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BON SECOURS HEALTH SYSTEM, INC. VISION PLAN 401k Plan overview

Plan NameBON SECOURS HEALTH SYSTEM, INC. VISION PLAN
Plan identification number 512

BON SECOURS HEALTH SYSTEM, INC. VISION PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Vision
  • 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

BON SECOURS MERCY HEALTH, INC. has sponsored the creation of one or more 401k plans.

Company Name:BON SECOURS MERCY HEALTH, INC.
Employer identification number (EIN):521301088
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BON SECOURS HEALTH SYSTEM, INC. VISION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5122019-09-01NICOLE MARTEL2021-09-21 NICOLE MARTEL2021-09-21
5122018-09-01NICOLE MARTEL2021-09-27 NICOLE MARTEL2021-09-27
5122017-09-01
5122016-09-01TIMOTHY DAVIS TIMOTHY DAVIS2018-07-13
5122015-09-01TIMOTHY DAVIS TIMOTHY DAVIS2017-07-13
5122014-09-01TIMOTHY DAVIS TIMOTHY DAVIS2016-06-29
5122013-09-01TIMOTHY DAVIS TIMOTHY DAVIS2015-02-18
5122012-09-01TIMOTHY DAVIS TIMOTHY DAVIS2014-03-27
5122011-09-01TIMOTHY J. DAVIS TIMOTHY J. DAVIS2013-03-07
5122010-09-01TIMOTHY J. DAVIS
5122009-09-01TIMOTHY J. DAVIS
5122009-01-01TIM DAVIS TIM DAVIS2010-04-12

Plan Statistics for BON SECOURS HEALTH SYSTEM, INC. VISION PLAN

401k plan membership statisitcs for BON SECOURS HEALTH SYSTEM, INC. VISION PLAN

Measure Date Value
2019: BON SECOURS HEALTH SYSTEM, INC. VISION PLAN 2019 401k membership
Total participants, beginning-of-year2019-09-0113,896
Total number of active participants reported on line 7a of the Form 55002019-09-0113,194
Number of retired or separated participants receiving benefits2019-09-01191
Total of all active and inactive participants2019-09-0113,385
Total participants2019-09-0113,385
2018: BON SECOURS HEALTH SYSTEM, INC. VISION PLAN 2018 401k membership
Total participants, beginning-of-year2018-09-0114,584
Total number of active participants reported on line 7a of the Form 55002018-09-0113,731
Number of retired or separated participants receiving benefits2018-09-01165
Total of all active and inactive participants2018-09-0113,896
Total participants2018-09-0113,896
2017: BON SECOURS HEALTH SYSTEM, INC. VISION PLAN 2017 401k membership
Total participants, beginning-of-year2017-09-0114,329
Total number of active participants reported on line 7a of the Form 55002017-09-0114,312
Number of retired or separated participants receiving benefits2017-09-01272
Total of all active and inactive participants2017-09-0114,584
Total participants2017-09-0114,584
2016: BON SECOURS HEALTH SYSTEM, INC. VISION PLAN 2016 401k membership
Total participants, beginning-of-year2016-09-0113,788
Total number of active participants reported on line 7a of the Form 55002016-09-0114,166
Number of retired or separated participants receiving benefits2016-09-01163
Total of all active and inactive participants2016-09-0114,329
Total participants2016-09-0114,329
2015: BON SECOURS HEALTH SYSTEM, INC. VISION PLAN 2015 401k membership
Total participants, beginning-of-year2015-09-0113,317
Total number of active participants reported on line 7a of the Form 55002015-09-0113,710
Number of retired or separated participants receiving benefits2015-09-0178
Total of all active and inactive participants2015-09-0113,788
Total participants2015-09-0113,788
2014: BON SECOURS HEALTH SYSTEM, INC. VISION PLAN 2014 401k membership
Total participants, beginning-of-year2014-09-0112,919
Total number of active participants reported on line 7a of the Form 55002014-09-0113,235
Number of retired or separated participants receiving benefits2014-09-0182
Total of all active and inactive participants2014-09-0113,317
Total participants2014-09-0113,317
2013: BON SECOURS HEALTH SYSTEM, INC. VISION PLAN 2013 401k membership
Total participants, beginning-of-year2013-09-0112,389
Total number of active participants reported on line 7a of the Form 55002013-09-0112,869
Number of retired or separated participants receiving benefits2013-09-0150
Total of all active and inactive participants2013-09-0112,919
Total participants2013-09-0112,919
2012: BON SECOURS HEALTH SYSTEM, INC. VISION PLAN 2012 401k membership
Total participants, beginning-of-year2012-09-0112,221
Total number of active participants reported on line 7a of the Form 55002012-09-0112,324
Number of retired or separated participants receiving benefits2012-09-0165
Total of all active and inactive participants2012-09-0112,389
Total participants2012-09-0112,389
2011: BON SECOURS HEALTH SYSTEM, INC. VISION PLAN 2011 401k membership
Total participants, beginning-of-year2011-09-0112,034
Total number of active participants reported on line 7a of the Form 55002011-09-0112,073
Number of retired or separated participants receiving benefits2011-09-01148
Total of all active and inactive participants2011-09-0112,221
2010: BON SECOURS HEALTH SYSTEM, INC. VISION PLAN 2010 401k membership
Total participants, beginning-of-year2010-09-0111,224
Total number of active participants reported on line 7a of the Form 55002010-09-0111,910
Number of retired or separated participants receiving benefits2010-09-01124
Number of other retired or separated participants entitled to future benefits2010-09-010
Total of all active and inactive participants2010-09-0112,034
2009: BON SECOURS HEALTH SYSTEM, INC. VISION PLAN 2009 401k membership
Total participants, beginning-of-year2009-09-0110,641
Total number of active participants reported on line 7a of the Form 55002009-09-0111,039
Number of retired or separated participants receiving benefits2009-09-01145
Number of other retired or separated participants entitled to future benefits2009-09-010
Total of all active and inactive participants2009-09-0111,184
Total participants, beginning-of-year2009-01-0110,221
Total number of active participants reported on line 7a of the Form 55002009-01-0110,483
Number of retired or separated participants receiving benefits2009-01-01158
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-0110,641

