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LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 401k Plan overview

Plan NameLONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT
Plan identification number 501

LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

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

Company Name:SUBURBAN HOSPITAL
Employer identification number (EIN):520610545
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01TIFFANY PRATT2023-10-06
5012021-01-01DIONE POWELL2022-10-06
5012020-01-01MARIO DELGADO2021-10-12
5012020-01-01MARIO DELGADO2021-10-12
5012019-01-01MARIO DELGADO2020-07-16
5012018-01-01MARIO DELGADO2019-09-26
5012017-01-01
5012016-01-01
5012015-01-01
5012014-01-01
5012013-01-01
5012012-01-01ADELE DRAIMAN
5012011-01-01ADELE DRAIMAN
5012010-01-01ADELE DRAIMAN
5012009-01-01ADELE DRAIMAN

Plan Statistics for LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT

401k plan membership statisitcs for LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT

Measure Date Value
2022: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 2022 401k membership
Total participants, beginning-of-year2022-01-011,330
Total number of active participants reported on line 7a of the Form 55002022-01-011,307
Total of all active and inactive participants2022-01-011,307
2021: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 2021 401k membership
Total participants, beginning-of-year2021-01-011,441
Total number of active participants reported on line 7a of the Form 55002021-01-011,330
Total of all active and inactive participants2021-01-011,330
2020: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 2020 401k membership
Total participants, beginning-of-year2020-01-011,406
Total number of active participants reported on line 7a of the Form 55002020-01-011,441
Total of all active and inactive participants2020-01-011,441
2019: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 2019 401k membership
Total participants, beginning-of-year2019-01-011,361
Total number of active participants reported on line 7a of the Form 55002019-01-011,406
Total of all active and inactive participants2019-01-011,406
2018: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 2018 401k membership
Total participants, beginning-of-year2018-01-011,387
Total number of active participants reported on line 7a of the Form 55002018-01-011,361
Total of all active and inactive participants2018-01-011,361
2017: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 2017 401k membership
Total participants, beginning-of-year2017-01-011,356
Total number of active participants reported on line 7a of the Form 55002017-01-011,387
Total of all active and inactive participants2017-01-011,387
Total participants2017-01-011,387
2016: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 2016 401k membership
Total participants, beginning-of-year2016-01-011,324
Total number of active participants reported on line 7a of the Form 55002016-01-011,356
Total of all active and inactive participants2016-01-011,356
Total participants2016-01-011,356
2015: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 2015 401k membership
Total participants, beginning-of-year2015-01-011,286
Total number of active participants reported on line 7a of the Form 55002015-01-011,324
Total of all active and inactive participants2015-01-011,324
Total participants2015-01-011,324
2014: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 2014 401k membership
Total participants, beginning-of-year2014-01-011,363
Total number of active participants reported on line 7a of the Form 55002014-01-011,286
Total of all active and inactive participants2014-01-011,286
Total participants2014-01-011,286
2013: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 2013 401k membership
Total participants, beginning-of-year2013-01-011,386
Total number of active participants reported on line 7a of the Form 55002013-01-011,363
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-011,363
Total participants2013-01-011,363
2012: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 2012 401k membership
Total participants, beginning-of-year2012-01-011,300
Total number of active participants reported on line 7a of the Form 55002012-01-011,386
Total of all active and inactive participants2012-01-011,386
Total participants2012-01-011,386
2011: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 2011 401k membership
Total participants, beginning-of-year2011-01-011,322
Total number of active participants reported on line 7a of the Form 55002011-01-011,300
Total of all active and inactive participants2011-01-011,300
Total participants2011-01-011,300
2010: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 2010 401k membership
Total participants, beginning-of-year2010-01-011,352
Total number of active participants reported on line 7a of the Form 55002010-01-011,322
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-011,322
Total participants2010-01-011,322
2009: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 2009 401k membership
Total participants, beginning-of-year2009-01-011,274
Total number of active participants reported on line 7a of the Form 55002009-01-011,352
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-011,352

