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| Plan Name | GROUP LONG-TERM DISABILITY & GROUP LIFE & AD&D PLAN I AND IV EMPLOYEES |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | J.C. BLAIR MEMORIAL HOSPITAL |
| Employer identification number (EIN): | 231352159 |
| NAIC Classification: | 622000 |
| NAIC Description: | Hospitals |
Additional information about J.C. BLAIR MEMORIAL HOSPITAL
| Jurisdiction of Incorporation: | COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF STATE |
| Incorporation Date: | |
| Company Identification Number: | 38355 |
More information about J.C. BLAIR MEMORIAL HOSPITAL
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2020-09-01 | ||||
| 501 | 2019-09-01 | ||||
| 501 | 2018-09-01 | ||||
| 501 | 2017-09-01 | JEFF TRAPP | JEFF TRAPP | 2019-03-08 | |
| 501 | 2016-09-01 | JEFF TRAPP | JEFF TRAPP | 2018-02-16 | |
| 501 | 2015-09-01 | DEBORAH SHUGHART | DEBORAH SHUGHART | 2017-03-13 | |
| 501 | 2014-09-01 | DEBORAH SHUGHART | DEBORAH SHUGHART | 2016-03-14 | |
| 501 | 2013-09-01 | DEBORAH SHUGHART | DEBORAH SHUGHART | 2015-03-12 | |
| 501 | 2012-09-01 | EDWARD M. QUINN | EDWARD M. QUINN | 2014-03-10 | |
| 501 | 2011-09-01 | EDWARD M. QUINN | EDWARD M. QUINN | 2013-03-12 | |
| 501 | 2009-09-01 | NANCY GLIDDEN | NANCY GLIDDEN | 2011-03-14 |
| 2020: GROUP LONG-TERM DISABILITY & GROUP LIFE & AD&D PLAN I AND IV EMPLOYEES 2020 form 5500 responses | ||
|---|---|---|
| 2020-09-01 | Type of plan entity | Single employer plan |
| 2020-09-01 | Plan funding arrangement – Insurance | Yes |
| 2020-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: GROUP LONG-TERM DISABILITY & GROUP LIFE & AD&D PLAN I AND IV EMPLOYEES 2019 form 5500 responses | ||
| 2019-09-01 | Type of plan entity | Single employer plan |
| 2019-09-01 | Plan funding arrangement – Insurance | Yes |
| 2019-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: GROUP LONG-TERM DISABILITY & GROUP LIFE & AD&D PLAN I AND IV EMPLOYEES 2018 form 5500 responses | ||
| 2018-09-01 | Type of plan entity | Single employer plan |
| 2018-09-01 | Plan funding arrangement – Insurance | Yes |
| 2018-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: GROUP LONG-TERM DISABILITY & GROUP LIFE & AD&D PLAN I AND IV EMPLOYEES 2017 form 5500 responses | ||
| 2017-09-01 | Type of plan entity | Single employer plan |
| 2017-09-01 | Plan funding arrangement – Insurance | Yes |
| 2017-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: GROUP LONG-TERM DISABILITY & GROUP LIFE & AD&D PLAN I AND IV EMPLOYEES 2016 form 5500 responses | ||
| 2016-09-01 | Type of plan entity | Single employer plan |
| 2016-09-01 | Plan funding arrangement – Insurance | Yes |
| 2016-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: GROUP LONG-TERM DISABILITY & GROUP LIFE & AD&D PLAN I AND IV EMPLOYEES 2015 form 5500 responses | ||
| 2015-09-01 | Type of plan entity | Single employer plan |
| 2015-09-01 | Plan funding arrangement – Insurance | Yes |
| 2015-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: GROUP LONG-TERM DISABILITY & GROUP LIFE & AD&D PLAN I AND IV EMPLOYEES 2014 form 5500 responses | ||
| 2014-09-01 | Type of plan entity | Single employer plan |
| 2014-09-01 | Plan funding arrangement – Insurance | Yes |
| 2014-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: GROUP LONG-TERM DISABILITY & GROUP LIFE & AD&D PLAN I AND IV EMPLOYEES 2013 form 5500 responses | ||
| 2013-09-01 | Type of plan entity | Single employer plan |
| 2013-09-01 | Plan funding arrangement – Insurance | Yes |
| 2013-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: GROUP LONG-TERM DISABILITY & GROUP LIFE & AD&D PLAN I AND IV EMPLOYEES 2012 form 5500 responses | ||
| 2012-09-01 | Type of plan entity | Single employer plan |
| 2012-09-01 | Plan funding arrangement – Insurance | Yes |
| 2012-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: GROUP LONG-TERM DISABILITY & GROUP LIFE & AD&D PLAN I AND IV EMPLOYEES 2011 form 5500 responses | ||
| 2011-09-01 | Type of plan entity | Single employer plan |
| 2011-09-01 | Plan funding arrangement – Insurance | Yes |
| 2011-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: GROUP LONG-TERM DISABILITY & GROUP LIFE & AD&D PLAN I AND IV EMPLOYEES 2009 form 5500 responses | ||
| 2009-09-01 | Type of plan entity | Single employer plan |
| 2009-09-01 | This submission is the final filing | No |
| 2009-09-01 | Plan funding arrangement – Insurance | Yes |
| 2009-09-01 | Plan benefit arrangement – Insurance | Yes |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | G 670385 |
| Policy instance | 4 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | VAR 672906 |
| Policy instance | 3 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | LTD 669884 |
| Policy instance | 2 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | GL 668923 |
| Policy instance | 1 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | G 670385 |
| Policy instance | 4 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | VAR 672906 |
| Policy instance | 3 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | LTD 669884 |
| Policy instance | 2 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | GL 668923 |
| Policy instance | 1 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | G 670385 |
| Policy instance | 4 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | VAR 672906 |
| Policy instance | 3 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | LTD 669884 |
| Policy instance | 2 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | GL 668923 |
| Policy instance | 1 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | G 670385 |
| Policy instance | 4 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | VAR 672906 |
| Policy instance | 3 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | GL 668923 |
| Policy instance | 1 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | LTD 669884 |
| Policy instance | 2 |
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