401k Plan data: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN plan

KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 401k Plan overview

Plan Name	KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN
Plan identification number	515

KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Long-term disability cover

401k Sponsoring company profile

KATHERINE SHAW BETHEA HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name: KATHERINE SHAW BETHEA HOSPITAL

Employer identification number (EIN): 361000540

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
515 2023-01-01
515 2023-01-01 HEATHER YOUNGMARK
515 2022-01-01
515 2022-01-01 SARAH ENGELKENS
515 2021-01-01
515 2021-01-01 SARAH ENGELKENS
515 2020-01-01
515 2019-01-01
515 2018-01-01
515 2017-01-01 SUZANNE RAVLIN
515 2016-01-01 SUZANNE RAVLIN
515 2016-01-01
515 2015-01-01 SUZANNE RAVLIN
515 2014-01-01 SUZANNE RAVLIN
515 2013-01-01 SUZANNE RAVLIN
515 2012-01-01 SUZANNE RAVLIN SUZANNE RAVLIN 2013-10-15
515 2011-01-01 SUZANNE RAVLIN
515 2009-01-01 DEBRA DIDIER 2010-07-21
515 2009-01-01 DEBRA DIDIER
515 2008-01-01 DEBRA DIDIER 2010-02-23
515 2007-01-01 DEBRA DIDIER 2010-02-23
515 2006-01-01 DEBRA DIDIER 2010-02-23
515 2005-01-01 DEBRA DIDIER 2010-02-23
515 2004-01-01 DEBRA DIDIER 2010-02-23
515 2003-01-01 DEBRA DIDIER 2010-02-23
515 2002-01-01 DEBRA DIDIER 2010-02-23
515 2001-01-01 DEBRA DIDIER 2010-02-23
515 2000-01-01 DEBRA DIDIER 2010-02-23

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
515	2023-01-01
515	2023-01-01	HEATHER YOUNGMARK
515	2022-01-01
515	2022-01-01	SARAH ENGELKENS
515	2021-01-01
515	2021-01-01	SARAH ENGELKENS
515	2020-01-01
515	2019-01-01
515	2018-01-01
515	2017-01-01	SUZANNE RAVLIN
515	2016-01-01	SUZANNE RAVLIN
515	2016-01-01
515	2015-01-01	SUZANNE RAVLIN
515	2014-01-01	SUZANNE RAVLIN
515	2013-01-01	SUZANNE RAVLIN
515	2012-01-01	SUZANNE RAVLIN	SUZANNE RAVLIN	2013-10-15
515	2011-01-01	SUZANNE RAVLIN
515	2009-01-01		DEBRA DIDIER	2010-07-21
515	2009-01-01	DEBRA DIDIER
515	2008-01-01		DEBRA DIDIER	2010-02-23
515	2007-01-01		DEBRA DIDIER	2010-02-23
515	2006-01-01		DEBRA DIDIER	2010-02-23
515	2005-01-01		DEBRA DIDIER	2010-02-23
515	2004-01-01		DEBRA DIDIER	2010-02-23
515	2003-01-01		DEBRA DIDIER	2010-02-23
515	2002-01-01		DEBRA DIDIER	2010-02-23
515	2001-01-01		DEBRA DIDIER	2010-02-23
515	2000-01-01		DEBRA DIDIER	2010-02-23

