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SUPERIOR VISION PLAN 401k Plan overview

Plan NameSUPERIOR VISION PLAN
Plan identification number 501

SUPERIOR VISION PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Vision

401k Sponsoring company profile

CENTEGRA HEALTH SYSTEM has sponsored the creation of one or more 401k plans.

Company Name:CENTEGRA HEALTH SYSTEM
Employer identification number (EIN):363196559
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SUPERIOR VISION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012017-01-01ROSA I. JESCHKE ROSA I. JESCHKE2018-09-28
5012017-01-01ROSA I. JESCHKE ROSA I. JESCHKE2018-09-28
5012016-01-01ROSA I. JESCHKE DOUG FENSTERMAKER2017-10-09
5012016-01-01 DOUG FENSTERMAKER2017-10-09
5012015-01-01ROSA I. JESCHKE DAVID TOMLINSON2016-10-10
5012015-01-01ROSA I. JESCHKE DAVID TOMLINSON2016-10-10
5012014-01-01ROSA I. JESCHKE DAVID TOMLINSON2015-10-12
5012014-01-01ROSA I. JESCHKE DAVID TOMLINSON2015-10-12
5012013-01-01ROSA I. JESCHKE DAVID TOMLINSON2014-10-06
5012012-01-01ROSA I. JESCHKE DAVID TOMLINSON2013-10-14
5012011-01-01ROBERT ROSENBERGER ROSA I. JESCHKE2012-10-15
5012009-01-01ROBERT ROSENBERGER ROSA I. JESCHKE2010-10-14
5012009-01-01ROBERT ROSENBERGER ROSA I. JESCHKE2010-10-14

Plan Statistics for SUPERIOR VISION PLAN

401k plan membership statisitcs for SUPERIOR VISION PLAN

Measure Date Value
2017: SUPERIOR VISION PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-012,314
Total number of active participants reported on line 7a of the Form 55002017-01-012,170
Total of all active and inactive participants2017-01-012,170
Total participants2017-01-012,170
2016: SUPERIOR VISION PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-012,066
Total number of active participants reported on line 7a of the Form 55002016-01-012,423
Total of all active and inactive participants2016-01-012,423
Total participants2016-01-012,423
2015: SUPERIOR VISION PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-011,837
Total number of active participants reported on line 7a of the Form 55002015-01-011,940
Total of all active and inactive participants2015-01-011,940
Total participants2015-01-011,940
2014: SUPERIOR VISION PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-011,970
Total number of active participants reported on line 7a of the Form 55002014-01-011,924
Total of all active and inactive participants2014-01-011,924
Total participants2014-01-011,924
2013: SUPERIOR VISION PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-011,833
Total number of active participants reported on line 7a of the Form 55002013-01-011,884
Total of all active and inactive participants2013-01-011,884
Total participants2013-01-011,884
2012: SUPERIOR VISION PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-011,988
Total number of active participants reported on line 7a of the Form 55002012-01-011,938
Total of all active and inactive participants2012-01-011,938
Total participants2012-01-011,938
2011: SUPERIOR VISION PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-011,975
Total number of active participants reported on line 7a of the Form 55002011-01-011,988
Total of all active and inactive participants2011-01-011,988
Total participants2011-01-011,988
2009: SUPERIOR VISION PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-011,997
Total number of active participants reported on line 7a of the Form 55002009-01-011,938
Total of all active and inactive participants2009-01-011,938
Total participants2009-01-011,938

Form 5500 Responses for SUPERIOR VISION PLAN

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

Insurance Providers Used on plan

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number27897
Policy instance 1
Insurance contract or identification number27897
Number of Individuals Covered5692
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $479,017
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number27897
Policy instance 1
Insurance contract or identification number27897
Number of Individuals Covered5549
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $251,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number27897
Policy instance 1
Insurance contract or identification number27897
Number of Individuals Covered4805
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $324,576
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number27897
Policy instance 1
Insurance contract or identification number27897
Number of Individuals Covered4697
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $11,955
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $301,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number27897
Policy instance 1
Insurance contract or identification number27897
Number of Individuals Covered5057
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $11,545
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $231,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,545
Insurance broker nameGNASTER & GNASTER INS.

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