Form 5500 Responses for BON SECOURS HEALTH SYSTEM, INC. VISION PLAN

2019: BON SECOURS HEALTH SYSTEM, INC. VISION PLAN 2019 form 5500 responses
2019-09-01Type of plan entitySingle employer plan
2019-09-01This return/report is a short plan year return/report (less than 12 months)Yes
2019-09-01Plan funding arrangement – InsuranceYes
2019-09-01Plan benefit arrangement – InsuranceYes
2018: BON SECOURS HEALTH SYSTEM, INC. VISION PLAN 2018 form 5500 responses
2018-09-01Type of plan entitySingle employer plan
2018-09-01Plan funding arrangement – InsuranceYes
2018-09-01Plan benefit arrangement – InsuranceYes
2017: BON SECOURS HEALTH SYSTEM, INC. VISION PLAN 2017 form 5500 responses
2017-09-01Type of plan entitySingle employer plan
2017-09-01Submission has been amendedNo
2017-09-01This submission is the final filingNo
2017-09-01This return/report is a short plan year return/report (less than 12 months)No
2017-09-01Plan is a collectively bargained planNo
2017-09-01Plan funding arrangement – InsuranceYes
2017-09-01Plan benefit arrangement – InsuranceYes
2016: BON SECOURS HEALTH SYSTEM, INC. VISION PLAN 2016 form 5500 responses
2016-09-01Type of plan entitySingle employer plan
2016-09-01Submission has been amendedNo
2016-09-01This submission is the final filingNo
2016-09-01This return/report is a short plan year return/report (less than 12 months)No
2016-09-01Plan is a collectively bargained planNo
2016-09-01Plan funding arrangement – InsuranceYes
2016-09-01Plan benefit arrangement – InsuranceYes
2015: BON SECOURS HEALTH SYSTEM, INC. VISION PLAN 2015 form 5500 responses
2015-09-01Type of plan entitySingle employer plan
2015-09-01Submission has been amendedNo
2015-09-01This submission is the final filingNo
2015-09-01This return/report is a short plan year return/report (less than 12 months)No
2015-09-01Plan is a collectively bargained planNo
2015-09-01Plan funding arrangement – InsuranceYes
2015-09-01Plan benefit arrangement – InsuranceYes
2014: BON SECOURS HEALTH SYSTEM, INC. VISION PLAN 2014 form 5500 responses
2014-09-01Type of plan entitySingle employer plan
2014-09-01Submission has been amendedNo
2014-09-01This submission is the final filingNo
2014-09-01This return/report is a short plan year return/report (less than 12 months)No
2014-09-01Plan is a collectively bargained planNo
2014-09-01Plan funding arrangement – InsuranceYes
2014-09-01Plan benefit arrangement – InsuranceYes
2013: BON SECOURS HEALTH SYSTEM, INC. VISION PLAN 2013 form 5500 responses
2013-09-01Type of plan entitySingle employer plan
2013-09-01Submission has been amendedNo
2013-09-01This submission is the final filingNo
2013-09-01This return/report is a short plan year return/report (less than 12 months)No
2013-09-01Plan is a collectively bargained planNo
2013-09-01Plan funding arrangement – InsuranceYes
2013-09-01Plan benefit arrangement – InsuranceYes
2012: BON SECOURS HEALTH SYSTEM, INC. VISION PLAN 2012 form 5500 responses
2012-09-01Type of plan entitySingle employer plan
2012-09-01Submission has been amendedNo
2012-09-01This submission is the final filingNo
2012-09-01This return/report is a short plan year return/report (less than 12 months)No
2012-09-01Plan is a collectively bargained planNo
2012-09-01Plan funding arrangement – InsuranceYes
2012-09-01Plan benefit arrangement – InsuranceYes
2011: BON SECOURS HEALTH SYSTEM, INC. VISION PLAN 2011 form 5500 responses
2011-09-01Type of plan entitySingle employer plan
2011-09-01Submission has been amendedNo