Form 5500 Responses for KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN

2023: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Submission has been amended	No
2023-01-01	This submission is the final filing	No
2023-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2023-01-01	Plan is a collectively bargained plan	No
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2022: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT 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: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT 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: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	Yes
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
2015: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT 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: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT 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: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT 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
2008: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2008 form 5500 responses
2008-01-01	Type of plan entity	Single employer plan
2008-01-01	Submission has been amended	No
2008-01-01	This submission is the final filing	No
2008-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-01-01	Plan is a collectively bargained plan	No
2008-01-01	Plan funding arrangement – Insurance	Yes
2008-01-01	Plan benefit arrangement – Insurance	Yes
2007: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2007 form 5500 responses
2007-01-01	Type of plan entity	Single employer plan
2007-01-01	Submission has been amended	No
2007-01-01	This submission is the final filing	No
2007-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2007-01-01	Plan is a collectively bargained plan	No
2007-01-01	Plan funding arrangement – Insurance	Yes
2007-01-01	Plan benefit arrangement – Insurance	Yes
2006: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2006 form 5500 responses
2006-01-01	Type of plan entity	Single employer plan
2006-01-01	Submission has been amended	No
2006-01-01	This submission is the final filing	No
2006-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2006-01-01	Plan is a collectively bargained plan	No
2006-01-01	Plan funding arrangement – Insurance	Yes
2006-01-01	Plan benefit arrangement – Insurance	Yes
2005: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2005 form 5500 responses
2005-01-01	Type of plan entity	Single employer plan
2005-01-01	Submission has been amended	No
2005-01-01	This submission is the final filing	No
2005-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2005-01-01	Plan is a collectively bargained plan	No
2005-01-01	Plan funding arrangement – Insurance	Yes
2005-01-01	Plan benefit arrangement – Insurance	Yes
2004: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2004 form 5500 responses
2004-01-01	Type of plan entity	Single employer plan
2004-01-01	Submission has been amended	No
2004-01-01	This submission is the final filing	No
2004-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2004-01-01	Plan is a collectively bargained plan	No
2004-01-01	Plan funding arrangement – Insurance	Yes
2004-01-01	Plan benefit arrangement – Insurance	Yes
2003: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2003 form 5500 responses
2003-01-01	Type of plan entity	Single employer plan
2003-01-01	Submission has been amended	No
2003-01-01	This submission is the final filing	No
2003-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2003-01-01	Plan is a collectively bargained plan	No
2003-01-01	Plan funding arrangement – Insurance	Yes
2003-01-01	Plan benefit arrangement – Insurance	Yes
2002: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2002 form 5500 responses
2002-01-01	Type of plan entity	Single employer plan
2002-01-01	Submission has been amended	No
2002-01-01	This submission is the final filing	No
2002-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2002-01-01	Plan is a collectively bargained plan	No
2002-01-01	Plan funding arrangement – Insurance	Yes
2002-01-01	Plan benefit arrangement – Insurance	Yes
2001: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2001 form 5500 responses
2001-01-01	Type of plan entity	Single employer plan
2001-01-01	Submission has been amended	No
2001-01-01	This submission is the final filing	No
2001-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2001-01-01	Plan is a collectively bargained plan	No
2001-01-01	Plan funding arrangement – Insurance	Yes
2001-01-01	Plan benefit arrangement – Insurance	Yes
2000: KATHERINE SHAW BETHEA HOSPITAL GROUP LONG TERM DISABILITY BENEFIT PLAN 2000 form 5500 responses
2000-01-01	Type of plan entity	Single employer plan
2000-01-01	First time form 5500 has been submitted	Yes
2000-01-01	Submission has been amended	No
2000-01-01	This submission is the final filing	No
2000-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2000-01-01	Plan is a collectively bargained plan	No
2000-01-01	Plan funding arrangement – Insurance	Yes
2000-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

Policy instance

Insurance contract or identification number	3
Number of Individuals Covered	329
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $13,322
Total amount of fees paid to insurance company	USD $16,962
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	No
Long Term Disability Insurance Welfare Benefit	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

Policy instance

Insurance contract or identification number	3
Number of Individuals Covered	353
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $12,133
Total amount of fees paid to insurance company	USD $4,403
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	No
Long Term Disability Insurance Welfare Benefit	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

Policy instance

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

Policy instance

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

Policy instance

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

Policy instance

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

Policy instance

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Company Name:	KATHERINE SHAW BETHEA HOSPITAL
Employer identification number (EIN):	361000540
NAIC Classification:	622000
NAIC Description:	Hospitals