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HOSPITAL SAN CARLOS BORROMEO EMPLOYEE ASSISTANCE PROGRAM 401k Plan overview

Plan NameHOSPITAL SAN CARLOS BORROMEO EMPLOYEE ASSISTANCE PROGRAM
Plan identification number 503

HOSPITAL SAN CARLOS BORROMEO EMPLOYEE ASSISTANCE PROGRAM Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

401k Sponsoring company profile

HOSPITAL SAN CARLOS BORROMEO has sponsored the creation of one or more 401k plans.

Company Name:HOSPITAL SAN CARLOS BORROMEO
Employer identification number (EIN):660371418
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HOSPITAL SAN CARLOS BORROMEO EMPLOYEE ASSISTANCE PROGRAM

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032023-02-01
5032022-02-01
5032021-05-01
5032020-05-01
5032019-05-01
5032018-05-01
5032017-05-01MIGDALIA ORTIZ MIGDALIA ORTIZ2018-12-19

Plan Statistics for HOSPITAL SAN CARLOS BORROMEO EMPLOYEE ASSISTANCE PROGRAM

401k plan membership statisitcs for HOSPITAL SAN CARLOS BORROMEO EMPLOYEE ASSISTANCE PROGRAM

Measure Date Value
2023: HOSPITAL SAN CARLOS BORROMEO EMPLOYEE ASSISTANCE PROGRAM 2023 401k membership
Total participants, beginning-of-year2023-02-01320
Total number of active participants reported on line 7a of the Form 55002023-02-01320
Total of all active and inactive participants2023-02-01320
Total participants2023-02-01320
2022: HOSPITAL SAN CARLOS BORROMEO EMPLOYEE ASSISTANCE PROGRAM 2022 401k membership
Total participants, beginning-of-year2022-02-01320
Total number of active participants reported on line 7a of the Form 55002022-02-01320
Total of all active and inactive participants2022-02-01320
Total participants2022-02-01320
2021: HOSPITAL SAN CARLOS BORROMEO EMPLOYEE ASSISTANCE PROGRAM 2021 401k membership
Total participants, beginning-of-year2021-05-01320
Total number of active participants reported on line 7a of the Form 55002021-05-01320
Total of all active and inactive participants2021-05-01320
Total participants2021-05-01320
2020: HOSPITAL SAN CARLOS BORROMEO EMPLOYEE ASSISTANCE PROGRAM 2020 401k membership
Total participants, beginning-of-year2020-05-01320
Total number of active participants reported on line 7a of the Form 55002020-05-01320
Total of all active and inactive participants2020-05-01320
Total participants2020-05-01320
2019: HOSPITAL SAN CARLOS BORROMEO EMPLOYEE ASSISTANCE PROGRAM 2019 401k membership
Total participants, beginning-of-year2019-05-01320
Total number of active participants reported on line 7a of the Form 55002019-05-01320
Total of all active and inactive participants2019-05-01320
Total participants2019-05-01320
2018: HOSPITAL SAN CARLOS BORROMEO EMPLOYEE ASSISTANCE PROGRAM 2018 401k membership
Total participants, beginning-of-year2018-05-01350
Total number of active participants reported on line 7a of the Form 55002018-05-01320
Total of all active and inactive participants2018-05-01320
Total participants2018-05-01320
2017: HOSPITAL SAN CARLOS BORROMEO EMPLOYEE ASSISTANCE PROGRAM 2017 401k membership
Total participants, beginning-of-year2017-05-01350
Total number of active participants reported on line 7a of the Form 55002017-05-01350
Total of all active and inactive participants2017-05-01350
Total participants2017-05-01350

