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KENTUCKY HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN 401k Plan overview

Plan NameKENTUCKY HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN
Plan identification number 501

KENTUCKY HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or 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

CLINTON COUNTY HOSPITAL INC has sponsored the creation of one or more 401k plans.

Company Name:CLINTON COUNTY HOSPITAL INC
Employer identification number (EIN):616008014
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KENTUCKY HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012015-05-01RONALD SOWELL
5012014-05-01
5012013-05-01
5012012-05-01J. D. MULLINS J. D. MULLINS2013-11-22
5012011-05-01J. D. MULLINS J. D. MULLINS2012-11-26
5012009-05-01J. D. MULLINS J. D. MULLINS2011-02-22

Plan Statistics for KENTUCKY HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN

401k plan membership statisitcs for KENTUCKY HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN

Measure Date Value
2015: KENTUCKY HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-05-0189
Total number of active participants reported on line 7a of the Form 55002015-05-010
Number of retired or separated participants receiving benefits2015-05-010
Number of other retired or separated participants entitled to future benefits2015-05-010
Total of all active and inactive participants2015-05-010
2014: KENTUCKY HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-05-01101
Total number of active participants reported on line 7a of the Form 55002014-05-0189
Total of all active and inactive participants2014-05-0189
2013: KENTUCKY HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-05-01118
Total number of active participants reported on line 7a of the Form 55002013-05-01101
Total of all active and inactive participants2013-05-01101
2012: KENTUCKY HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-05-01125
Total number of active participants reported on line 7a of the Form 55002012-05-01118
Total of all active and inactive participants2012-05-01118
2011: KENTUCKY HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-05-01136
Total number of active participants reported on line 7a of the Form 55002011-05-01125
Total of all active and inactive participants2011-05-01125
2009: KENTUCKY HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-05-01107
Total number of active participants reported on line 7a of the Form 55002009-05-01136
Total of all active and inactive participants2009-05-01136

Financial Data on KENTUCKY HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN

