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HEALTH BENEFIT PLAN MULTI-OPTION 401k Plan overview

Plan NameHEALTH BENEFIT PLAN MULTI-OPTION
Plan identification number 506

HEALTH BENEFIT PLAN MULTI-OPTION Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

HEBREW HOME AND HOSPITAL, INC. has sponsored the creation of one or more 401k plans.

Company Name:HEBREW HOME AND HOSPITAL, INC.
Employer identification number (EIN):060646672
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HEALTH BENEFIT PLAN MULTI-OPTION

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5062017-04-01
5062016-04-01
5062016-04-01DEBBI STETSON2019-02-26
5062015-04-01ASHLEY OUELUTTE
5062014-04-01DAVID A HOULE
5062013-04-01DAVID HOULE
5062012-04-01DAVID A HOULE
5062011-04-01DAVID A HOULE
5062010-04-01DAVID HOULE
5062009-04-01DAVID HOULE
5062009-04-01DAVID HOULE

Plan Statistics for HEALTH BENEFIT PLAN MULTI-OPTION

401k plan membership statisitcs for HEALTH BENEFIT PLAN MULTI-OPTION

Measure Date Value
2017: HEALTH BENEFIT PLAN MULTI-OPTION 2017 401k membership
Total participants, beginning-of-year2017-04-01130
Total number of active participants reported on line 7a of the Form 55002017-04-01111
Number of retired or separated participants receiving benefits2017-04-010
Number of other retired or separated participants entitled to future benefits2017-04-010
Total of all active and inactive participants2017-04-01111
Number of employers contributing to the scheme2017-04-010
2016: HEALTH BENEFIT PLAN MULTI-OPTION 2016 401k membership
Total participants, beginning-of-year2016-04-01500
Total number of active participants reported on line 7a of the Form 55002016-04-01500
Number of retired or separated participants receiving benefits2016-04-010
Number of other retired or separated participants entitled to future benefits2016-04-010
Total of all active and inactive participants2016-04-01500
Number of employers contributing to the scheme2016-04-010
2015: HEALTH BENEFIT PLAN MULTI-OPTION 2015 401k membership
Total participants, beginning-of-year2015-04-01550
Total number of active participants reported on line 7a of the Form 55002015-04-01550
Number of retired or separated participants receiving benefits2015-04-010
Number of other retired or separated participants entitled to future benefits2015-04-010
Total of all active and inactive participants2015-04-01550
2014: HEALTH BENEFIT PLAN MULTI-OPTION 2014 401k membership
Total participants, beginning-of-year2014-04-01550
Total number of active participants reported on line 7a of the Form 55002014-04-01550
Number of retired or separated participants receiving benefits2014-04-010
Number of other retired or separated participants entitled to future benefits2014-04-010
Total of all active and inactive participants2014-04-01550
2013: HEALTH BENEFIT PLAN MULTI-OPTION 2013 401k membership
Total participants, beginning-of-year2013-04-01451
Total number of active participants reported on line 7a of the Form 55002013-04-01550
Number of retired or separated participants receiving benefits2013-04-010
Number of other retired or separated participants entitled to future benefits2013-04-010
Total of all active and inactive participants2013-04-01550
2012: HEALTH BENEFIT PLAN MULTI-OPTION 2012 401k membership
Total participants, beginning-of-year2012-04-01504
Total number of active participants reported on line 7a of the Form 55002012-04-01451
Number of retired or separated participants receiving benefits2012-04-010
Number of other retired or separated participants entitled to future benefits2012-04-010
Total of all active and inactive participants2012-04-01451
2011: HEALTH BENEFIT PLAN MULTI-OPTION 2011 401k membership
Total participants, beginning-of-year2011-04-01568
Total number of active participants reported on line 7a of the Form 55002011-04-01504
Number of retired or separated participants receiving benefits2011-04-010
Number of other retired or separated participants entitled to future benefits2011-04-010
Total of all active and inactive participants2011-04-01504
2010: HEALTH BENEFIT PLAN MULTI-OPTION 2010 401k membership
Total participants, beginning-of-year2010-04-01491
Total number of active participants reported on line 7a of the Form 55002010-04-01568
Total of all active and inactive participants2010-04-01568
Total participants2010-04-01568
2009: HEALTH BENEFIT PLAN MULTI-OPTION 2009 401k membership
Total participants, beginning-of-year2009-04-01533
Total number of active participants reported on line 7a of the Form 55002009-04-01491
Total of all active and inactive participants2009-04-01491
Total participants2009-04-01491

