINA M. CADY
504 2016-01-01 CHRISTINA M. CADY

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
504	2022-01-01	CHRISTINA M. CADY	2023-06-20
504	2021-01-01	CHRISTINEA M. CADY	2022-05-25	CHRISTINEA M. CADY	2022-05-25
504	2020-01-01	CHRISTINA M. CADY	2021-06-14	CHRISTINA M. CADY	2021-06-14
504	2019-01-01	CHRISTINA M. CADY	2020-06-10	CHRISTINA M. CADY	2020-06-10
504	2018-01-01	CHRISTINA M. CADY
504	2017-01-01	CHRISTINA M. CADY
504	2016-01-01	CHRISTINA M. CADY

Plan Statistics for DEACONESS WOMENS HOSPITAL STD PLAN

401k plan membership statisitcs for DEACONESS WOMENS HOSPITAL STD PLAN

Measure Date Value
2022: DEACONESS WOMENS HOSPITAL STD PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 584
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 571
Total of all active and inactive participants 2022-01-01 571
Total participants 2022-01-01 571
2021: DEACONESS WOMENS HOSPITAL STD PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 550
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 572
Total of all active and inactive participants 2021-01-01 572
Total participants 2021-01-01 572
2020: DEACONESS WOMENS HOSPITAL STD PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 554
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 544
Total of all active and inactive participants 2020-01-01 544
Total participants 2020-01-01 544
2019: DEACONESS WOMENS HOSPITAL STD PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 525
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 544
Total of all active and inactive participants 2019-01-01 544
Total participants 2019-01-01 544
2018: DEACONESS WOMENS HOSPITAL STD PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 523
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 524
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 2018-01-01 524
2017: DEACONESS WOMENS HOSPITAL STD PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 506
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 518
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 518
2016: DEACONESS WOMENS HOSPITAL STD PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 510
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 551
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 551

Measure	Date	Value
2022: DEACONESS WOMENS HOSPITAL STD PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	584
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	571
Total of all active and inactive participants	2022-01-01	571
Total participants	2022-01-01	571
2021: DEACONESS WOMENS HOSPITAL STD PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	550
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	572
Total of all active and inactive participants	2021-01-01	572
Total participants	2021-01-01	572
2020: DEACONESS WOMENS HOSPITAL STD PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	554
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	544
Total of all active and inactive participants	2020-01-01	544
Total participants	2020-01-01	544
2019: DEACONESS WOMENS HOSPITAL STD PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	525
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	544
Total of all active and inactive participants	2019-01-01	544
Total participants	2019-01-01	544
2018: DEACONESS WOMENS HOSPITAL STD PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	523
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	524
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	524
2017: DEACONESS WOMENS HOSPITAL STD PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	506
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	518
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	518
2016: DEACONESS WOMENS HOSPITAL STD PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	510
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	551
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	551

Form 5500 Responses for DEACONESS WOMENS HOSPITAL STD PLAN

2022: DEACONESS WOMENS HOSPITAL STD PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: DEACONESS WOMENS HOSPITAL STD PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: DEACONESS WOMENS HOSPITAL STD PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: DEACONESS WOMENS HOSPITAL STD PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: DEACONESS WOMENS HOSPITAL STD PLAN 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	No
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: DEACONESS WOMENS HOSPITAL STD PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: DEACONESS WOMENS HOSPITAL STD PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	First time form 5500 has been submitted	Yes
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 751940

Policy instance

Insurance contract or identification number	LK 751940
Number of Individuals Covered	571
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $43,133
Total amount of fees paid to insurance company	USD $1,021
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $317,857
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $43,133
Insurance broker organization code?	3
Amount paid for insurance broker fees	1021
Additional information about fees paid to insurance broker	SERVICE FEES

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 751940

Policy instance

Insurance contract or identification number	LK 751940
Number of Individuals Covered	572
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $39,841
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $265,604
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,841
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 751940

Policy instance

Insurance contract or identification number	LK 751940
Number of Individuals Covered	544
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $18,207
Total amount of fees paid to insurance company	USD $4,722
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $121,378
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $18,207
Amount paid for insurance broker fees	4722
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 751940

Policy instance

Insurance contract or identification number	LK 751940
Number of Individuals Covered	544
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $37,819
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $252,124
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,819
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 751940

Policy instance

Insurance contract or identification number	LK 751940
Number of Individuals Covered	524
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $29,854
Total amount of fees paid to insurance company	USD $4,180
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $199,026
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,854
Amount paid for insurance broker fees	4180
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 751940

Policy instance

Insurance contract or identification number	LK 751940
Number of Individuals Covered	518
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $36,251
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $241,674
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36,251
Insurance broker organization code?	3
Insurance broker name	CLIPPINGER FINANCIAL GROUP

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Company Name:	DEACONESS WOMENS HOSPITAL OF SOUTHERN INDIANA, LLC
Employer identification number (EIN):	352062016
NAIC Classification:	622000
NAIC Description:	Hospitals