401k Plan data: OUR LADY OF LOURDES GR TERM LIFE AD&D&LONG plan

OUR LADY OF LOURDES GR TERM LIFE AD&D&LONG 401k Plan overview

Plan Name	OUR LADY OF LOURDES GR TERM LIFE AD&D&LONG
Plan identification number	501

OUR LADY OF LOURDES GR TERM LIFE AD&D&LONG Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover

401k Sponsoring company profile

OUR LADY OF LOURDES HOSPITAL AT PASCO has sponsored the creation of one or more 401k plans.

Company Name: OUR LADY OF LOURDES HOSPITAL AT PASCO

Employer identification number (EIN): 910349750

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OUR LADY OF LOURDES GR TERM LIFE AD&D&LONG

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2014-01-01 BARBARA BLOOD FRANK BECKER 2015-10-14
501 2013-01-01 BARBARA BLOOD FRANK BECKER 2014-10-14
501 2012-01-01 BARBARA BLOOD FRANK BECKER 2013-09-30
501 2011-01-01 BARBARA BLOOD
501 2009-01-01 CRAIG PEARSALL FRANK R BECKER 2010-10-14

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2014-01-01	BARBARA BLOOD	FRANK BECKER	2015-10-14
501	2013-01-01	BARBARA BLOOD	FRANK BECKER	2014-10-14
501	2012-01-01	BARBARA BLOOD	FRANK BECKER	2013-09-30
501	2011-01-01	BARBARA BLOOD
501	2009-01-01	CRAIG PEARSALL	FRANK R BECKER	2010-10-14

Plan Statistics for OUR LADY OF LOURDES GR TERM LIFE AD&D&LONG

401k plan membership statisitcs for OUR LADY OF LOURDES GR TERM LIFE AD&D&LONG

Measure Date Value
2014: OUR LADY OF LOURDES GR TERM LIFE AD&D&LONG 2014 401k membership
Total participants, beginning-of-year 2014-01-01 565
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 0
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 0
2013: OUR LADY OF LOURDES GR TERM LIFE AD&D&LONG 2013 401k membership
Total participants, beginning-of-year 2013-01-01 601
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 565
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 565
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 565
2012: OUR LADY OF LOURDES GR TERM LIFE AD&D&LONG 2012 401k membership
Total participants, beginning-of-year 2012-01-01 622
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 601
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 601
2011: OUR LADY OF LOURDES GR TERM LIFE AD&D&LONG 2011 401k membership
Total participants, beginning-of-year 2011-01-01 592
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 619
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 619
Total participants 2011-01-01 619
2009: OUR LADY OF LOURDES GR TERM LIFE AD&D&LONG 2009 401k membership
Total participants, beginning-of-year 2009-01-01 522
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 572
Total of all active and inactive participants 2009-01-01 572
Total participants 2009-01-01 572

Measure	Date	Value
2014: OUR LADY OF LOURDES GR TERM LIFE AD&D&LONG 2014 401k membership
Total participants, beginning-of-year	2014-01-01	565
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	0
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	0
2013: OUR LADY OF LOURDES GR TERM LIFE AD&D&LONG 2013 401k membership
Total participants, beginning-of-year	2013-01-01	601
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	565
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	565
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	565
2012: OUR LADY OF LOURDES GR TERM LIFE AD&D&LONG 2012 401k membership
Total participants, beginning-of-year	2012-01-01	622
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	601
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	601
2011: OUR LADY OF LOURDES GR TERM LIFE AD&D&LONG 2011 401k membership
Total participants, beginning-of-year	2011-01-01	592
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	619
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	619
Total participants	2011-01-01	619
2009: OUR LADY OF LOURDES GR TERM LIFE AD&D&LONG 2009 401k membership
Total participants, beginning-of-year	2009-01-01	522
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	572
Total of all active and inactive participants	2009-01-01	572
Total participants	2009-01-01	572

Form 5500 Responses for OUR LADY OF LOURDES GR TERM LIFE AD&D&LONG

2014: OUR LADY OF LOURDES GR TERM LIFE AD&D&LONG 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	Yes
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 funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: OUR LADY OF LOURDES GR TERM LIFE AD&D&LONG 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 funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: OUR LADY OF LOURDES GR TERM LIFE AD&D&LONG 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 funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: OUR LADY OF LOURDES GR TERM LIFE AD&D&LONG 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 funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: OUR LADY OF LOURDES GR TERM LIFE AD&D&LONG 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

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Company Name:	OUR LADY OF LOURDES HOSPITAL AT PASCO
Employer identification number (EIN):	910349750
NAIC Classification:	622000
NAIC Description:	Hospitals