Form 5500 Responses for LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT

2022: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedYes
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: LONG TERM DISABILITY LIFE ACCIDENTAL DEATH AND DISMEMBERMENT 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 benefit arrangement – InsuranceYes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number231315
Policy instance 2
Insurance contract or identification number231315
Number of Individuals Covered911
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $15,228
Total amount of fees paid to insurance companyUSD $1,721
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $316,919
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,139
Insurance broker organization code?3
Amount paid for insurance broker fees1721
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0232348
Policy instance 1
Insurance contract or identification number0232348
Number of Individuals Covered1307
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $12,770
Total amount of fees paid to insurance companyUSD $1,315
Life Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $244,381
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,773
Insurance broker organization code?3
Amount paid for insurance broker fees1315
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number231315
Policy instance 2
Insurance contract or identification number231315
Number of Individuals Covered976
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $9,056
Total amount of fees paid to insurance companyUSD $1,164
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $318,686
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,528
Insurance broker organization code?3
Amount paid for insurance broker fees1164
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0232348
Policy instance 1
Insurance contract or identification number0232348
Number of Individuals Covered1875
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $6,258
Total amount of fees paid to insurance companyUSD $836
Life Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $219,377
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees836
Commission paid to Insurance BrokerUSD $3,129
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number087131
Policy instance 1
Insurance contract or identification number087131
Number of Individuals Covered1425
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $47,032
Total amount of fees paid to insurance companyUSD $6,693
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $795,916
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,708
Amount paid for insurance broker fees3437
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number087131
Policy instance 1
Insurance contract or identification number087131
Number of Individuals Covered1406
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $40,428
Total amount of fees paid to insurance companyUSD $8,086
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $880,935
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,214
Amount paid for insurance broker fees5054
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number087131
Policy instance 1
Insurance contract or identification number087131
Number of Individuals Covered1361
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $39,530
Total amount of fees paid to insurance companyUSD $7,384
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $738,401
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,460
Amount paid for insurance broker fees4615
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number087131
Policy instance 1
Insurance contract or identification number087131
Number of Individuals Covered1387
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $61,440
Total amount of fees paid to insurance companyUSD $11,013
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $827,638
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,360
Amount paid for insurance broker fees7659
Insurance broker organization code?3
Insurance broker nameMGFS INSURANCE BROKERAGE INC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number087131
Policy instance 1
Insurance contract or identification number087131
Number of Individuals Covered1324
Insurance policy start date2015-01-01
Insurance policy end date2016-01-01
Total amount of commissions paid to insurance brokerUSD $45,285
Total amount of fees paid to insurance companyUSD $5,939
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $598,233
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,223
Amount paid for insurance broker fees3033
Insurance broker organization code?3
Insurance broker nameMGFS INSURANCE BROKERAGE INC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number087131
Policy instance 1
Insurance contract or identification number087131
Number of Individuals Covered1286
Insurance policy start date2014-01-01
Insurance policy end date2015-01-01
Total amount of commissions paid to insurance brokerUSD $41,565
Total amount of fees paid to insurance companyUSD $5,736
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $624,221
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,339
Amount paid for insurance broker fees3585
Insurance broker organization code?3
Insurance broker nameMGFS INSURANCE BROKERAGE INC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number087131
Policy instance 1
Insurance contract or identification number087131
Number of Individuals Covered1363
Insurance policy start date2013-01-01
Insurance policy end date2014-01-01
Total amount of commissions paid to insurance brokerUSD $41,241
Total amount of fees paid to insurance companyUSD $5,216
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $704,328
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,608
Amount paid for insurance broker fees4402
Insurance broker organization code?3
Insurance broker nameMGFS INSURANCE BROKERAGE INC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number087131
Policy instance 1
Insurance contract or identification number087131
Number of Individuals Covered1374
Insurance policy start date2012-01-01
Insurance policy end date2013-01-01
Total amount of commissions paid to insurance brokerUSD $31,055
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $693,498
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,610
Insurance broker organization code?3
Insurance broker nameSEGAL COMPANY
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number087131
Policy instance 1
Insurance contract or identification number087131
Number of Individuals Covered1348
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $56,868
Total amount of fees paid to insurance companyUSD $578
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $779,728
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 number087131
Policy instance 1
Insurance contract or identification number087131
Number of Individuals Covered1322
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $65,945
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 $830,521
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $65,945
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameSEGAL COMPANY

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