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GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 401k Plan overview

Plan NameGOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN
Plan identification number 501

GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 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)
  • Other welfare benefit cover
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

THE GOOD SAMARITAN HOME OF QUINCY has sponsored the creation of one or more 401k plans.

Company Name:THE GOOD SAMARITAN HOME OF QUINCY
Employer identification number (EIN):370724112
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012024-01-01MATTHEW DORIAN
5012023-01-01
5012023-01-01MATTHEW DORIAN
5012022-01-01
5012022-01-01MATTHEW DORIAN
5012021-01-01
5012021-01-01MATTHEW DORIAN
5012020-01-01
5012019-01-01
5012017-03-01MICHAEL DUFFY
5012016-03-01
5012015-03-01MICHAEL P. DUFFY
5012014-03-01JUDY GRAHAM
5012013-03-01JUDY GRAHAM
5012012-03-01JUDY GRAHAM
5012011-03-01JUDY GRAHAM
5012010-03-01
5012009-03-01
5012008-03-01

Plan Statistics for GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN

401k plan membership statisitcs for GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN

Measure Date Value
2023: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-01237
Total number of active participants reported on line 7a of the Form 55002023-01-01237
Number of retired or separated participants receiving benefits2023-01-010
Number of other retired or separated participants entitled to future benefits2023-01-010
Total of all active and inactive participants2023-01-01237
2022: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01115
Total number of active participants reported on line 7a of the Form 55002022-01-0135
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-0135
2021: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01199
Total number of active participants reported on line 7a of the Form 55002021-01-01115
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01115
2020: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01210
Total number of active participants reported on line 7a of the Form 55002020-01-01199
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01199
2019: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01215
Total number of active participants reported on line 7a of the Form 55002019-01-01209
Number of retired or separated participants receiving benefits2019-01-011
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01210
2017: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-03-01140
Total number of active participants reported on line 7a of the Form 55002017-03-01134
Number of retired or separated participants receiving benefits2017-03-010
Number of other retired or separated participants entitled to future benefits2017-03-010
Total of all active and inactive participants2017-03-01134
2016: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-03-01135
Total number of active participants reported on line 7a of the Form 55002016-03-01136
Number of retired or separated participants receiving benefits2016-03-010
Number of other retired or separated participants entitled to future benefits2016-03-010
Total of all active and inactive participants2016-03-01136
2015: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-03-01142
Total number of active participants reported on line 7a of the Form 55002015-03-01131
Number of retired or separated participants receiving benefits2015-03-010
Number of other retired or separated participants entitled to future benefits2015-03-010
Total of all active and inactive participants2015-03-01131
2014: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-03-01132
Total number of active participants reported on line 7a of the Form 55002014-03-01144
Number of retired or separated participants receiving benefits2014-03-010
Number of other retired or separated participants entitled to future benefits2014-03-010
Total of all active and inactive participants2014-03-01144
2013: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-03-01154
Total number of active participants reported on line 7a of the Form 55002013-03-01139
Number of retired or separated participants receiving benefits2013-03-011
Total of all active and inactive participants2013-03-01140
2012: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-03-01157
Total number of active participants reported on line 7a of the Form 55002012-03-01153
Number of retired or separated participants receiving benefits2012-03-011
Total of all active and inactive participants2012-03-01154
2011: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-03-01147
Total number of active participants reported on line 7a of the Form 55002011-03-01155
Number of retired or separated participants receiving benefits2011-03-012
Total of all active and inactive participants2011-03-01157
Total participants2011-03-01157
2010: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-03-01140
Total number of active participants reported on line 7a of the Form 55002010-03-01145
Number of retired or separated participants receiving benefits2010-03-012
Total of all active and inactive participants2010-03-01147
Total participants2010-03-01147
2009: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-03-01131
Total number of active participants reported on line 7a of the Form 55002009-03-01140
Number of retired or separated participants receiving benefits2009-03-010
Total of all active and inactive participants2009-03-01140
Total participants2009-03-01140
2008: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2008 401k membership
Total participants, beginning-of-year2008-03-01133
Total number of active participants reported on line 7a of the Form 55002008-03-01131
Number of retired or separated participants receiving benefits2008-03-010
Total of all active and inactive participants2008-03-01131
Total participants2008-03-01131

