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GOODALL-WITCHER HOSPITAL AUTHORITY MEDICAL BENEFIT PLAN 401k Plan overview

Plan NameGOODALL-WITCHER HOSPITAL AUTHORITY MEDICAL BENEFIT PLAN
Plan identification number 501

GOODALL-WITCHER HOSPITAL AUTHORITY MEDICAL BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

GOODALL-WITCHER HOSPTIAL AUTHORITY has sponsored the creation of one or more 401k plans.

Company Name:GOODALL-WITCHER HOSPTIAL AUTHORITY
Employer identification number (EIN):461020526
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GOODALL-WITCHER HOSPITAL AUTHORITY MEDICAL BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012019-09-01
5012018-09-01
5012017-09-01
5012016-09-01VICKI GLOFF ADAM WILLMANN2018-05-31
5012015-09-01VICKI GLOFF ADAM WILLMANN2017-05-09

Plan Statistics for GOODALL-WITCHER HOSPITAL AUTHORITY MEDICAL BENEFIT PLAN

401k plan membership statisitcs for GOODALL-WITCHER HOSPITAL AUTHORITY MEDICAL BENEFIT PLAN

Measure Date Value
2019: GOODALL-WITCHER HOSPITAL AUTHORITY MEDICAL BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-09-011,407
Total number of active participants reported on line 7a of the Form 55002019-09-011,500
Total of all active and inactive participants2019-09-011,500
2018: GOODALL-WITCHER HOSPITAL AUTHORITY MEDICAL BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-09-01651
Total number of active participants reported on line 7a of the Form 55002018-09-010
Total of all active and inactive participants2018-09-010
2017: GOODALL-WITCHER HOSPITAL AUTHORITY MEDICAL BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-09-01651
Total number of active participants reported on line 7a of the Form 55002017-09-01651
Total of all active and inactive participants2017-09-01651
2016: GOODALL-WITCHER HOSPITAL AUTHORITY MEDICAL BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-09-01406
Total number of active participants reported on line 7a of the Form 55002016-09-01651
Total of all active and inactive participants2016-09-01651
2015: GOODALL-WITCHER HOSPITAL AUTHORITY MEDICAL BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-09-010
Total number of active participants reported on line 7a of the Form 55002015-09-01406
Total of all active and inactive participants2015-09-01406

