| Plan Name | THE JAMES B. HAGGIN MEMORIAL HOSPITAL GROUP LIFE PLAN |
| Plan identification number | 504 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | THE JAMES B. HAGGIN MEMORIAL HOSPITAL |
| Employer identification number (EIN): | 610510934 |
| NAIC Classification: | 622000 |
| NAIC Description: | Hospitals |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 504 | 2017-09-01 | ||||
| 504 | 2016-09-01 | ||||
| 504 | 2015-09-01 | ||||
| 504 | 2014-09-01 | ||||
| 504 | 2013-09-01 |
| 2017: THE JAMES B. HAGGIN MEMORIAL HOSPITAL GROUP LIFE PLAN 2017 form 5500 responses | ||
|---|---|---|
| 2017-09-01 | Type of plan entity | Single employer plan |
| 2017-09-01 | This submission is the final filing | Yes |
| 2017-09-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2017-09-01 | Plan funding arrangement – Insurance | Yes |
| 2017-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: THE JAMES B. HAGGIN MEMORIAL HOSPITAL GROUP LIFE PLAN 2016 form 5500 responses | ||
| 2016-09-01 | Type of plan entity | Single employer plan |
| 2016-09-01 | Plan funding arrangement – Insurance | Yes |
| 2016-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: THE JAMES B. HAGGIN MEMORIAL HOSPITAL GROUP LIFE PLAN 2015 form 5500 responses | ||
| 2015-09-01 | Type of plan entity | Single employer plan |
| 2015-09-01 | Plan funding arrangement – Insurance | Yes |
| 2015-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: THE JAMES B. HAGGIN MEMORIAL HOSPITAL GROUP LIFE PLAN 2014 form 5500 responses | ||
| 2014-09-01 | Type of plan entity | Single employer plan |
| 2014-09-01 | Plan funding arrangement – Insurance | Yes |
| 2014-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: THE JAMES B. HAGGIN MEMORIAL HOSPITAL GROUP LIFE PLAN 2013 form 5500 responses | ||
| 2013-09-01 | Type of plan entity | Single employer plan |
| 2013-09-01 | First time form 5500 has been submitted | Yes |
| 2013-09-01 | Plan funding arrangement – Insurance | Yes |
| 2013-09-01 | Plan benefit arrangement – Insurance | Yes |
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 ) | |
| Policy contract number | E3786480 |
| Policy instance | 1 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) | |
| Policy contract number | 876538G |
| Policy instance | 2 |