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BELLIN MEMORIAL HOSPITAL SHORT TERM DISABILIITY INSURANCE 401k Plan overview

Plan NameBELLIN MEMORIAL HOSPITAL SHORT TERM DISABILIITY INSURANCE
Plan identification number 510

BELLIN MEMORIAL HOSPITAL SHORT TERM DISABILIITY INSURANCE Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Temporary disability (accident and sickness)

401k Sponsoring company profile

BELLIN MEMORIAL HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name:BELLIN MEMORIAL HOSPITAL
Employer identification number (EIN):390884478
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BELLIN MEMORIAL HOSPITAL SHORT TERM DISABILIITY INSURANCE

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5102016-10-01TROY KOEBKE
5102015-10-01TROY KOEBKE
5102014-10-01TROY KOEBKE
5102013-10-01TROY KOEBKE
5102012-10-01TROY KOEBKE TROY KOEBKE2014-04-29
5102011-10-01KENNETH PETERS KENNETH PETERS2013-07-09
5102009-10-01KENNETH PETERS

Plan Statistics for BELLIN MEMORIAL HOSPITAL SHORT TERM DISABILIITY INSURANCE

401k plan membership statisitcs for BELLIN MEMORIAL HOSPITAL SHORT TERM DISABILIITY INSURANCE

Measure Date Value
2016: BELLIN MEMORIAL HOSPITAL SHORT TERM DISABILIITY INSURANCE 2016 401k membership
Total participants, beginning-of-year2016-10-012,515
Total number of active participants reported on line 7a of the Form 55002016-10-010
Number of retired or separated participants receiving benefits2016-10-010
Number of other retired or separated participants entitled to future benefits2016-10-010
Total of all active and inactive participants2016-10-010
2015: BELLIN MEMORIAL HOSPITAL SHORT TERM DISABILIITY INSURANCE 2015 401k membership
Total participants, beginning-of-year2015-10-012,014
Total number of active participants reported on line 7a of the Form 55002015-10-012,515
Number of retired or separated participants receiving benefits2015-10-010
Number of other retired or separated participants entitled to future benefits2015-10-010
Total of all active and inactive participants2015-10-012,515
2014: BELLIN MEMORIAL HOSPITAL SHORT TERM DISABILIITY INSURANCE 2014 401k membership
Total participants, beginning-of-year2014-10-011,910
Total number of active participants reported on line 7a of the Form 55002014-10-012,014
Number of retired or separated participants receiving benefits2014-10-010
Number of other retired or separated participants entitled to future benefits2014-10-010
Total of all active and inactive participants2014-10-012,014
2013: BELLIN MEMORIAL HOSPITAL SHORT TERM DISABILIITY INSURANCE 2013 401k membership
Total participants, beginning-of-year2013-10-012,074
Total number of active participants reported on line 7a of the Form 55002013-10-011,910
Number of retired or separated participants receiving benefits2013-10-010
Number of other retired or separated participants entitled to future benefits2013-10-010
Total of all active and inactive participants2013-10-011,910
2012: BELLIN MEMORIAL HOSPITAL SHORT TERM DISABILIITY INSURANCE 2012 401k membership
Total participants, beginning-of-year2012-10-012,037
Total number of active participants reported on line 7a of the Form 55002012-10-012,074
Number of retired or separated participants receiving benefits2012-10-010
Number of other retired or separated participants entitled to future benefits2012-10-010
Total of all active and inactive participants2012-10-012,074
Total participants2012-10-012,074
2011: BELLIN MEMORIAL HOSPITAL SHORT TERM DISABILIITY INSURANCE 2011 401k membership
Total participants, beginning-of-year2011-10-011,943
Total number of active participants reported on line 7a of the Form 55002011-10-012,037
Number of retired or separated participants receiving benefits2011-10-010
Number of other retired or separated participants entitled to future benefits2011-10-010
Total of all active and inactive participants2011-10-012,037
Total participants2011-10-012,037
2009: BELLIN MEMORIAL HOSPITAL SHORT TERM DISABILIITY INSURANCE 2009 401k membership
Total participants, beginning-of-year2009-10-011,718
Total number of active participants reported on line 7a of the Form 55002009-10-011,768
Number of retired or separated participants receiving benefits2009-10-010
Number of other retired or separated participants entitled to future benefits2009-10-010
Total of all active and inactive participants2009-10-011,768
Total participants2009-10-011,768

Form 5500 Responses for BELLIN MEMORIAL HOSPITAL SHORT TERM DISABILIITY INSURANCE

