401k Plan data: HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN plan

HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN 401k Plan overview

Plan Name	HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN
Plan identification number	501

HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental

401k Sponsoring company profile

HOSPITAL EPISCOPAL SAN LUCAS GUAYAMA, INC. has sponsored the creation of one or more 401k plans.

Company Name: HOSPITAL EPISCOPAL SAN LUCAS GUAYAMA, INC.

Employer identification number (EIN): 660558342

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-01-01 ELYONEL PONTON
501 2016-01-01 ELYONEL PONTON
501 2015-01-01 ELYONEL PONTON
501 2014-01-01 ELYONEL PONTON CRUZ
501 2013-01-01 ARNALDO RODRIGUEZ SANCHEZ
501 2012-01-01 ARNALDO RODRIGUEZ SANCHEZ
501 2011-01-01 ARNALDO RODRIGUEZ SANCHEZ
501 2009-01-01 GUILLERMO MARTIN

Plan id#	Filing Submission Date	Name of Administrator
501	2017-01-01	ELYONEL PONTON
501	2016-01-01	ELYONEL PONTON
501	2015-01-01	ELYONEL PONTON
501	2014-01-01	ELYONEL PONTON CRUZ
501	2013-01-01	ARNALDO RODRIGUEZ SANCHEZ
501	2012-01-01	ARNALDO RODRIGUEZ SANCHEZ
501	2011-01-01	ARNALDO RODRIGUEZ SANCHEZ
501	2009-01-01	GUILLERMO MARTIN

Plan Statistics for HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN

401k plan membership statisitcs for HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN

Measure Date Value
2017: HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 227
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 233
Total of all active and inactive participants 2017-01-01 233
Total participants 2017-01-01 233
2016: HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 221
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 227
Total of all active and inactive participants 2016-01-01 227
Total participants 2016-01-01 227
2015: HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 242
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 221
Total of all active and inactive participants 2015-01-01 221
Total participants 2015-01-01 221
2014: HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 247
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 242
Total of all active and inactive participants 2014-01-01 242
Total participants 2014-01-01 242
2013: HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 242
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 247
Total of all active and inactive participants 2013-01-01 247
Total participants 2013-01-01 247
2012: HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 216
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 242
Total of all active and inactive participants 2012-01-01 242
Total participants 2012-01-01 242
2011: HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 125
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 216
Total of all active and inactive participants 2011-01-01 216
Total participants 2011-01-01 216
2009: HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 120
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 120
Total of all active and inactive participants 2009-01-01 120
Total participants 2009-01-01 120

Measure	Date	Value
2017: HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	227
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	233
Total of all active and inactive participants	2017-01-01	233
Total participants	2017-01-01	233
2016: HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	221
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	227
Total of all active and inactive participants	2016-01-01	227
Total participants	2016-01-01	227
2015: HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	242
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	221
Total of all active and inactive participants	2015-01-01	221
Total participants	2015-01-01	221
2014: HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	247
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	242
Total of all active and inactive participants	2014-01-01	242
Total participants	2014-01-01	242
2013: HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	242
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	247
Total of all active and inactive participants	2013-01-01	247
Total participants	2013-01-01	247
2012: HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	216
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	242
Total of all active and inactive participants	2012-01-01	242
Total participants	2012-01-01	242
2011: HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	125
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	216
Total of all active and inactive participants	2011-01-01	216
Total participants	2011-01-01	216
2009: HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	120
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	120
Total of all active and inactive participants	2009-01-01	120
Total participants	2009-01-01	120

Form 5500 Responses for HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN

2017: HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	Yes
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: HOSPITAL SAN LUCAS GUAYAMA- HEALTH PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	First time form 5500 has been submitted	Yes
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )
Policy contract number	SP0003559
Policy instance	1
DELTA DENTAL OF PUERTO RICO, INC. (National Association of Insurance Commissioners NAIC id number: 47085 )
Policy contract number	2044
Policy instance	2
TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )
Policy contract number	SP0003559
Policy instance	1
TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )
Policy contract number	SP0003559
Policy instance	1
DELTA DENTAL OF PUERTO RICO, INC. (National Association of Insurance Commissioners NAIC id number: 47085 )
Policy contract number	2044
Policy instance	2
TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )
Policy contract number	SP0003559
Policy instance	1
DELTA DENTAL OF PUERTO RICO, INC. (National Association of Insurance Commissioners NAIC id number: 47085 )
Policy contract number	2044
Policy instance	2
DELTA DENTAL OF PUERTO RICO, INC. (National Association of Insurance Commissioners NAIC id number: 47085 )
Policy contract number	2044
Policy instance	2
TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )
Policy contract number	110670SP0003559
Policy instance	1
TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )
Policy contract number	110670SP0003559
Policy instance	1
DELTA DENTAL OF PUERTO RICO, INC. (National Association of Insurance Commissioners NAIC id number: 47085 )
Policy contract number	2044
Policy instance	2
DELTA DENTAL OF PUERTO RICO, INC. (National Association of Insurance Commissioners NAIC id number: 47085 )
Policy contract number	2044
Policy instance	2
TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )
Policy contract number	110670SP0003559
Policy instance	1

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Company Name:	HOSPITAL EPISCOPAL SAN LUCAS GUAYAMA, INC.
Employer identification number (EIN):	660558342
NAIC Classification:	622000
NAIC Description:	Hospitals