Form 5500 Responses for GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN

2023: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Submission has been amendedNo
2023-01-01This submission is the final filingNo
2023-01-01This return/report is a short plan year return/report (less than 12 months)No
2023-01-01Plan is a collectively bargained planNo
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan funding arrangement – General assets of the sponsorYes
2023-01-01Plan benefit arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – General assets of the sponsorYes
2022: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-03-01Type of plan entitySingle employer plan
2017-03-01Submission has been amendedNo
2017-03-01This submission is the final filingNo
2017-03-01This return/report is a short plan year return/report (less than 12 months)Yes
2017-03-01Plan is a collectively bargained planNo
2017-03-01Plan funding arrangement – General assets of the sponsorYes
2017-03-01Plan benefit arrangement – General assets of the sponsorYes
2016: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-03-01Type of plan entitySingle employer plan
2016-03-01Submission has been amendedNo
2016-03-01This submission is the final filingNo
2016-03-01This return/report is a short plan year return/report (less than 12 months)No
2016-03-01Plan is a collectively bargained planNo
2016-03-01Plan funding arrangement – General assets of the sponsorYes
2016-03-01Plan benefit arrangement – General assets of the sponsorYes
2015: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-03-01Type of plan entitySingle employer plan
2015-03-01Submission has been amendedNo
2015-03-01This submission is the final filingNo
2015-03-01This return/report is a short plan year return/report (less than 12 months)No
2015-03-01Plan is a collectively bargained planNo
2015-03-01Plan funding arrangement – General assets of the sponsorYes
2015-03-01Plan benefit arrangement – General assets of the sponsorYes
2014: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-03-01Type of plan entitySingle employer plan
2014-03-01Submission has been amendedNo
2014-03-01This submission is the final filingNo
2014-03-01This return/report is a short plan year return/report (less than 12 months)No
2014-03-01Plan is a collectively bargained planNo
2014-03-01Plan funding arrangement – General assets of the sponsorYes
2014-03-01Plan benefit arrangement – General assets of the sponsorYes
2013: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-03-01Type of plan entitySingle employer plan
2013-03-01Submission has been amendedNo
2013-03-01This submission is the final filingNo
2013-03-01This return/report is a short plan year return/report (less than 12 months)No
2013-03-01Plan is a collectively bargained planNo
2013-03-01Plan funding arrangement – General assets of the sponsorYes
2013-03-01Plan benefit arrangement – General assets of the sponsorYes
2012: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-03-01Type of plan entitySingle employer plan
2012-03-01Submission has been amendedNo
2012-03-01This submission is the final filingNo
2012-03-01This return/report is a short plan year return/report (less than 12 months)No
2012-03-01Plan is a collectively bargained planNo
2012-03-01Plan funding arrangement – General assets of the sponsorYes
2012-03-01Plan benefit arrangement – General assets of the sponsorYes
2011: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-03-01Type of plan entitySingle employer plan
2011-03-01Submission has been amendedNo
2011-03-01This submission is the final filingNo
2011-03-01This return/report is a short plan year return/report (less than 12 months)No
2011-03-01Plan is a collectively bargained planNo
2011-03-01Plan funding arrangement – General assets of the sponsorYes
2011-03-01Plan benefit arrangement – General assets of the sponsorYes
2010: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-03-01Type of plan entitySingle employer plan
2010-03-01Submission has been amendedNo
2010-03-01This submission is the final filingNo
2010-03-01This return/report is a short plan year return/report (less than 12 months)No
2010-03-01Plan is a collectively bargained planNo
2010-03-01Plan funding arrangement – General assets of the sponsorYes
2010-03-01Plan benefit arrangement – General assets of the sponsorYes
2009: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-03-01Type of plan entitySingle employer plan
2009-03-01Submission has been amendedNo
2009-03-01This submission is the final filingNo
2009-03-01This return/report is a short plan year return/report (less than 12 months)No
2009-03-01Plan is a collectively bargained planNo
2009-03-01Plan funding arrangement – General assets of the sponsorYes
2009-03-01Plan benefit arrangement – General assets of the sponsorYes
2008: GOOD SAMARITAN HOME OF QUINCY IL WELFARE BENEFIT PLAN 2008 form 5500 responses
2008-03-01Type of plan entitySingle employer plan
2008-03-01Submission has been amendedNo
2008-03-01This submission is the final filingNo
2008-03-01This return/report is a short plan year return/report (less than 12 months)No
2008-03-01Plan is a collectively bargained planNo
2008-03-01Plan funding arrangement – General assets of the sponsorYes
2008-03-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0245151
Policy instance 3
Insurance contract or identification number0245151
Number of Individuals Covered64
Insurance policy start date2023-10-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $1,876
Total amount of fees paid to insurance companyUSD $242
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,760
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5397398
Policy instance 2
Insurance contract or identification number5397398
Number of Individuals Covered237
Insurance policy start date2023-10-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $5,726
Total amount of fees paid to insurance companyUSD $1,524
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $32,256
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number496899
Policy instance 1
Insurance contract or identification number496899
Number of Individuals Covered15
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $1,018
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $7,035
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0008460648
Policy instance 2
Insurance contract or identification number0008460648
Number of Individuals Covered35
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $412
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,224
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number496899
Policy instance 1
Insurance contract or identification number496899
Number of Individuals Covered14
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $890
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $6,168
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0008460648
Policy instance 2
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number496899
Policy instance 1
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )
Policy contract number30013146
Policy instance 4
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number575845
Policy instance 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0008460648
Policy instance 2
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number496899
Policy instance 1
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 )
Policy contract number30013146
Policy instance 4
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0008460648
Policy instance 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number496899
Policy instance 2
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number575845
Policy instance 1

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