401k Plan data: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN plan

LA PAZ REGIONAL HOSPITAL BENEFIT PLAN 401k Plan overview

Plan Name	LA PAZ REGIONAL HOSPITAL BENEFIT PLAN
Plan identification number	503

LA PAZ REGIONAL HOSPITAL BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Supplemental unemployment Temporary disability (accident and sickness)

401k Sponsoring company profile

LA PAZ REGIONAL HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name: LA PAZ REGIONAL HOSPITAL

Employer identification number (EIN): 860260959

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LA PAZ REGIONAL HOSPITAL BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2021-07-01
503 2020-07-01
503 2019-01-01
503 2018-07-01
503 2018-07-01 REGINA MARTINEZ 2021-04-01 KEVIN M. BROWN 2021-04-01
503 2014-01-01 REGINA MARTINEZ

Plan Statistics for LA PAZ REGIONAL HOSPITAL BENEFIT PLAN

401k plan membership statisitcs for LA PAZ REGIONAL HOSPITAL BENEFIT PLAN

Measure Date Value
2021: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-07-01 120
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 120
Total of all active and inactive participants 2021-07-01 120
Total participants 2021-07-01 120
2020: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-07-01 131
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 288
Total of all active and inactive participants 2020-07-01 288
Total participants 2020-07-01 288
2019: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 125
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 275
Total of all active and inactive participants 2019-01-01 275
Total participants 2019-01-01 275
2018: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-07-01 120
Total number of active participants reported on line 7a of the Form 5500 2018-07-01 120
Total of all active and inactive participants 2018-07-01 120
Total participants 2018-07-01 120
Number of retired or separated participants receiving benefits 2018-07-01 0
Number of other retired or separated participants entitled to future benefits 2018-07-01 0
2014: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 107
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 107
Total of all active and inactive participants 2014-01-01 107
Total participants 2014-01-01 107

Measure	Date	Value
2021: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-07-01	120
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	120
Total of all active and inactive participants	2021-07-01	120
Total participants	2021-07-01	120
2020: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-07-01	131
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	288
Total of all active and inactive participants	2020-07-01	288
Total participants	2020-07-01	288
2019: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	125
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	275
Total of all active and inactive participants	2019-01-01	275
Total participants	2019-01-01	275
2018: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-07-01	120
Total number of active participants reported on line 7a of the Form 5500	2018-07-01	120
Total of all active and inactive participants	2018-07-01	120
Total participants	2018-07-01	120
Number of retired or separated participants receiving benefits	2018-07-01	0
Number of other retired or separated participants entitled to future benefits	2018-07-01	0
2014: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	107
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	107
Total of all active and inactive participants	2014-01-01	107
Total participants	2014-01-01	107

Form 5500 Responses for LA PAZ REGIONAL HOSPITAL BENEFIT PLAN

2021: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Submission has been amended	No
2021-07-01	This submission is the final filing	No
2021-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-07-01	Plan is a collectively bargained plan	No
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2020: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	Submission has been amended	No
2020-07-01	This submission is the final filing	No
2020-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-07-01	Plan is a collectively bargained plan	No
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2019: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN 2018 form 5500 responses
2018-07-01	Type of plan entity	Single employer plan
2018-07-01	Submission has been amended	No
2018-07-01	This submission is the final filing	No
2018-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-07-01	Plan is a collectively bargained plan	No
2018-07-01	Plan funding arrangement – Insurance	Yes
2018-07-01	Plan benefit arrangement – Insurance	Yes
2014: LA PAZ REGIONAL HOSPITAL BENEFIT 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

Insurance Providers Used on plan

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-051181

Policy instance

Insurance contract or identification number	010-051181
Number of Individuals Covered	264
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $66,400
Total amount of fees paid to insurance company	USD $867
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $66,398
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $66,400
Amount paid for insurance broker fees	867
Insurance broker organization code?	3

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-051181

Policy instance

Insurance contract or identification number	010-051181
Number of Individuals Covered	288
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $7,303
Total amount of fees paid to insurance company	USD $445
Are there contracts with allocated funds for individual policies?	1
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,303
Amount paid for insurance broker fees	445
Additional information about fees paid to insurance broker	DENTAL INSURANCE
Insurance broker organization code?	3

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-051181

Policy instance

Insurance contract or identification number	010-051181
Number of Individuals Covered	275
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $6,532
Total amount of fees paid to insurance company	USD $1,427
Are there contracts with allocated funds for individual policies?	1
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	7559
Additional information about fees paid to insurance broker	DENTAL INSURANCE
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

912687

Policy instance

Insurance contract or identification number	912687
Number of Individuals Covered	120
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $6,843
Are there contracts with allocated funds for individual policies?	1
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Total amount of fees paid to insurance company	USD $0
Commission paid to Insurance Broker	USD $6,843
Insurance broker organization code?	3

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Company Name:	LA PAZ REGIONAL HOSPITAL
Employer identification number (EIN):	860260959
NAIC Classification:	622000
NAIC Description:	Hospitals