Measure Date Value
2015 : KENTUCKY HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total income from all sources (including contributions)2015-12-31$183,017
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$199,334
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$184,033
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$183,017
Value of total assets at end of year2015-12-31$0
Value of total assets at beginning of year2015-12-31$16,317
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$15,301
Total interest from all sources2015-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2015-12-31$0
Administrative expenses professional fees incurred2015-12-31$15,301
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$49,197
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$-16,317
Value of net assets at end of year (total assets less liabilities)2015-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$16,317
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-12-31$16,317
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-12-31$16,317
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$64,003
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31Yes
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$133,820
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$120,030
Did the plan have assets held for investment2015-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31MOUNTJOY CHILTON MEDLEY LLP
Accountancy firm EIN2015-12-31271235638
Total income from all sources (including contributions)2015-04-30$765,171
Total of all expenses incurred2015-04-30$750,349
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-04-30$703,664
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-04-30$765,162
Value of total assets at end of year2015-04-30$16,317
Value of total assets at beginning of year2015-04-30$1,495
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-04-30$46,685
Total interest from all sources2015-04-30$9
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-04-30Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2015-04-30$0
Administrative expenses professional fees incurred2015-04-30$46,685
Was this plan covered by a fidelity bond2015-04-30Yes
Value of fidelity bond cover2015-04-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2015-04-30No
Contributions received from participants2015-04-30$210,368
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-04-30No
Value of net income/loss2015-04-30$14,822
Value of net assets at end of year (total assets less liabilities)2015-04-30$16,317
Value of net assets at beginning of year (total assets less liabilities)2015-04-30$1,495
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2015-04-30No
Were any leases to which the plan was party in default or uncollectible2015-04-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-04-30$16,317
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-04-30$1,495
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-04-30$1,495
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-04-30$9
Expenses. Payments to insurance carriers foe the provision of benefits2015-04-30$191,584
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-04-30Yes
Was there a failure to transmit to the plan any participant contributions2015-04-30No
Has the plan failed to provide any benefit when due under the plan2015-04-30No
Contributions received in cash from employer2015-04-30$554,794
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-04-30$512,080
Did the plan have assets held for investment2015-04-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-04-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-04-30Yes
Opinion of an independent qualified public accountant for this plan2015-04-30Disclaimer
Accountancy firm name2015-04-30MOUNTJOY CHILTON MEDLEY, LLP
Accountancy firm EIN2015-04-30271235638
2014 : KENTUCKY HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN 2014 401k financial data
Total income from all sources (including contributions)2014-04-30$715,042
Total of all expenses incurred2014-04-30$760,342
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-04-30$707,009
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-04-30$715,027
Value of total assets at end of year2014-04-30$1,495
Value of total assets at beginning of year2014-04-30$46,795
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-04-30$53,333
Total interest from all sources2014-04-30$15
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-04-30No
Administrative expenses professional fees incurred2014-04-30$53,333
Was this plan covered by a fidelity bond2014-04-30Yes
Value of fidelity bond cover2014-04-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2014-04-30No
Contributions received from participants2014-04-30$239,503
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-04-30No
Value of net income/loss2014-04-30$-45,300
Value of net assets at end of year (total assets less liabilities)2014-04-30$1,495
Value of net assets at beginning of year (total assets less liabilities)2014-04-30$46,795
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2014-04-30No
Were any leases to which the plan was party in default or uncollectible2014-04-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-04-30$1,495
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-04-30$46,795
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-04-30$46,795
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-04-30$15
Expenses. Payments to insurance carriers foe the provision of benefits2014-04-30$192,101
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-04-30Yes
Was there a failure to transmit to the plan any participant contributions2014-04-30No
Has the plan failed to provide any benefit when due under the plan2014-04-30No
Contributions received in cash from employer2014-04-30$475,524
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-04-30$514,908
Did the plan have assets held for investment2014-04-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-04-30Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-04-30Yes
Opinion of an independent qualified public accountant for this plan2014-04-30Disclaimer
Accountancy firm name2014-04-30MOUNTJOY CHILTON MEDLEY, LLP
Accountancy firm EIN2014-04-30271235638
2013 : KENTUCKY HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN 2013 401k financial data
Total income from all sources (including contributions)2013-04-30$700,243
Total of all expenses incurred2013-04-30$726,589
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-04-30$670,844
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-04-30$700,210
Value of total assets at end of year2013-04-30$46,795
Value of total assets at beginning of year2013-04-30$73,141
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-04-30$55,745