2011-09-01This submission is the final filingNo
2011-09-01This return/report is a short plan year return/report (less than 12 months)No
2011-09-01Plan is a collectively bargained planNo
2011-09-01Plan funding arrangement – InsuranceYes
2011-09-01Plan benefit arrangement – InsuranceYes
2010: BON SECOURS HEALTH SYSTEM, INC. VISION PLAN 2010 form 5500 responses
2010-09-01Type of plan entitySingle employer plan
2010-09-01Submission has been amendedNo
2010-09-01This submission is the final filingNo
2010-09-01This return/report is a short plan year return/report (less than 12 months)No
2010-09-01Plan is a collectively bargained planNo
2010-09-01Plan funding arrangement – InsuranceYes
2010-09-01Plan benefit arrangement – InsuranceYes
2009: BON SECOURS HEALTH SYSTEM, INC. VISION PLAN 2009 form 5500 responses
2009-09-01Type of plan entitySingle employer plan
2009-09-01Submission has been amendedNo
2009-09-01This submission is the final filingNo
2009-09-01This return/report is a short plan year return/report (less than 12 months)No
2009-09-01Plan is a collectively bargained planNo
2009-09-01Plan funding arrangement – InsuranceYes
2009-09-01Plan benefit arrangement – InsuranceYes
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)Yes
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

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number715906
Policy instance 1
Insurance contract or identification number715906
Number of Individuals Covered2278
Insurance policy start date2019-09-01
Insurance policy end date2019-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $544,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number715906
Policy instance 1
Insurance contract or identification number715906
Number of Individuals Covered28985
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,707,137
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number715906
Policy instance 1
Insurance contract or identification number715906
Number of Individuals Covered23345
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 $1,611,924
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0715906
Policy instance 1
Insurance contract or identification number0715906
Number of Individuals Covered13317
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 $1,622,993
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker name
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number715906
Policy instance 1
Insurance contract or identification number715906
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
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 $2,493,712
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number715906
Policy instance 1
Insurance contract or identification number715906
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
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 $1,428,075
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number715906,235418
Policy instance 1
Insurance contract or identification number715906,235418
Number of Individuals Covered12221
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 $1,246,115
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number235418
Policy instance 1
Insurance contract or identification number235418
Number of Individuals Covered12034
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 $1,389,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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