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| Plan Name | FOX CHASE CANCER CENTER GROUP LIFE AND ACCIDENTAL DEATH DISMEMBERMENT PLAN |
| Plan identification number | 503 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | THE AMERICAN ONCOLOGIC HOSPITAL D/B/A THE HOSPITAL OF FOX CHASE |
| Employer identification number (EIN): | 231352156 |
| NAIC Classification: | 622000 |
| NAIC Description: | Hospitals |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 503 | 2013-03-01 | PAUL A. CSIGI | ROBERT H. LUX | 2014-04-15 | |
| 503 | 2012-03-01 | PAUL A. CSIGI | ROBERT H. LUX | 2013-10-15 |
| Measure | Date | Value |
|---|---|---|
| 2013: FOX CHASE CANCER CENTER GROUP LIFE AND ACCIDENTAL DEATH DISMEMBERMENT PLAN 2013 401k membership | ||
| Total participants, beginning-of-year | 2013-03-01 | 2,198 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-03-01 | 0 |
| Number of retired or separated participants receiving benefits | 2013-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-03-01 | 0 |
| Total of all active and inactive participants | 2013-03-01 | 0 |
| 2012: FOX CHASE CANCER CENTER GROUP LIFE AND ACCIDENTAL DEATH DISMEMBERMENT PLAN 2012 401k membership | ||
| Total participants, beginning-of-year | 2012-03-01 | 2,190 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-03-01 | 1,971 |
| Number of retired or separated participants receiving benefits | 2012-03-01 | 227 |
| Number of other retired or separated participants entitled to future benefits | 2012-03-01 | 0 |
| Total of all active and inactive participants | 2012-03-01 | 2,198 |
| 2013: FOX CHASE CANCER CENTER GROUP LIFE AND ACCIDENTAL DEATH DISMEMBERMENT PLAN 2013 form 5500 responses | ||
|---|---|---|
| 2013-03-01 | Type of plan entity | Single employer plan |
| 2013-03-01 | Submission has been amended | No |
| 2013-03-01 | This submission is the final filing | Yes |
| 2013-03-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2013-03-01 | Plan is a collectively bargained plan | No |
| 2013-03-01 | Plan funding arrangement – Insurance | Yes |
| 2013-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: FOX CHASE CANCER CENTER GROUP LIFE AND ACCIDENTAL DEATH DISMEMBERMENT PLAN 2012 form 5500 responses | ||
| 2012-03-01 | Type of plan entity | Single employer plan |
| 2012-03-01 | Submission has been amended | No |
| 2012-03-01 | This submission is the final filing | No |
| 2012-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-03-01 | Plan is a collectively bargained plan | No |
| 2012-03-01 | Plan funding arrangement – Insurance | Yes |
| 2012-03-01 | Plan benefit arrangement – Insurance | Yes |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | VAR 051597 |
| Policy instance | 2 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | GL 022933 |
| Policy instance | 1 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | GL 022933 |
| Policy instance | 1 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | VAR 051597 |
| Policy instance | 2 |
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