401k Plan data: ALLEGHENY HEALTH NETWORK WELFARE BENEFIT PLAN plan

ALLEGHENY HEALTH NETWORK WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	ALLEGHENY HEALTH NETWORK WELFARE BENEFIT PLAN
Plan identification number	501

ALLEGHENY HEALTH NETWORK WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	SELECT distinct(Description) AS Description FROM 401k_benefit_codes LEFT JOIN 401k_benefit_code_description ON BenefitCode=Code COLLATE utf8_unicode_ci WHERE EIN='251375204' AND PlanID='501'

401k Sponsoring company profile

ALLEGHENY HEALTH NETWORK HOME has sponsored the creation of one or more 401k plans.

Company Name: ALLEGHENY HEALTH NETWORK HOME

Employer identification number (EIN): 251375204

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ALLEGHENY HEALTH NETWORK WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01
501 2022-01-01 JODI TROUTMAN
501 2021-01-01
501 2021-01-01 CHRISTOPHER PHILLIPS
501 2020-01-01
501 2019-01-01
501 2018-01-01
501 2017-01-01 DAVE PETROSKY DAVE PETROSKY 2018-07-17
501 2016-01-01 REBECCA MEYER REBECCA MEYER 2017-10-06
501 2015-01-01 DAVE PETROSKY DAVE PETROSKY 2016-10-13

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01
501	2022-01-01	JODI TROUTMAN
501	2021-01-01
501	2021-01-01	CHRISTOPHER PHILLIPS
501	2020-01-01
501	2019-01-01
501	2018-01-01
501	2017-01-01	DAVE PETROSKY	DAVE PETROSKY	2018-07-17
501	2016-01-01	REBECCA MEYER	REBECCA MEYER	2017-10-06
501	2015-01-01	DAVE PETROSKY	DAVE PETROSKY	2016-10-13

Insurance Providers Used on plan

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

01668005

Policy instance

Insurance contract or identification number	01668005
Number of Individuals Covered	174
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $860,521
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

907818

Policy instance

Insurance contract or identification number	907818
Number of Individuals Covered	186
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $51,871
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

LTD-0000102043

Policy instance

Insurance contract or identification number	LTD-0000102043
Number of Individuals Covered	178
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,803
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

STD-0000102044

Policy instance

Insurance contract or identification number	STD-0000102044
Number of Individuals Covered	178
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,710
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

LIFE-0000102045

Policy instance

Insurance contract or identification number	LIFE-0000102045
Number of Individuals Covered	178
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,314
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

LIFE-0000102046

Policy instance

Insurance contract or identification number	LIFE-0000102046
Number of Individuals Covered	100
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,945
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

907818

Policy instance

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

01668005

Policy instance

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

239074

Policy instance

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

239074

Policy instance

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

01668005

Policy instance

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

907818

Policy instance

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

239074

Policy instance

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

01668005

Policy instance

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

907818

Policy instance

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

239074

Policy instance

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

01668005

Policy instance

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

907818

Policy instance

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

97818000

Policy instance

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

01668005

Policy instance

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

239074

Policy instance

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

405486

Policy instance

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

01668005

Policy instance

UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 )

Policy contract number

907818-000

Policy instance

Potentially related plans

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Company Name:	ALLEGHENY HEALTH NETWORK HOME
Employer identification number (EIN):	251375204
NAIC Classification:	622000
NAIC Description:	Hospitals