Form 5500 Responses for HEALTH BENEFIT PLAN MULTI-OPTION

2017: HEALTH BENEFIT PLAN MULTI-OPTION 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan funding arrangement – General assets of the sponsorYes
2017-04-01Plan benefit arrangement – InsuranceYes
2017-04-01Plan benefit arrangement – General assets of the sponsorYes
2016: HEALTH BENEFIT PLAN MULTI-OPTION 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01Submission has been amendedNo
2016-04-01This submission is the final filingNo
2016-04-01This return/report is a short plan year return/report (less than 12 months)No
2016-04-01Plan is a collectively bargained planNo
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan funding arrangement – General assets of the sponsorYes
2016-04-01Plan benefit arrangement – InsuranceYes
2016-04-01Plan benefit arrangement – General assets of the sponsorYes
2015: HEALTH BENEFIT PLAN MULTI-OPTION 2015 form 5500 responses
2015-04-01Type of plan entitySingle employer plan
2015-04-01Submission has been amendedNo
2015-04-01This submission is the final filingNo
2015-04-01This return/report is a short plan year return/report (less than 12 months)No
2015-04-01Plan is a collectively bargained planNo
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan funding arrangement – General assets of the sponsorYes
2015-04-01Plan benefit arrangement – InsuranceYes
2015-04-01Plan benefit arrangement – General assets of the sponsorYes
2014: HEALTH BENEFIT PLAN MULTI-OPTION 2014 form 5500 responses
2014-04-01Type of plan entitySingle employer plan
2014-04-01Submission has been amendedNo
2014-04-01This submission is the final filingNo
2014-04-01This return/report is a short plan year return/report (less than 12 months)No
2014-04-01Plan is a collectively bargained planNo
2014-04-01Plan funding arrangement – InsuranceYes
2014-04-01Plan funding arrangement – General assets of the sponsorYes
2014-04-01Plan benefit arrangement – InsuranceYes
2014-04-01Plan benefit arrangement – General assets of the sponsorYes
2013: HEALTH BENEFIT PLAN MULTI-OPTION 2013 form 5500 responses
2013-04-01Type of plan entitySingle employer plan
2013-04-01Submission has been amendedNo
2013-04-01This submission is the final filingNo
2013-04-01This return/report is a short plan year return/report (less than 12 months)No
2013-04-01Plan is a collectively bargained planNo
2013-04-01Plan funding arrangement – InsuranceYes
2013-04-01Plan funding arrangement – General assets of the sponsorYes
2013-04-01Plan benefit arrangement – InsuranceYes
2013-04-01Plan benefit arrangement – General assets of the sponsorYes
2012: HEALTH BENEFIT PLAN MULTI-OPTION 2012 form 5500 responses
2012-04-01Type of plan entitySingle employer plan
2012-04-01Submission has been amendedNo
2012-04-01This submission is the final filingNo
2012-04-01This return/report is a short plan year return/report (less than 12 months)No
2012-04-01Plan is a collectively bargained planNo
2012-04-01Plan funding arrangement – InsuranceYes
2012-04-01Plan funding arrangement – General assets of the sponsorYes
2012-04-01Plan benefit arrangement – InsuranceYes
2012-04-01Plan benefit arrangement – General assets of the sponsorYes
2011: HEALTH BENEFIT PLAN MULTI-OPTION 2011 form 5500 responses
2011-04-01Type of plan entitySingle employer plan
2011-04-01Submission has been amendedYes
2011-04-01This submission is the final filingNo
2011-04-01This return/report is a short plan year return/report (less than 12 months)No
2011-04-01Plan is a collectively bargained planNo
2011-04-01Plan funding arrangement – InsuranceYes
2011-04-01Plan funding arrangement – General assets of the sponsorYes
2011-04-01Plan benefit arrangement – InsuranceYes
2011-04-01Plan benefit arrangement – General assets of the sponsorYes
2010: HEALTH BENEFIT PLAN MULTI-OPTION 2010 form 5500 responses
2010-04-01Type of plan entitySingle employer plan
2010-04-01First time form 5500 has been submittedYes
2010-04-01Submission has been amendedNo
2010-04-01This submission is the final filingNo
2010-04-01This return/report is a short plan year return/report (less than 12 months)No
2010-04-01Plan is a collectively bargained planNo
2010-04-01Plan funding arrangement – InsuranceYes
2010-04-01Plan funding arrangement – General assets of the sponsorYes
2010-04-01Plan benefit arrangement – InsuranceYes
2010-04-01Plan benefit arrangement – General assets of the sponsorYes
2009: HEALTH BENEFIT PLAN MULTI-OPTION 2009 form 5500 responses
2009-04-01Type of plan entitySingle employer plan
2009-04-01Submission has been amendedYes
2009-04-01This submission is the final filingNo
2009-04-01This return/report is a short plan year return/report (less than 12 months)No
2009-04-01Plan is a collectively bargained planNo
2009-04-01Plan funding arrangement – InsuranceYes
2009-04-01Plan funding arrangement – General assets of the sponsorYes
2009-04-01Plan benefit arrangement – InsuranceYes
2009-04-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

ANTHEM HEALTH PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 60217 )
Policy contract number800107
Policy instance 1
Insurance contract or identification number800107
Number of Individuals Covered111
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $1,765
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $54,618
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $1,765
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES LLC
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0314852
Policy instance 2
Insurance contract or identification number0314852
Number of Individuals Covered262
Insurance policy start date2016-10-01
Insurance policy end date2017-09-30
Total amount of commissions paid to insurance brokerUSD $1,517
Total amount of fees paid to insurance companyUSD $16,626
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $1,528,321
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,517
Amount paid for insurance broker fees16534
Additional information about fees paid to insurance brokerDIRECT COMPENSATION
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES LLC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30032389
Policy instance 3
Insurance contract or identification number30032389
Number of Individuals Covered51
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $878
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,594
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $878
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES LLC

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