Total interest from all sources2013-04-30$33
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-04-30No
Administrative expenses professional fees incurred2013-04-30$55,745
Was this plan covered by a fidelity bond2013-04-30Yes
Value of fidelity bond cover2013-04-30$1,000,000
If this is an individual account plan, was there a blackout period2013-04-30No
Were there any nonexempt tranactions with any party-in-interest2013-04-30No
Contributions received from participants2013-04-30$240,824
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-04-30No
Value of net income/loss2013-04-30$-26,346
Value of net assets at end of year (total assets less liabilities)2013-04-30$46,795
Value of net assets at beginning of year (total assets less liabilities)2013-04-30$73,141
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2013-04-30No
Were any leases to which the plan was party in default or uncollectible2013-04-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-04-30$46,795
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-04-30$73,141
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-04-30$73,141
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-04-30$33
Expenses. Payments to insurance carriers foe the provision of benefits2013-04-30$161,210
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-04-30Yes
Was there a failure to transmit to the plan any participant contributions2013-04-30No
Has the plan failed to provide any benefit when due under the plan2013-04-30No
Contributions received in cash from employer2013-04-30$459,386
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-04-30$509,634
Did the plan have assets held for investment2013-04-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-04-30Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-04-30Yes
Opinion of an independent qualified public accountant for this plan2013-04-30Disclaimer
Accountancy firm name2013-04-30MOUNTJOY CHILTON MEDLEY, LLP
Accountancy firm EIN2013-04-30271235638
2012 : KENTUCKY HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN 2012 401k financial data
Total income from all sources (including contributions)2012-04-30$825,060
Total of all expenses incurred2012-04-30$860,859
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-04-30$802,196
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-04-30$825,034
Value of total assets at end of year2012-04-30$73,141
Value of total assets at beginning of year2012-04-30$108,940
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-04-30$58,663
Total interest from all sources2012-04-30$26
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-04-30No
Administrative expenses professional fees incurred2012-04-30$58,663
Was this plan covered by a fidelity bond2012-04-30Yes
Value of fidelity bond cover2012-04-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2012-04-30No
Contributions received from participants2012-04-30$226,231
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-04-30No
Value of net income/loss2012-04-30$-35,799
Value of net assets at end of year (total assets less liabilities)2012-04-30$73,141
Value of net assets at beginning of year (total assets less liabilities)2012-04-30$108,940
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2012-04-30No
Were any leases to which the plan was party in default or uncollectible2012-04-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-04-30$73,141
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-04-30$108,940
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-04-30$108,940
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-04-30$26
Expenses. Payments to insurance carriers foe the provision of benefits2012-04-30$139,048
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-04-30Yes
Was there a failure to transmit to the plan any participant contributions2012-04-30No
Has the plan failed to provide any benefit when due under the plan2012-04-30No
Contributions received in cash from employer2012-04-30$598,803
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-04-30$663,148
Did the plan have assets held for investment2012-04-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-04-30Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-04-30Yes
Opinion of an independent qualified public accountant for this plan2012-04-30Disclaimer
Accountancy firm name2012-04-30MOUNTJOY CHILTON MEDLEY, LLP
Accountancy firm EIN2012-04-30271235638
2011 : KENTUCKY HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN 2011 401k financial data
Total income from all sources (including contributions)2011-04-30$898,549
Total of all expenses incurred2011-04-30$821,355
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-04-30$761,223
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-04-30$898,470
Value of total assets at end of year2011-04-30$108,940
Value of total assets at beginning of year2011-04-30$31,746
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-04-30$60,132
Total interest from all sources2011-04-30$79
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-04-30No
Administrative expenses professional fees incurred2011-04-30$60,132
Was this plan covered by a fidelity bond2011-04-30Yes
Value of fidelity bond cover2011-04-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2011-04-30No
Contributions received from participants2011-04-30$209,387
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-04-30No
Value of net income/loss2011-04-30$77,194
Value of net assets at end of year (total assets less liabilities)2011-04-30$108,940
Value of net assets at beginning of year (total assets less liabilities)2011-04-30$31,746
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2011-04-30No
Were any leases to which the plan was party in default or uncollectible2011-04-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-04-30$108,940
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-04-30$31,746
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-04-30$31,746
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-04-30$79
Expenses. Payments to insurance carriers foe the provision of benefits2011-04-30$138,326
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-04-30No
Was there a failure to transmit to the plan any participant contributions2011-04-30No
Has the plan failed to provide any benefit when due under the plan2011-04-30No
Contributions received in cash from employer2011-04-30$689,083
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-04-30$622,897
Did the plan have assets held for investment2011-04-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-04-30Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-04-30Yes
Opinion of an independent qualified public accountant for this plan2011-04-30Disclaimer
Accountancy firm name2011-04-30MOUNTJOY CHILTON MEDLEY, LLP
Accountancy firm EIN2011-04-30271235638