2016: BELLIN MEMORIAL HOSPITAL SHORT TERM DISABILIITY INSURANCE 2016 form 5500 responses
2016-10-01Type of plan entitySingle employer plan
2016-10-01Submission has been amendedNo
2016-10-01This submission is the final filingYes
2016-10-01This return/report is a short plan year return/report (less than 12 months)No
2016-10-01Plan is a collectively bargained planNo
2016-10-01Plan funding arrangement – InsuranceYes
2016-10-01Plan benefit arrangement – InsuranceYes
2015: BELLIN MEMORIAL HOSPITAL SHORT TERM DISABILIITY INSURANCE 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01Submission has been amendedNo
2015-10-01This submission is the final filingNo
2015-10-01This return/report is a short plan year return/report (less than 12 months)No
2015-10-01Plan is a collectively bargained planNo
2015-10-01Plan funding arrangement – InsuranceYes
2015-10-01Plan benefit arrangement – InsuranceYes
2014: BELLIN MEMORIAL HOSPITAL SHORT TERM DISABILIITY INSURANCE 2014 form 5500 responses
2014-10-01Type of plan entitySingle employer plan
2014-10-01Submission has been amendedNo
2014-10-01This submission is the final filingNo
2014-10-01This return/report is a short plan year return/report (less than 12 months)No
2014-10-01Plan is a collectively bargained planNo
2014-10-01Plan funding arrangement – InsuranceYes
2014-10-01Plan benefit arrangement – InsuranceYes
2013: BELLIN MEMORIAL HOSPITAL SHORT TERM DISABILIITY INSURANCE 2013 form 5500 responses
2013-10-01Type of plan entitySingle employer plan
2013-10-01Submission has been amendedNo
2013-10-01This submission is the final filingNo
2013-10-01This return/report is a short plan year return/report (less than 12 months)No
2013-10-01Plan is a collectively bargained planNo
2013-10-01Plan funding arrangement – InsuranceYes
2013-10-01Plan benefit arrangement – InsuranceYes
2012: BELLIN MEMORIAL HOSPITAL SHORT TERM DISABILIITY INSURANCE 2012 form 5500 responses
2012-10-01Type of plan entitySingle employer plan
2012-10-01Submission has been amendedNo
2012-10-01This submission is the final filingNo
2012-10-01This return/report is a short plan year return/report (less than 12 months)No
2012-10-01Plan is a collectively bargained planNo
2012-10-01Plan funding arrangement – InsuranceYes
2012-10-01Plan benefit arrangement – InsuranceYes
2011: BELLIN MEMORIAL HOSPITAL SHORT TERM DISABILIITY INSURANCE 2011 form 5500 responses
2011-10-01Type of plan entitySingle employer plan
2011-10-01Submission has been amendedNo
2011-10-01This submission is the final filingNo
2011-10-01This return/report is a short plan year return/report (less than 12 months)No
2011-10-01Plan is a collectively bargained planNo
2011-10-01Plan funding arrangement – InsuranceYes
2011-10-01Plan benefit arrangement – InsuranceYes
2009: BELLIN MEMORIAL HOSPITAL SHORT TERM DISABILIITY INSURANCE 2009 form 5500 responses
2009-10-01Type of plan entitySingle employer plan
2009-10-01Submission has been amendedNo
2009-10-01This submission is the final filingNo
2009-10-01This return/report is a short plan year return/report (less than 12 months)No
2009-10-01Plan is a collectively bargained planNo
2009-10-01Plan funding arrangement – InsuranceYes
2009-10-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number603410
Policy instance 1
Insurance contract or identification number603410
Number of Individuals Covered2515
Insurance policy start date2015-10-01
Insurance policy end date2016-09-30
Total amount of commissions paid to insurance brokerUSD $42,387
Total amount of fees paid to insurance companyUSD $16,955
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $789,775
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,387
Amount paid for insurance broker fees16955
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameASSOCIATED FINANCIAL GROUP LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number603410
Policy instance 1
Insurance contract or identification number603410
Number of Individuals Covered2014
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $35,166
Total amount of fees paid to insurance companyUSD $21,491
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $703,836
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,166
Amount paid for insurance broker fees21491
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?4
Insurance broker nameASSOCIATED FINANCIAL GROUP LLC
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number026884
Policy instance 1
Insurance contract or identification number026884
Number of Individuals Covered2086
Insurance policy start date2013-10-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $8,926
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $178,527
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,926
Insurance broker organization code?4
Insurance broker nameASSOCIATED FINANCIAL GROUP LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number603410
Policy instance 2
Insurance contract or identification number603410
Number of Individuals Covered1910
Insurance policy start date2014-01-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $24,603
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $553,883
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,603
Insurance broker organization code?3
Insurance broker nameASSOCIATED FINANCIAL GROUP LLC
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number026884
Policy instance 1
Insurance contract or identification number026884
Number of Individuals Covered2074
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $35,458
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $703,131
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,458
Amount paid for insurance broker fees0
Insurance broker organization code?4
Insurance broker nameASSOCIATED FINANCIAL GROUP LLC
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number026884
Policy instance 1
Insurance contract or identification number026884
Number of Individuals Covered2037
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $46,401
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $648,914
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number026884
Policy instance 1
Insurance contract or identification number026884
Number of Individuals Covered1943
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $56,070
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $623,574
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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