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ST CHARLES SURGICAL HOSPITAL 401k Plan overview

Plan NameST CHARLES SURGICAL HOSPITAL
Plan identification number 502

ST CHARLES SURGICAL HOSPITAL 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

ST CHARLES SURGICAL HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name:ST CHARLES SURGICAL HOSPITAL
Employer identification number (EIN):200094270
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ST CHARLES SURGICAL HOSPITAL

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022023-02-01SARAH UNDERWOOD2024-10-15
5022022-02-01SCOTT SULLIVAN2023-10-16
5022021-02-01SARAH UNDERWOOD2022-09-15
5022021-02-01SCOTT SULLIVAN2023-10-13
5022020-02-01SARAH UNDERWOOD2021-08-16
5022019-02-01SARAH UNDERWOOD2020-08-25
5022019-02-01SCOTT SULLIVAN2023-10-13

Plan Statistics for ST CHARLES SURGICAL HOSPITAL

401k plan membership statisitcs for ST CHARLES SURGICAL HOSPITAL

Measure Date Value
2023: ST CHARLES SURGICAL HOSPITAL 2023 401k membership
Total participants, beginning-of-year2023-02-01145
Total number of active participants reported on line 7a of the Form 55002023-02-01130
Number of retired or separated participants receiving benefits2023-02-0175
Number of other retired or separated participants entitled to future benefits2023-02-010
Total of all active and inactive participants2023-02-01205
Number of employers contributing to the scheme2023-02-010
2022: ST CHARLES SURGICAL HOSPITAL 2022 401k membership
Total participants, beginning-of-year2022-02-01152
Total number of active participants reported on line 7a of the Form 55002022-02-01145
Number of retired or separated participants receiving benefits2022-02-010
Number of other retired or separated participants entitled to future benefits2022-02-010
Total of all active and inactive participants2022-02-01145
Number of employers contributing to the scheme2022-02-010
2021: ST CHARLES SURGICAL HOSPITAL 2021 401k membership
Total participants, beginning-of-year2021-02-01115
Total number of active participants reported on line 7a of the Form 55002021-02-01121
Number of retired or separated participants receiving benefits2021-02-010
Number of other retired or separated participants entitled to future benefits2021-02-010
Total of all active and inactive participants2021-02-01121
Number of employers contributing to the scheme2021-02-010
2020: ST CHARLES SURGICAL HOSPITAL 2020 401k membership
Total participants, beginning-of-year2020-02-01109
Total number of active participants reported on line 7a of the Form 55002020-02-01115
Number of retired or separated participants receiving benefits2020-02-010
Number of other retired or separated participants entitled to future benefits2020-02-010
Total of all active and inactive participants2020-02-01115
Number of employers contributing to the scheme2020-02-010
2019: ST CHARLES SURGICAL HOSPITAL 2019 401k membership
Total participants, beginning-of-year2019-02-01100
Total number of active participants reported on line 7a of the Form 55002019-02-01109
Number of retired or separated participants receiving benefits2019-02-010
Number of other retired or separated participants entitled to future benefits2019-02-010
Total of all active and inactive participants2019-02-01109
Number of employers contributing to the scheme2019-02-010

Form 5500 Responses for ST CHARLES SURGICAL HOSPITAL

2023: ST CHARLES SURGICAL HOSPITAL 2023 form 5500 responses
2023-02-01Type of plan entitySingle employer plan
2023-02-01Plan funding arrangement – InsuranceYes
2023-02-01Plan benefit arrangement – InsuranceYes
2022: ST CHARLES SURGICAL HOSPITAL 2022 form 5500 responses
2022-02-01Type of plan entitySingle employer plan
2022-02-01Plan funding arrangement – InsuranceYes
2022-02-01Plan benefit arrangement – InsuranceYes
2021: ST CHARLES SURGICAL HOSPITAL 2021 form 5500 responses
2021-02-01Type of plan entitySingle employer plan
2021-02-01Submission has been amendedYes
2021-02-01Plan funding arrangement – InsuranceYes
2021-02-01Plan benefit arrangement – InsuranceYes
2020: ST CHARLES SURGICAL HOSPITAL 2020 form 5500 responses
2020-02-01Type of plan entitySingle employer plan
2020-02-01Plan funding arrangement – InsuranceYes
2020-02-01Plan benefit arrangement – InsuranceYes
2019: ST CHARLES SURGICAL HOSPITAL 2019 form 5500 responses
2019-02-01Type of plan entitySingle employer plan
2019-02-01First time form 5500 has been submittedYes
2019-02-01Submission has been amendedYes
2019-02-01Plan funding arrangement – InsuranceYes
2019-02-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number27A90ERC
Policy instance 2
Insurance contract or identification number27A90ERC
Number of Individuals Covered223
Insurance policy start date2023-02-01
Insurance policy end date2024-01-31
Total amount of commissions paid to insurance brokerUSD $30,226
Total amount of fees paid to insurance companyUSD $16,319
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,075,864
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MONY (National Association of Insurance Commissioners NAIC id number: 78077 )
Policy contract number9557
Policy instance 1
Insurance contract or identification number9557
Number of Individuals Covered135
Insurance policy start date2023-02-01
Insurance policy end date2024-01-31
Total amount of commissions paid to insurance brokerUSD $17,103
Total amount of fees paid to insurance companyUSD $5,679
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $131,803
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number10-050115
Policy instance 3
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number27A90ERC
Policy instance 2
MONY (National Association of Insurance Commissioners NAIC id number: 78077 )
Policy contract number9557
Policy instance 1
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number27A90ERC
Policy instance 2
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number10-050115
Policy instance 3
MONY (National Association of Insurance Commissioners NAIC id number: 78077 )
Policy contract number9557
Policy instance 1
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0BB9K
Policy instance 1
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLTD0BB9K
Policy instance 3
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number10-050115
Policy instance 2
BLUE CROSS BLUE SHIELD OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 81200 )
Policy contract number27A90ERC
Policy instance 1
Insurance contract or identification number27A90ERC
Number of Individuals Covered160
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $18,999
Total amount of fees paid to insurance companyUSD $14,687
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $697,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes

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