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COMMUNITY HOSPITAL EMPLOYEES' SHORT TERM AND LONG TERM DISABILITY PLAN 401k Plan overview

Plan NameCOMMUNITY HOSPITAL EMPLOYEES' SHORT TERM AND LONG TERM DISABILITY PLAN
Plan identification number 511

COMMUNITY HOSPITAL EMPLOYEES' SHORT TERM AND LONG TERM DISABILITY PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Temporary disability (accident and sickness)
  • Long-term disability 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

COMMUNITY HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name:COMMUNITY HOSPITAL
Employer identification number (EIN):470533373
NAIC Classification:622000
NAIC Description: Hospitals

Additional information about COMMUNITY HOSPITAL

Jurisdiction of Incorporation: California Department of State
Incorporation Date:
Company Identification Number: C0315660

More information about COMMUNITY HOSPITAL

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COMMUNITY HOSPITAL EMPLOYEES' SHORT TERM AND LONG TERM DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5112015-10-01SHARON BEIBER
5112014-10-01SHARON BEIBER JAMES ULRICH2016-06-24
5112013-10-01SHARON BEIBER JAMES ULRICH2015-04-28
5112012-10-01SHARON BEIBER JAMES ULRICH2014-05-28
5112011-10-01SHARON BEIBER JAMES ULRICH2013-04-22
5112010-10-01SHARON BEIBER JAMES ULRICH2012-04-24
5112009-10-01SHARON BEIBER JAMES ULRICH2010-12-30

Plan Statistics for COMMUNITY HOSPITAL EMPLOYEES' SHORT TERM AND LONG TERM DISABILITY PLAN

401k plan membership statisitcs for COMMUNITY HOSPITAL EMPLOYEES' SHORT TERM AND LONG TERM DISABILITY PLAN

Measure Date Value
2015: COMMUNITY HOSPITAL EMPLOYEES' SHORT TERM AND LONG TERM DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year2015-10-01214
Total number of active participants reported on line 7a of the Form 55002015-10-010
Number of retired or separated participants receiving benefits2015-10-010
Number of other retired or separated participants entitled to future benefits2015-10-010
Total of all active and inactive participants2015-10-010
2014: COMMUNITY HOSPITAL EMPLOYEES' SHORT TERM AND LONG TERM DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year2014-10-01219
Total number of active participants reported on line 7a of the Form 55002014-10-01214
Total of all active and inactive participants2014-10-01214
Total participants2014-10-01214
2013: COMMUNITY HOSPITAL EMPLOYEES' SHORT TERM AND LONG TERM DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year2013-10-01217
Total number of active participants reported on line 7a of the Form 55002013-10-01219
Total of all active and inactive participants2013-10-01219
Total participants2013-10-01219
2012: COMMUNITY HOSPITAL EMPLOYEES' SHORT TERM AND LONG TERM DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year2012-10-01210
Total number of active participants reported on line 7a of the Form 55002012-10-01217
Total of all active and inactive participants2012-10-01217
Total participants2012-10-01217
2011: COMMUNITY HOSPITAL EMPLOYEES' SHORT TERM AND LONG TERM DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year2011-10-01199
Total number of active participants reported on line 7a of the Form 55002011-10-01210
Total of all active and inactive participants2011-10-01210
Total participants2011-10-01210
2010: COMMUNITY HOSPITAL EMPLOYEES' SHORT TERM AND LONG TERM DISABILITY PLAN 2010 401k membership
Total participants, beginning-of-year2010-10-01196
Total number of active participants reported on line 7a of the Form 55002010-10-01199
Total of all active and inactive participants2010-10-01199
Total participants2010-10-01199
2009: COMMUNITY HOSPITAL EMPLOYEES' SHORT TERM AND LONG TERM DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year2009-10-01188
Total number of active participants reported on line 7a of the Form 55002009-10-01196
Total of all active and inactive participants2009-10-01196
Total participants2009-10-01196

