401k Plan data: ERMC LIFE INSURANCE 2017 plan

ERMC LIFE INSURANCE 2017 401k Plan overview

Plan Name	ERMC LIFE INSURANCE 2017
Plan identification number	504

ERMC LIFE INSURANCE 2017 Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

EATON RAPIDS MEDICAL CENTER has sponsored the creation of one or more 401k plans.

Company Name: EATON RAPIDS MEDICAL CENTER

Employer identification number (EIN): 381559180

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about EATON RAPIDS MEDICAL CENTER

Jurisdiction of Incorporation: Michigan Department of Licensing & Regulatory Affairs

Incorporation Date:

Company Identification Number: 861068

More information about EATON RAPIDS MEDICAL CENTER

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ERMC LIFE INSURANCE 2017

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2017-01-01 SHARI GLYNN SHARI GLYNN 2018-09-07
504 2013-01-01 SHARI GLYNN SHARI GLYNN 2014-07-14
504 2012-01-01 SHARI GLYNN SHARI GLYNN 2013-07-24
504 2011-01-01 SHARI GLYNN
504 2010-01-01 SHARI GLYNN
504 2009-01-01 SHARI GLYNN
504 2009-01-01 SHARI GLYNN 2010-07-30

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
504	2017-01-01	SHARI GLYNN	SHARI GLYNN	2018-09-07
504	2013-01-01	SHARI GLYNN	SHARI GLYNN	2014-07-14
504	2012-01-01	SHARI GLYNN	SHARI GLYNN	2013-07-24
504	2011-01-01	SHARI GLYNN
504	2010-01-01	SHARI GLYNN
504	2009-01-01	SHARI GLYNN
504	2009-01-01		SHARI GLYNN	2010-07-30

Plan Statistics for ERMC LIFE INSURANCE 2017

401k plan membership statisitcs for ERMC LIFE INSURANCE 2017

Measure Date Value
2017: ERMC LIFE INSURANCE 2017 2017 401k membership
Total participants, beginning-of-year 2017-01-01 161
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 161
Total of all active and inactive participants 2017-01-01 161
Total participants 2017-01-01 161
2013: ERMC LIFE INSURANCE 2017 2013 401k membership
Total participants, beginning-of-year 2013-01-01 147
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 141
Total of all active and inactive participants 2013-01-01 141
Total participants 2013-01-01 141
2012: ERMC LIFE INSURANCE 2017 2012 401k membership
Total participants, beginning-of-year 2012-01-01 133
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 145
Total of all active and inactive participants 2012-01-01 145
Total participants 2012-01-01 145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: ERMC LIFE INSURANCE 2017 2011 401k membership
Total participants, beginning-of-year 2011-01-01 133
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 133
Total of all active and inactive participants 2011-01-01 133
Total participants 2011-01-01 133
2010: ERMC LIFE INSURANCE 2017 2010 401k membership
Total participants, beginning-of-year 2010-01-01 138
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 138
Total of all active and inactive participants 2010-01-01 138
Total participants 2010-01-01 138
2009: ERMC LIFE INSURANCE 2017 2009 401k membership
Total participants, beginning-of-year 2009-01-01 149
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 149
Total of all active and inactive participants 2009-01-01 149
Total participants 2009-01-01 149

Measure	Date	Value
2017: ERMC LIFE INSURANCE 2017 2017 401k membership
Total participants, beginning-of-year	2017-01-01	161
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	161
Total of all active and inactive participants	2017-01-01	161
Total participants	2017-01-01	161
2013: ERMC LIFE INSURANCE 2017 2013 401k membership
Total participants, beginning-of-year	2013-01-01	147
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	141
Total of all active and inactive participants	2013-01-01	141
Total participants	2013-01-01	141
2012: ERMC LIFE INSURANCE 2017 2012 401k membership
Total participants, beginning-of-year	2012-01-01	133
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	145
Total of all active and inactive participants	2012-01-01	145
Total participants	2012-01-01	145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: ERMC LIFE INSURANCE 2017 2011 401k membership
Total participants, beginning-of-year	2011-01-01	133
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	133
Total of all active and inactive participants	2011-01-01	133
Total participants	2011-01-01	133
2010: ERMC LIFE INSURANCE 2017 2010 401k membership
Total participants, beginning-of-year	2010-01-01	138
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	138
Total of all active and inactive participants	2010-01-01	138
Total participants	2010-01-01	138
2009: ERMC LIFE INSURANCE 2017 2009 401k membership
Total participants, beginning-of-year	2009-01-01	149
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	149
Total of all active and inactive participants	2009-01-01	149
Total participants	2009-01-01	149

Form 5500 Responses for ERMC LIFE INSURANCE 2017

2017: ERMC LIFE INSURANCE 2017 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
2013: ERMC LIFE INSURANCE 2017 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: ERMC LIFE INSURANCE 2017 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: ERMC LIFE INSURANCE 2017 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
2010: ERMC LIFE INSURANCE 2017 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: ERMC LIFE INSURANCE 2017 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 benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010003745

Policy instance

Insurance contract or identification number	000010003745
Number of Individuals Covered	161
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,988
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	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D
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 $19,875
Commission paid to Insurance Broker	USD $1,988
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	COVERYS INS SVCS INC

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Company Name:	EATON RAPIDS MEDICAL CENTER
Employer identification number (EIN):	381559180
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	Michigan Department of Licensing & Regulatory Affairs
Incorporation Date:
Company Identification Number:	861068