Form 5500 Responses for KENTUCKY HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN

2015: KENTUCKY HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN 2015 form 5500 responses
2015-05-01Type of plan entitySingle employer plan
2015-05-01Submission has been amendedNo
2015-05-01This submission is the final filingYes
2015-05-01This return/report is a short plan year return/report (less than 12 months)Yes
2015-05-01Plan is a collectively bargained planNo
2015-05-01Plan funding arrangement – InsuranceYes
2015-05-01Plan funding arrangement – TrustYes
2015-05-01Plan benefit arrangement – InsuranceYes
2015-05-01Plan benefit arrangement - TrustYes
2014: KENTUCKY HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN 2014 form 5500 responses
2014-05-01Type of plan entitySingle employer plan
2014-05-01Submission has been amendedNo
2014-05-01This submission is the final filingNo
2014-05-01This return/report is a short plan year return/report (less than 12 months)No
2014-05-01Plan is a collectively bargained planNo
2014-05-01Plan funding arrangement – InsuranceYes
2014-05-01Plan funding arrangement – TrustYes
2014-05-01Plan benefit arrangement – InsuranceYes
2014-05-01Plan benefit arrangement - TrustYes
2013: KENTUCKY HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN 2013 form 5500 responses
2013-05-01Type of plan entitySingle employer plan
2013-05-01Submission has been amendedNo
2013-05-01This submission is the final filingNo
2013-05-01This return/report is a short plan year return/report (less than 12 months)No
2013-05-01Plan is a collectively bargained planNo
2013-05-01Plan funding arrangement – InsuranceYes
2013-05-01Plan funding arrangement – TrustYes
2013-05-01Plan benefit arrangement – InsuranceYes
2013-05-01Plan benefit arrangement - TrustYes
2012: KENTUCKY HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN 2012 form 5500 responses
2012-05-01Type of plan entitySingle employer plan
2012-05-01Submission has been amendedNo
2012-05-01This submission is the final filingNo
2012-05-01This return/report is a short plan year return/report (less than 12 months)No
2012-05-01Plan is a collectively bargained planNo
2012-05-01Plan funding arrangement – InsuranceYes
2012-05-01Plan funding arrangement – TrustYes
2012-05-01Plan benefit arrangement – InsuranceYes
2012-05-01Plan benefit arrangement - TrustYes
2011: KENTUCKY HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN 2011 form 5500 responses
2011-05-01Type of plan entitySingle employer plan
2011-05-01Submission has been amendedNo
2011-05-01This submission is the final filingNo
2011-05-01This return/report is a short plan year return/report (less than 12 months)No
2011-05-01Plan is a collectively bargained planNo
2011-05-01Plan funding arrangement – InsuranceYes
2011-05-01Plan funding arrangement – TrustYes
2011-05-01Plan benefit arrangement – InsuranceYes
2011-05-01Plan benefit arrangement - TrustYes
2009: KENTUCKY HOSPITAL EMPLOYEE HEALTH BENEFIT PLAN 2009 form 5500 responses
2009-05-01Type of plan entitySingle employer plan
2009-05-01Submission has been amendedNo
2009-05-01This submission is the final filingNo
2009-05-01This return/report is a short plan year return/report (less than 12 months)No
2009-05-01Plan is a collectively bargained planNo
2009-05-01Plan funding arrangement – TrustYes
2009-05-01Plan benefit arrangement – InsuranceYes
2009-05-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )
Policy contract number00183091
Policy instance 1
Insurance contract or identification number00183091
Number of Individuals Covered0
Insurance policy start date2015-05-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $6,400
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $64,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,400
Insurance broker organization code?3
Insurance broker nameKENTUCKY HOSPITAL SERVICE COMPANY
ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )
Policy contract number00183091
Policy instance 1
Insurance contract or identification number00183091
Number of Individuals Covered89
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $19,158
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $191,584
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,158
Insurance broker organization code?3
Insurance broker nameKENTUCKY HOSPITAL SERVICE COMPANY
ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )
Policy contract number00183091
Policy instance 1
Insurance contract or identification number00183091
Number of Individuals Covered101
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $19,210
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $192,101
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,210
Insurance broker organization code?3
Insurance broker nameKENTUCKY HOSPITAL SERVICE COMPANY
ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )
Policy contract number00183091
Policy instance 1
Insurance contract or identification number00183091
Number of Individuals Covered118
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $16,121
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $161,210
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,121
Insurance broker organization code?3
Insurance broker nameKENTUCKY HOSPITAL SERVICE COMPANY
ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )
Policy contract number00183091
Policy instance 1
Insurance contract or identification number00183091
Number of Individuals Covered125
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Total amount of commissions paid to insurance brokerUSD $13,905
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $139,048
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )
Policy contract number00183091
Policy instance 1
Insurance contract or identification number00183091
Number of Individuals Covered136
Insurance policy start date2010-05-01
Insurance policy end date2011-04-30
Total amount of commissions paid to insurance brokerUSD $13,833
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $138,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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