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BATH COMMUNITY HOSPITAL LIFE AND DISABILITY PLAN 401k Plan overview

Plan NameBATH COMMUNITY HOSPITAL LIFE AND DISABILITY PLAN
Plan identification number 501

BATH COMMUNITY HOSPITAL LIFE AND DISABILITY PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

BATH COMMUNITY HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name:BATH COMMUNITY HOSPITAL
Employer identification number (EIN):540505913
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BATH COMMUNITY HOSPITAL LIFE AND DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012016-01-01CARA MAJOR
5012015-01-01CARA MAJOR
5012015-01-01JACOB GRIMES2022-04-22
5012014-01-01CARA MAJOR

Plan Statistics for BATH COMMUNITY HOSPITAL LIFE AND DISABILITY PLAN

401k plan membership statisitcs for BATH COMMUNITY HOSPITAL LIFE AND DISABILITY PLAN

Measure Date Value
2016: BATH COMMUNITY HOSPITAL LIFE AND DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01114
Total number of active participants reported on line 7a of the Form 55002016-01-010
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 participants2016-01-010
2015: BATH COMMUNITY HOSPITAL LIFE AND DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01114
Total number of active participants reported on line 7a of the Form 55002015-01-01114
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01114
Number of employers contributing to the scheme2015-01-010
2014: BATH COMMUNITY HOSPITAL LIFE AND DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01106
Total number of active participants reported on line 7a of the Form 55002014-01-01114
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01114

Form 5500 Responses for BATH COMMUNITY HOSPITAL LIFE AND DISABILITY PLAN

2016: BATH COMMUNITY HOSPITAL LIFE AND DISABILITY PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingYes
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: BATH COMMUNITY HOSPITAL LIFE AND DISABILITY PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: BATH COMMUNITY HOSPITAL LIFE AND DISABILITY PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUGA0ADDT
Policy instance 1
Insurance contract or identification numberGLUGA0ADDT
Number of Individuals Covered114
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $10,870
Total amount of fees paid to insurance companyUSD $4,269
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $72,469
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,870
Amount paid for insurance broker fees2096
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3

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