401k Plan data: MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM plan

MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM 401k Plan overview

Plan Name	MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM
Plan identification number	503

MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Other welfare benefit cover

401k Sponsoring company profile

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

Company Name: MILLINOCKET REGIONAL HOSPITAL

Employer identification number (EIN): 010223482

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about MILLINOCKET REGIONAL HOSPITAL

Jurisdiction of Incorporation: Maine Bureau of Corporations, Elections & Commissions

Incorporation Date:

Company Identification Number: 19520003ND

More information about MILLINOCKET REGIONAL HOSPITAL

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2017-01-01 ROBERT PETERSON ROBERT PETERSON 2018-10-15
503 2015-01-01 ROBERT PETERSON
503 2014-01-01 CHRISTINE MCLAUGHLIN
503 2013-01-01 CHRISTINE MCLAUGHLIN
503 2012-01-01 CHRISTINE MCLAUGHLIN
503 2011-01-01 CHRISTINE MCLAUGHLIN
503 2009-01-01 CHRISTINE MCLAUGHLIN
503 2009-01-01 CHRISTINE MCLAUGHLIN

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
503	2017-01-01	ROBERT PETERSON	ROBERT PETERSON	2018-10-15
503	2015-01-01	ROBERT PETERSON
503	2014-01-01	CHRISTINE MCLAUGHLIN
503	2013-01-01	CHRISTINE MCLAUGHLIN
503	2012-01-01	CHRISTINE MCLAUGHLIN
503	2011-01-01	CHRISTINE MCLAUGHLIN
503	2009-01-01	CHRISTINE MCLAUGHLIN
503	2009-01-01	CHRISTINE MCLAUGHLIN

Plan Statistics for MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM

401k plan membership statisitcs for MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM

Measure Date Value
2017: MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM 2017 401k membership
Total participants, beginning-of-year 2017-01-01 193
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 230
Total of all active and inactive participants 2017-01-01 230
Total participants 2017-01-01 230
2015: MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM 2015 401k membership
Total participants, beginning-of-year 2015-01-01 192
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 193
Total of all active and inactive participants 2015-01-01 193
Total participants 2015-01-01 193
2014: MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM 2014 401k membership
Total participants, beginning-of-year 2014-01-01 199
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 192
Total of all active and inactive participants 2014-01-01 192
Total participants 2014-01-01 192
2013: MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM 2013 401k membership
Total participants, beginning-of-year 2013-01-01 199
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 199
Total of all active and inactive participants 2013-01-01 199
Total participants 2013-01-01 199
2012: MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM 2012 401k membership
Total participants, beginning-of-year 2012-01-01 208
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 199
Total of all active and inactive participants 2012-01-01 199
Total participants 2012-01-01 199
2011: MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM 2011 401k membership
Total participants, beginning-of-year 2011-01-01 201
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 208
Total of all active and inactive participants 2011-01-01 208
Total participants 2011-01-01 208
2009: MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM 2009 401k membership
Total participants, beginning-of-year 2009-01-01 212
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 213
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 213
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 213
Number of participants with account balances 2009-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2017: MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM 2017 401k membership
Total participants, beginning-of-year	2017-01-01	193
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	230
Total of all active and inactive participants	2017-01-01	230
Total participants	2017-01-01	230
2015: MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM 2015 401k membership
Total participants, beginning-of-year	2015-01-01	192
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	193
Total of all active and inactive participants	2015-01-01	193
Total participants	2015-01-01	193
2014: MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM 2014 401k membership
Total participants, beginning-of-year	2014-01-01	199
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	192
Total of all active and inactive participants	2014-01-01	192
Total participants	2014-01-01	192
2013: MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM 2013 401k membership
Total participants, beginning-of-year	2013-01-01	199
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	199
Total of all active and inactive participants	2013-01-01	199
Total participants	2013-01-01	199
2012: MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM 2012 401k membership
Total participants, beginning-of-year	2012-01-01	208
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	199
Total of all active and inactive participants	2012-01-01	199
Total participants	2012-01-01	199
2011: MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM 2011 401k membership
Total participants, beginning-of-year	2011-01-01	201
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	208
Total of all active and inactive participants	2011-01-01	208
Total participants	2011-01-01	208
2009: MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM 2009 401k membership
Total participants, beginning-of-year	2009-01-01	212
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	213
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	213
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	213
Number of participants with account balances	2009-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Form 5500 Responses for MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM

2017: MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM 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)	No
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
2015: MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM 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: MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM 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: MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM 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: MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM 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: MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	First time form 5500 has been submitted	Yes
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: MILLINOCKET REGIONAL HOSPITAL GROUP TERM LIFE PROGRAM 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
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

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

01-016925-00

Policy instance

Insurance contract or identification number	01-016925-00
Number of Individuals Covered	230
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $10,987
Total amount of fees paid to insurance company	USD $3,820
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	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
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 $118,089
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,987
Amount paid for insurance broker fees	3820
Additional information about fees paid to insurance broker	GROUP VOLUME BONUS
Insurance broker organization code?	3
Insurance broker name	VHA MID AMERICA INSURANCE SERV

Potentially related plans

MILLINOCKET REGIONAL HOSPITAL PARTNERSHIP RETIREMENT PLAN [EIN = 010222382]

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Company Name:	MILLINOCKET REGIONAL HOSPITAL
Employer identification number (EIN):	010223482
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	Maine Bureau of Corporations, Elections & Commissions
Incorporation Date:
Company Identification Number:	19520003ND