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NANTICOKE MEMORIAL HOSPITAL, INC. EMPLOYEE WELFARE BENEFITS PLAN 401k Plan overview

Plan NameNANTICOKE MEMORIAL HOSPITAL, INC. EMPLOYEE WELFARE BENEFITS PLAN
Plan identification number 502

NANTICOKE MEMORIAL HOSPITAL, INC. EMPLOYEE WELFARE BENEFITS 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
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

NMH has sponsored the creation of one or more 401k plans.

Company Name:NMH
Employer identification number (EIN):510069243
NAIC Classification:622000
NAIC Description: Hospitals

Additional information about NMH

Jurisdiction of Incorporation: State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number: 398126

More information about NMH

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NANTICOKE MEMORIAL HOSPITAL, INC. EMPLOYEE WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022021-01-01JENNIFER SPINELLI2022-03-01
5022021-01-01JENNIFER SPINELLI2022-03-01
5022020-01-01JENNIFER SPINELLI2021-11-01

Plan Statistics for NANTICOKE MEMORIAL HOSPITAL, INC. EMPLOYEE WELFARE BENEFITS PLAN

401k plan membership statisitcs for NANTICOKE MEMORIAL HOSPITAL, INC. EMPLOYEE WELFARE BENEFITS PLAN

Measure Date Value
2021: NANTICOKE MEMORIAL HOSPITAL, INC. EMPLOYEE WELFARE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01699
Total number of active participants reported on line 7a of the Form 55002021-01-010
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-010
Number of employers contributing to the scheme2021-01-010
2020: NANTICOKE MEMORIAL HOSPITAL, INC. EMPLOYEE WELFARE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01733
Total number of active participants reported on line 7a of the Form 55002020-01-01699
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01699
Number of employers contributing to the scheme2020-01-010

Form 5500 Responses for NANTICOKE MEMORIAL HOSPITAL, INC. EMPLOYEE WELFARE BENEFITS PLAN

2021: NANTICOKE MEMORIAL HOSPITAL, INC. EMPLOYEE WELFARE BENEFITS PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01This submission is the final filingYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: NANTICOKE MEMORIAL HOSPITAL, INC. EMPLOYEE WELFARE BENEFITS PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedYes
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

DELTA DENTAL OF DELAWARE (National Association of Insurance Commissioners NAIC id number: 11132 )
Policy contract number15451
Policy instance 1
Insurance contract or identification number15451
Number of Individuals Covered1466
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $10,722
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $536,092
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $10,722
Amount paid for insurance broker fees0
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30048244
Policy instance 2
Insurance contract or identification number30048244
Number of Individuals Covered632
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $13,525
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $147,087
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,525
Amount paid for insurance broker fees0
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK965967
Policy instance 3
Insurance contract or identification numberOK965967
Number of Individuals Covered699
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $59,153
Total amount of fees paid to insurance companyUSD $21,189
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT,HOSPITAL,CRITICAL ILLNESS,ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $639,034
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $59,079
Amount paid for insurance broker fees8408
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberHC960211
Policy instance 4
Insurance contract or identification numberHC960211
Number of Individuals Covered699
Insurance policy start date2020-07-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $17,894
Total amount of fees paid to insurance companyUSD $9,994
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedHOSPITAL,CRITICAL ILLNESS,ACCIDENT,ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $193,788
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $17,894
Amount paid for insurance broker fees6882
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3

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