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| Plan Name | GOOD SHEPHERD COMMUNITY CARE HEALTH & WELFARE PLAN |
| Plan identification number | 503 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | HOSPICE OF THE GOOD SHEPHERD, INC. DBA GOOD SHEPHERD COMMUNITY CARE |
| Employer identification number (EIN): | 042655734 |
| NAIC Classification: | 621498 |
| NAIC Description: | All Other Outpatient Care Centers |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 503 | 2024-03-01 | MEREDITH TANSEY | |||
| 503 | 2023-03-01 | ||||
| 503 | 2023-03-01 | MEREDITH TANSEY | |||
| 503 | 2022-03-01 | ||||
| 503 | 2022-03-01 | MEREDITH TANSEY | |||
| 503 | 2021-03-01 | ||||
| 503 | 2021-03-01 | DAISY MARTINEZ |
| Measure | Date | Value |
|---|---|---|
| 2023: GOOD SHEPHERD COMMUNITY CARE HEALTH & WELFARE PLAN 2023 401k membership | ||
| Total participants, beginning-of-year | 2023-03-01 | 128 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-03-01 | 118 |
| Number of retired or separated participants receiving benefits | 2023-03-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2023-03-01 | 0 |
| Total of all active and inactive participants | 2023-03-01 | 119 |
| 2022: GOOD SHEPHERD COMMUNITY CARE HEALTH & WELFARE PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-03-01 | 134 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-03-01 | 125 |
| Number of retired or separated participants receiving benefits | 2022-03-01 | 3 |
| Total of all active and inactive participants | 2022-03-01 | 128 |
| 2021: GOOD SHEPHERD COMMUNITY CARE HEALTH & WELFARE PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-03-01 | 129 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-03-01 | 132 |
| Number of retired or separated participants receiving benefits | 2021-03-01 | 2 |
| Total of all active and inactive participants | 2021-03-01 | 134 |
| 2023: GOOD SHEPHERD COMMUNITY CARE HEALTH & WELFARE PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-03-01 | Type of plan entity | Single employer plan |
| 2023-03-01 | Submission has been amended | No |
| 2023-03-01 | This submission is the final filing | No |
| 2023-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2023-03-01 | Plan is a collectively bargained plan | No |
| 2023-03-01 | Plan funding arrangement – Insurance | Yes |
| 2023-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: GOOD SHEPHERD COMMUNITY CARE HEALTH & WELFARE PLAN 2022 form 5500 responses | ||
| 2022-03-01 | Type of plan entity | Single employer plan |
| 2022-03-01 | Submission has been amended | No |
| 2022-03-01 | This submission is the final filing | No |
| 2022-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-03-01 | Plan is a collectively bargained plan | No |
| 2022-03-01 | Plan funding arrangement – Insurance | Yes |
| 2022-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: GOOD SHEPHERD COMMUNITY CARE HEALTH & WELFARE PLAN 2021 form 5500 responses | ||
| 2021-03-01 | Type of plan entity | Single employer plan |
| 2021-03-01 | First time form 5500 has been submitted | Yes |
| 2021-03-01 | Submission has been amended | No |
| 2021-03-01 | This submission is the final filing | No |
| 2021-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-03-01 | Plan is a collectively bargained plan | No |
| 2021-03-01 | Plan funding arrangement – Insurance | Yes |
| 2021-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 0206193 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 50002092 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 0206193 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| |||||||||||||||||||||||||||||||||||||||||||||||||||||
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 50002092 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| |||||||||||||||||||||||||||||||||||||||||||||||||||||
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 0206193 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 50002092 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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