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GOOD SAMARITAN HOSPICE, INC. HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameGOOD SAMARITAN HOSPICE, INC. HEALTH AND WELFARE PLAN
Plan identification number 501

GOOD SAMARITAN HOSPICE, INC. HEALTH AND WELFARE 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)

401k Sponsoring company profile

GOOD SAMARITAN HOSPICE, INC. has sponsored the creation of one or more 401k plans.

Company Name:GOOD SAMARITAN HOSPICE, INC.
Employer identification number (EIN):541608259
NAIC Classification:621399
NAIC Description:Offices of All Other Miscellaneous Health Practitioners

Additional information about GOOD SAMARITAN HOSPICE, INC.

Jurisdiction of Incorporation: Virginia Secretary of State
Incorporation Date: 1991-12-13
Company Identification Number: 0385107
Legal Registered Office Address: 2408 ELECTRIC ROAD SW

ROANOKE
United States of America (USA)
24018

More information about GOOD SAMARITAN HOSPICE, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GOOD SAMARITAN HOSPICE, INC. HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-07-01MELISSA LUCAS2024-10-14

Form 5500 Responses for GOOD SAMARITAN HOSPICE, INC. HEALTH AND WELFARE PLAN

2023: GOOD SAMARITAN HOSPICE, INC. HEALTH AND WELFARE PLAN 2023 form 5500 responses
2023-07-01Type of plan entitySingle employer plan
2023-07-01First time form 5500 has been submittedYes
2023-07-01Plan funding arrangement – InsuranceYes
2023-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number632920
Policy instance 1
Insurance contract or identification number632920
Number of Individuals Covered120
Insurance policy start date2023-07-01
Insurance policy end date2024-06-30
Total amount of commissions paid to insurance brokerUSD $5,520
Total amount of fees paid to insurance companyUSD $30,308
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,148,620
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number22332
Policy instance 2
Insurance contract or identification number22332
Number of Individuals Covered108
Insurance policy start date2023-07-01
Insurance policy end date2024-06-30
Total amount of commissions paid to insurance brokerUSD $19,103
Total amount of fees paid to insurance companyUSD $3,385
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS, CANCER
Welfare Benefit Premiums Paid to CarrierUSD $102,681
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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