401k Plan data: GRAHAM HOSPITAL ASSOCIATION HEALTH PLAN plan

GRAHAM HOSPITAL ASSOCIATION HEALTH PLAN 401k Plan overview

Plan Name	GRAHAM HOSPITAL ASSOCIATION HEALTH PLAN
Plan identification number	502

GRAHAM HOSPITAL ASSOCIATION HEALTH PLAN Benefits

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

401k Sponsoring company profile

GRAHAM HOSPITAL ASSOCIATION has sponsored the creation of one or more 401k plans.

Company Name: GRAHAM HOSPITAL ASSOCIATION

Employer identification number (EIN): 370673506

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GRAHAM HOSPITAL ASSOCIATION HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2023-07-01 MELANIE EWALT 2024-11-11
502 2022-07-01 KYLE COOK 2023-11-02
502 2022-01-01 KYLE COOK 2023-01-31
502 2021-01-01 KYLE COOK 2022-09-22
502 2020-01-01 KYLE COOK 2021-10-04
502 2019-01-01
502 2019-01-01 KYLE COOK 2021-12-06
502 2018-01-01 KYLE COOK
502 2017-01-01 KYLE COOK
502 2016-01-01 KYLE COOK KYLE COOK 2017-07-28
502 2015-01-01 JULIE REEDER JULIE REEDER 2016-07-19
502 2014-01-01 JULIE REEDER JULIE REEDER 2015-06-08
502 2013-01-01 MELISSA WILSON MELISSA WILSON 2014-06-24
502 2012-01-01 MELISSA WILSON MELISSA WILSON 2013-05-14
502 2011-01-01 MELISSA WILSON
502 2009-01-01 MELISSA WILSON
502 2009-01-01 MELISSA WILSON 2010-08-08
502 2009-01-01 MELISSA WILSON 2010-07-29

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2023-07-01	MELANIE EWALT	2024-11-11
502	2022-07-01	KYLE COOK	2023-11-02
502	2022-01-01	KYLE COOK	2023-01-31
502	2021-01-01	KYLE COOK	2022-09-22
502	2020-01-01	KYLE COOK	2021-10-04
502	2019-01-01
502	2019-01-01	KYLE COOK	2021-12-06
502	2018-01-01	KYLE COOK
502	2017-01-01	KYLE COOK
502	2016-01-01	KYLE COOK		KYLE COOK	2017-07-28
502	2015-01-01	JULIE REEDER		JULIE REEDER	2016-07-19
502	2014-01-01	JULIE REEDER		JULIE REEDER	2015-06-08
502	2013-01-01	MELISSA WILSON		MELISSA WILSON	2014-06-24
502	2012-01-01	MELISSA WILSON		MELISSA WILSON	2013-05-14
502	2011-01-01	MELISSA WILSON
502	2009-01-01	MELISSA WILSON
502	2009-01-01			MELISSA WILSON	2010-08-08
502	2009-01-01			MELISSA WILSON	2010-07-29

Form 5500 Responses for GRAHAM HOSPITAL ASSOCIATION HEALTH PLAN

2023: GRAHAM HOSPITAL ASSOCIATION HEALTH PLAN 2023 form 5500 responses
2023-07-01	Type of plan entity	Single employer plan
2023-07-01	Plan funding arrangement – Insurance	Yes
2023-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-07-01	Plan benefit arrangement – Insurance	Yes
2023-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2022: GRAHAM HOSPITAL ASSOCIATION HEALTH PLAN 2022 form 5500 responses
2022-07-01	Type of plan entity	Single employer plan
2022-07-01	Plan funding arrangement – Insurance	Yes
2022-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-07-01	Plan benefit arrangement – Insurance	Yes
2022-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: GRAHAM HOSPITAL ASSOCIATION HEALTH PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: GRAHAM HOSPITAL ASSOCIATION HEALTH PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: GRAHAM HOSPITAL ASSOCIATION HEALTH 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 funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: GRAHAM HOSPITAL ASSOCIATION HEALTH 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 funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: GRAHAM HOSPITAL ASSOCIATION HEALTH 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 funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: GRAHAM HOSPITAL ASSOCIATION HEALTH PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
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 funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: GRAHAM HOSPITAL ASSOCIATION HEALTH 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 funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: GRAHAM HOSPITAL ASSOCIATION HEALTH 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 funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: GRAHAM HOSPITAL ASSOCIATION HEALTH 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 funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: GRAHAM HOSPITAL ASSOCIATION HEALTH 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 funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: GRAHAM HOSPITAL ASSOCIATION HEALTH 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 funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: GRAHAM HOSPITAL ASSOCIATION HEALTH PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
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 funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

11640

Policy instance

Insurance contract or identification number	11640
Number of Individuals Covered	506
Insurance policy start date	2023-07-01
Insurance policy end date	2024-06-30
Total amount of commissions paid to insurance broker	USD $8,317
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $302,099
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

11640

Policy instance

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

11640

Policy instance

Insurance contract or identification number	11640
Number of Individuals Covered	441
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $6,462
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $215,404
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

059101

Policy instance

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 04758 )

Policy contract number

10809

Policy instance

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

059101

Policy instance

DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

10809

Policy instance

HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL RESERVE COMPANY (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

059101

Policy instance

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 47589 )

Policy contract number

10809

Policy instance

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Company Name:	GRAHAM HOSPITAL ASSOCIATION
Employer identification number (EIN):	370673506
NAIC Classification:	622000
NAIC Description:	Hospitals