Form 5500 Responses for HOSPITAL SAN CARLOS BORROMEO EMPLOYEE ASSISTANCE PROGRAM

2023: HOSPITAL SAN CARLOS BORROMEO EMPLOYEE ASSISTANCE PROGRAM 2023 form 5500 responses
2023-02-01Type of plan entitySingle employer plan
2023-02-01Submission has been amendedNo
2023-02-01This submission is the final filingNo
2023-02-01This return/report is a short plan year return/report (less than 12 months)No
2023-02-01Plan is a collectively bargained planNo
2023-02-01Plan funding arrangement – InsuranceYes
2023-02-01Plan benefit arrangement – InsuranceYes
2022: HOSPITAL SAN CARLOS BORROMEO EMPLOYEE ASSISTANCE PROGRAM 2022 form 5500 responses
2022-02-01Type of plan entitySingle employer plan
2022-02-01Submission has been amendedNo
2022-02-01This submission is the final filingNo
2022-02-01This return/report is a short plan year return/report (less than 12 months)No
2022-02-01Plan is a collectively bargained planNo
2022-02-01Plan funding arrangement – InsuranceYes
2022-02-01Plan benefit arrangement – InsuranceYes
2021: HOSPITAL SAN CARLOS BORROMEO EMPLOYEE ASSISTANCE PROGRAM 2021 form 5500 responses
2021-05-01Type of plan entitySingle employer plan
2021-05-01Submission has been amendedNo
2021-05-01This submission is the final filingNo
2021-05-01This return/report is a short plan year return/report (less than 12 months)Yes
2021-05-01Plan is a collectively bargained planNo
2021-05-01Plan funding arrangement – InsuranceYes
2021-05-01Plan benefit arrangement – InsuranceYes
2020: HOSPITAL SAN CARLOS BORROMEO EMPLOYEE ASSISTANCE PROGRAM 2020 form 5500 responses
2020-05-01Type of plan entitySingle employer plan
2020-05-01Submission has been amendedNo
2020-05-01This submission is the final filingNo
2020-05-01This return/report is a short plan year return/report (less than 12 months)No
2020-05-01Plan is a collectively bargained planNo
2020-05-01Plan funding arrangement – InsuranceYes
2020-05-01Plan benefit arrangement – InsuranceYes
2019: HOSPITAL SAN CARLOS BORROMEO EMPLOYEE ASSISTANCE PROGRAM 2019 form 5500 responses
2019-05-01Type of plan entitySingle employer plan
2019-05-01Submission has been amendedNo
2019-05-01This submission is the final filingNo
2019-05-01This return/report is a short plan year return/report (less than 12 months)No
2019-05-01Plan is a collectively bargained planNo
2019-05-01Plan funding arrangement – InsuranceYes
2019-05-01Plan benefit arrangement – InsuranceYes
2018: HOSPITAL SAN CARLOS BORROMEO EMPLOYEE ASSISTANCE PROGRAM 2018 form 5500 responses
2018-05-01Type of plan entitySingle employer plan
2018-05-01Submission has been amendedNo
2018-05-01This submission is the final filingNo
2018-05-01This return/report is a short plan year return/report (less than 12 months)No
2018-05-01Plan is a collectively bargained planNo
2018-05-01Plan funding arrangement – InsuranceYes
2018-05-01Plan benefit arrangement – InsuranceYes
2017: HOSPITAL SAN CARLOS BORROMEO EMPLOYEE ASSISTANCE PROGRAM 2017 form 5500 responses
2017-05-01Type of plan entitySingle employer plan
2017-05-01Submission has been amendedNo
2017-05-01This submission is the final filingNo
2017-05-01This return/report is a short plan year return/report (less than 12 months)No
2017-05-01Plan is a collectively bargained planNo
2017-05-01Plan funding arrangement – InsuranceYes
2017-05-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

OPTIMIND MANAGED BEHAVIORAL HEALTHCARE ORGANIZATION, CORP. (National Association of Insurance Commissioners NAIC id number: 62111 )
Policy contract number
Policy instance 1
Number of Individuals Covered320
Insurance policy start date2023-02-01
Insurance policy end date2024-01-31
Total amount of commissions paid to insurance brokerUSD $510
Are there contracts with allocated funds for individual policies?0
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 BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
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 $5,103
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
OPTIMIND MANAGED BEHAVIORAL HEALTHCARE ORGANIZATION, CORP. (National Association of Insurance Commissioners NAIC id number: 6211 )
Policy contract numberHSCB
Policy instance 1
Insurance contract or identification numberHSCB
Number of Individuals Covered320
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $518
Are there contracts with allocated funds for individual policies?0
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 BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
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 $5,184
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $518
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?3
OPTIMIND MANAGED BEHAVIORAL HEALTHCARE ORGANIZATION (National Association of Insurance Commissioners NAIC id number: 62111 )
Policy contract numberHSCB
Policy instance 1
Insurance contract or identification numberHSCB
Number of Individuals Covered320
Insurance policy start date2021-05-01
Insurance policy end date2022-01-21
Total amount of commissions paid to insurance brokerUSD $388
Are there contracts with allocated funds for individual policies?0
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 BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
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 $3,888
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $388
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?3
OPTIMIND MANAGED BEHAVIORAL HEALTHCARE ORGANIZATION, CORP. (National Association of Insurance Commissioners NAIC id number: 62111 )
Policy contract numberHSCB
Policy instance 1
Insurance contract or identification numberHSCB
Number of Individuals Covered320
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Total amount of commissions paid to insurance brokerUSD $518
Are there contracts with allocated funds for individual policies?0
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 BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
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 $5,184
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $518
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?3
OPTIMIND MANAGED BEHAVIORAL HEALTHCARE ORGANIZATION, CORP. (National Association of Insurance Commissioners NAIC id number: 62111 )
Policy contract numberHSCB
Policy instance 1
Insurance contract or identification numberHSCB
Number of Individuals Covered320
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Total amount of commissions paid to insurance brokerUSD $518
Are there contracts with allocated funds for individual policies?0
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 BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
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 $5,184
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $518
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?3
OPTIMIND MANAGED BEHAVIORAL HEALTHCARE ORGANIZATION, CORP. (National Association of Insurance Commissioners NAIC id number: 62111 )
Policy contract numberHSCB
Policy instance 1
Insurance contract or identification numberHSCB
Number of Individuals Covered320
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $518
Are there contracts with allocated funds for individual policies?0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $518
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?3
LUCY LOPEZ ROIG EAP, INC. (National Association of Insurance Commissioners NAIC id number: 62133 )
Policy contract numberN/A
Policy instance 1
Insurance contract or identification numberN/A
Number of Individuals Covered350
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $410
Are there contracts with allocated funds for individual policies?0
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 BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
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 $6,300
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees410
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?3
Insurance broker nameIKON BENEFITS GROUP, INC.

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