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| Plan Name | LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-STOP LOSS |
| Plan identification number | 505 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | LA PAZ REGIONAL HOSPITAL |
| Employer identification number (EIN): | 860260959 |
| NAIC Classification: | 622000 |
| NAIC Description: | Hospitals |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 505 | 2018-08-01 | ||||
| 505 | 2018-08-01 | REGINA MARTINEZ | 2021-04-01 | KEVIN M. BROWN | 2021-04-01 |
| 505 | 2016-07-01 | REGINA MARTINEZ | |||
| 505 | 2014-07-01 | REGINA MARTINEZ |
| Measure | Date | Value |
|---|---|---|
| 2018: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-STOP LOSS 2018 401k membership | ||
| Total participants, beginning-of-year | 2018-08-01 | 126 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-08-01 | 126 |
| Total of all active and inactive participants | 2018-08-01 | 126 |
| Total participants | 2018-08-01 | 126 |
| Number of retired or separated participants receiving benefits | 2018-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-08-01 | 0 |
| 2016: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-STOP LOSS 2016 401k membership | ||
| Total participants, beginning-of-year | 2016-07-01 | 124 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-07-01 | 124 |
| Total of all active and inactive participants | 2016-07-01 | 124 |
| Total participants | 2016-07-01 | 124 |
| 2014: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-STOP LOSS 2014 401k membership | ||
| Total participants, beginning-of-year | 2014-07-01 | 149 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-07-01 | 149 |
| Total of all active and inactive participants | 2014-07-01 | 149 |
| Total participants | 2014-07-01 | 149 |
| 2018: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-STOP LOSS 2018 form 5500 responses | ||
|---|---|---|
| 2018-08-01 | Type of plan entity | Single employer plan |
| 2018-08-01 | Submission has been amended | No |
| 2018-08-01 | This submission is the final filing | No |
| 2018-08-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-08-01 | Plan is a collectively bargained plan | No |
| 2018-08-01 | Plan funding arrangement – Insurance | Yes |
| 2018-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-STOP LOSS 2016 form 5500 responses | ||
| 2016-07-01 | Type of plan entity | Single employer plan |
| 2016-07-01 | First time form 5500 has been submitted | Yes |
| 2016-07-01 | Submission has been amended | No |
| 2016-07-01 | This submission is the final filing | No |
| 2016-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-07-01 | Plan is a collectively bargained plan | No |
| 2016-07-01 | Plan funding arrangement – Insurance | Yes |
| 2016-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: LA PAZ REGIONAL HOSPITAL BENEFIT PLAN-STOP LOSS 2014 form 5500 responses | ||
| 2014-07-01 | Type of plan entity | Single employer plan |
| 2014-07-01 | Submission has been amended | No |
| 2014-07-01 | This submission is the final filing | No |
| 2014-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-07-01 | Plan is a collectively bargained plan | No |
| 2014-07-01 | Plan funding arrangement – Insurance | Yes |
| 2014-07-01 | Plan benefit arrangement – Insurance | Yes |
| DELTA DENTAL OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53597 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 20181 00000 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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