Form 5500 Responses for GOODALL-WITCHER HOSPITAL AUTHORITY MEDICAL BENEFIT PLAN

2019: GOODALL-WITCHER HOSPITAL AUTHORITY MEDICAL BENEFIT PLAN 2019 form 5500 responses
2019-09-01Type of plan entitySingle employer plan
2019-09-01Plan funding arrangement – InsuranceYes
2019-09-01Plan funding arrangement – General assets of the sponsorYes
2019-09-01Plan benefit arrangement – InsuranceYes
2018: GOODALL-WITCHER HOSPITAL AUTHORITY MEDICAL BENEFIT PLAN 2018 form 5500 responses
2018-09-01Type of plan entitySingle employer plan
2018-09-01This submission is the final filingYes
2018-09-01Plan funding arrangement – InsuranceYes
2018-09-01Plan funding arrangement – General assets of the sponsorYes
2018-09-01Plan benefit arrangement – InsuranceYes
2017: GOODALL-WITCHER HOSPITAL AUTHORITY MEDICAL BENEFIT PLAN 2017 form 5500 responses
2017-09-01Type of plan entitySingle employer plan
2017-09-01Plan funding arrangement – InsuranceYes
2017-09-01Plan funding arrangement – General assets of the sponsorYes
2017-09-01Plan benefit arrangement – InsuranceYes
2016: GOODALL-WITCHER HOSPITAL AUTHORITY MEDICAL BENEFIT PLAN 2016 form 5500 responses
2016-09-01Type of plan entitySingle employer plan
2016-09-01Plan funding arrangement – InsuranceYes
2016-09-01Plan funding arrangement – General assets of the sponsorYes
2016-09-01Plan benefit arrangement – InsuranceYes
2015: GOODALL-WITCHER HOSPITAL AUTHORITY MEDICAL BENEFIT PLAN 2015 form 5500 responses
2015-09-01Type of plan entitySingle employer plan
2015-09-01First time form 5500 has been submittedYes
2015-09-01Plan funding arrangement – InsuranceYes
2015-09-01Plan funding arrangement – General assets of the sponsorYes
2015-09-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number61739
Policy instance 6
Insurance contract or identification number61739
Number of Individuals Covered943
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $18,831
Total amount of fees paid to insurance companyUSD $56
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $86,228
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,934
Insurance broker organization code?3
Amount paid for insurance broker fees34
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0908978
Policy instance 5
Insurance contract or identification number0908978
Number of Individuals Covered256
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $1,542
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,917
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,542
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4662425
Policy instance 4
Insurance contract or identification numberE4662425
Number of Individuals Covered64
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $10,186
Total amount of fees paid to insurance companyUSD $2,143
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $60,966
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,382
Amount paid for insurance broker fees485
Additional information about fees paid to insurance brokerOTHER FEES
Insurance broker organization code?3
UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 )
Policy contract number417007410010
Policy instance 3
Insurance contract or identification number417007410010
Number of Individuals Covered122
Insurance policy start date2019-09-01
Insurance policy end date2020-09-01
Total amount of commissions paid to insurance brokerUSD $52,045
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $351,325
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $52,045
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BDTB
Policy instance 2
Insurance contract or identification numberG000BDTB
Number of Individuals Covered111
Insurance policy start date2019-09-01
Insurance policy end date2020-09-01
Total amount of commissions paid to insurance brokerUSD $5,500
Total amount of fees paid to insurance companyUSD $1,736
Welfare Benefit Premiums Paid to CarrierUSD $54,996
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,500
Amount paid for insurance broker fees1736
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE466137
Policy instance 1
Insurance contract or identification numberE466137
Number of Individuals Covered4
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $776
Total amount of fees paid to insurance companyUSD $101
Other welfare benefits providedHOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $6,962
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $180
Amount paid for insurance broker fees42
Additional information about fees paid to insurance brokerOTHER FEES
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4662425
Policy instance 1
Insurance contract or identification numberE4662425
Number of Individuals Covered68
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $13,874
Total amount of fees paid to insurance companyUSD $3,784
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $55,083
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,776
Amount paid for insurance broker fees502
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 )
Policy contract number417007410010
Policy instance 6
Insurance contract or identification number417007410010
Number of Individuals Covered127
Insurance policy start date2018-09-01
Insurance policy end date2019-09-01
Total amount of commissions paid to insurance brokerUSD $55,520
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $335,169
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $55,520
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0908978
Policy instance 2
Insurance contract or identification number0908978
Number of Individuals Covered238
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $1,501
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,007
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,501
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE466137
Policy instance 3
Insurance contract or identification numberE466137
Number of Individuals Covered7
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $1,522
Total amount of fees paid to insurance companyUSD $460
Other welfare benefits providedHOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $5,873
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $632
Amount paid for insurance broker fees55
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number61739
Policy instance 4
Insurance contract or identification number61739
Number of Individuals Covered938
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $19,551
Total amount of fees paid to insurance companyUSD $57
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $85,018
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,753
Insurance broker organization code?3
Amount paid for insurance broker fees57
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000BDTB
Policy instance 5
Insurance contract or identification numberG000BDTB
Number of Individuals Covered104
Insurance policy start date2018-09-01
Insurance policy end date2019-09-01
Total amount of commissions paid to insurance brokerUSD $5,371
Total amount of fees paid to insurance companyUSD $3,257
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $53,705
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,371
Amount paid for insurance broker fees3257
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010220110 00
Policy instance 2
Insurance contract or identification number000010220110 00
Number of Individuals Covered179
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $448
Total amount of fees paid to insurance companyUSD $82
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $2,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4666137
Policy instance 7
Insurance contract or identification numberE4666137
Number of Individuals Covered5
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $1,447
Total amount of fees paid to insurance companyUSD $486
Other welfare benefits providedHOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $3,764
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract number417006410010
Policy instance 6
Insurance contract or identification number417006410010
Number of Individuals Covered135
Insurance policy start date2017-09-01
Insurance policy end date2018-09-01
Total amount of commissions paid to insurance brokerUSD $42,823
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $328,831
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0908978
Policy instance 5
Insurance contract or identification number0908978
Number of Individuals Covered108
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $1,293
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010220115 00
Policy instance 1
Insurance contract or identification number000010220115 00
Number of Individuals Covered180
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $5,907
Total amount of fees paid to insurance companyUSD $1,052
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $39,377
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number0001D032897 000
Policy instance 3
Insurance contract or identification number0001D032897 000
Number of Individuals Covered101
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $7,530
Total amount of fees paid to insurance companyUSD $1,532
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,198
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4662425
Policy instance 4
Insurance contract or identification numberE4662425
Number of Individuals Covered61
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $11,320
Total amount of fees paid to insurance companyUSD $3,748
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $39,886
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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