Form 5500 Responses for COMMUNITY HOSPITAL EMPLOYEES' SHORT TERM AND LONG TERM DISABILITY PLAN

2015: COMMUNITY HOSPITAL EMPLOYEES' SHORT TERM AND LONG TERM DISABILITY PLAN 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01Submission has been amendedNo
2015-10-01This submission is the final filingYes
2015-10-01This return/report is a short plan year return/report (less than 12 months)No
2015-10-01Plan is a collectively bargained planNo
2015-10-01Plan funding arrangement – InsuranceYes
2015-10-01Plan benefit arrangement – InsuranceYes
2014: COMMUNITY HOSPITAL EMPLOYEES' SHORT TERM AND LONG TERM DISABILITY PLAN 2014 form 5500 responses
2014-10-01Type of plan entitySingle employer plan
2014-10-01Submission has been amendedNo
2014-10-01This submission is the final filingNo
2014-10-01This return/report is a short plan year return/report (less than 12 months)No
2014-10-01Plan is a collectively bargained planNo
2014-10-01Plan funding arrangement – InsuranceYes
2014-10-01Plan benefit arrangement – InsuranceYes
2013: COMMUNITY HOSPITAL EMPLOYEES' SHORT TERM AND LONG TERM DISABILITY PLAN 2013 form 5500 responses
2013-10-01Type of plan entitySingle employer plan
2013-10-01Submission has been amendedNo
2013-10-01This submission is the final filingNo
2013-10-01This return/report is a short plan year return/report (less than 12 months)No
2013-10-01Plan is a collectively bargained planNo
2013-10-01Plan funding arrangement – InsuranceYes
2013-10-01Plan benefit arrangement – InsuranceYes
2012: COMMUNITY HOSPITAL EMPLOYEES' SHORT TERM AND LONG TERM DISABILITY PLAN 2012 form 5500 responses
2012-10-01Type of plan entitySingle employer plan
2012-10-01Submission has been amendedNo
2012-10-01This submission is the final filingNo
2012-10-01This return/report is a short plan year return/report (less than 12 months)No
2012-10-01Plan is a collectively bargained planNo
2012-10-01Plan funding arrangement – InsuranceYes
2012-10-01Plan benefit arrangement – InsuranceYes
2011: COMMUNITY HOSPITAL EMPLOYEES' SHORT TERM AND LONG TERM DISABILITY PLAN 2011 form 5500 responses
2011-10-01Type of plan entitySingle employer plan
2011-10-01Submission has been amendedNo
2011-10-01This submission is the final filingNo
2011-10-01This return/report is a short plan year return/report (less than 12 months)No
2011-10-01Plan is a collectively bargained planNo
2011-10-01Plan funding arrangement – InsuranceYes
2011-10-01Plan benefit arrangement – InsuranceYes
2010: COMMUNITY HOSPITAL EMPLOYEES' SHORT TERM AND LONG TERM DISABILITY PLAN 2010 form 5500 responses
2010-10-01Type of plan entitySingle employer plan
2010-10-01Submission has been amendedNo
2010-10-01This submission is the final filingNo
2010-10-01This return/report is a short plan year return/report (less than 12 months)No
2010-10-01Plan is a collectively bargained planNo
2010-10-01Plan funding arrangement – InsuranceYes
2010-10-01Plan benefit arrangement – InsuranceYes
2009: COMMUNITY HOSPITAL EMPLOYEES' SHORT TERM AND LONG TERM DISABILITY PLAN 2009 form 5500 responses
2009-10-01Type of plan entitySingle employer plan
2009-10-01Submission has been amendedNo
2009-10-01This submission is the final filingNo
2009-10-01This return/report is a short plan year return/report (less than 12 months)No
2009-10-01Plan is a collectively bargained planNo
2009-10-01Plan funding arrangement – InsuranceYes
2009-10-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number113016
Policy instance 1
Insurance contract or identification number113016
Number of Individuals Covered248
Insurance policy start date2015-10-01
Insurance policy end date2016-09-30
Total amount of commissions paid to insurance brokerUSD $22,034
Total amount of fees paid to insurance companyUSD $3,443
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 BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 $275,420
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,034
Amount paid for insurance broker fees3443
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameTIM OLSON INC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number113016 0001
Policy instance 1
Insurance contract or identification number113016 0001
Number of Individuals Covered214
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $18,684
Total amount of fees paid to insurance companyUSD $2,919
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 BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
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 $233,556
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,684
Amount paid for insurance broker fees2919
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Insurance broker nameTIM OLSON INC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number113016 0001
Policy instance 1
Insurance contract or identification number113016 0001
Number of Individuals Covered219
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $18,165
Total amount of fees paid to insurance companyUSD $2,838
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 BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
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 $227,058
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,165
Amount paid for insurance broker fees2838
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Insurance broker nameTIM OLSON INC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number113016 0001
Policy instance 1
Insurance contract or identification number113016 0001
Number of Individuals Covered217
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $17,045
Total amount of fees paid to insurance companyUSD $2,663
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 BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
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 $213,056
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,045
Amount paid for insurance broker fees2663
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Insurance broker nameTIM OLSON INC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number113016 0001
Policy instance 1
Insurance contract or identification number113016 0001
Number of Individuals Covered210
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $16,326
Total amount of fees paid to insurance companyUSD $2,427
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $204,071
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 number113016 0001
Policy instance 1
Insurance contract or identification number113016 0001
Number of Individuals Covered199
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $15,210
Total amount of fees paid to insurance companyUSD $1,784
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $190,130
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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