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PERRY COUNTY MEMORIAL HOSPITAL GROUP HEALTH PLAN 401k Plan overview

Plan NamePERRY COUNTY MEMORIAL HOSPITAL GROUP HEALTH PLAN
Plan identification number 501

PERRY COUNTY MEMORIAL HOSPITAL GROUP HEALTH PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover

401k Sponsoring company profile

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

Company Name:PERRY COUNTY MEMORIAL HOSPITAL
Employer identification number (EIN):431741457
NAIC Classification:622000
NAIC Description: Hospitals

Additional information about PERRY COUNTY MEMORIAL HOSPITAL

Jurisdiction of Incorporation: Indiana Secretary of State
Incorporation Date:
Company Identification Number: 014042200228

More information about PERRY COUNTY MEMORIAL HOSPITAL

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PERRY COUNTY MEMORIAL HOSPITAL GROUP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012017-01-01ANGIE BREWER
5012016-01-01CHRIS WIBBENMEYER

Plan Statistics for PERRY COUNTY MEMORIAL HOSPITAL GROUP HEALTH PLAN

401k plan membership statisitcs for PERRY COUNTY MEMORIAL HOSPITAL GROUP HEALTH PLAN

Measure Date Value
2017: PERRY COUNTY MEMORIAL HOSPITAL GROUP HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01285
Total number of active participants reported on line 7a of the Form 55002017-01-01306
Total of all active and inactive participants2017-01-01306
2016: PERRY COUNTY MEMORIAL HOSPITAL GROUP HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-010
Total number of active participants reported on line 7a of the Form 55002016-01-01286
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01286

Financial Data on PERRY COUNTY MEMORIAL HOSPITAL GROUP HEALTH PLAN

Measure Date Value
2017 : PERRY COUNTY MEMORIAL HOSPITAL GROUP HEALTH PLAN 2017 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Was this plan covered by a fidelity bond2017-12-31No
If this is an individual account plan, was there a blackout period2017-12-31No
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-12-31No
Did the plan have assets held for investment2017-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No

Form 5500 Responses for PERRY COUNTY MEMORIAL HOSPITAL GROUP HEALTH PLAN

2017: PERRY COUNTY MEMORIAL HOSPITAL GROUP HEALTH PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: PERRY COUNTY MEMORIAL HOSPITAL GROUP HEALTH PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AMK7
Policy instance 1
Insurance contract or identification numberG000AMK7
Number of Individuals Covered365
Insurance policy end date2017-11-01
Total amount of commissions paid to insurance brokerUSD $58,715
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $58,715
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD
Insurance broker organization code?3
Insurance broker nameRELIABLE INS SERVICES LLC
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberERR1086-17
Policy instance 2
Insurance contract or identification numberERR1086-17
Number of Individuals Covered306
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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