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| Plan Name | ACCIDENTAL INJURY |
| Plan identification number | 506 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | SPEARE MEMORIAL HOSPITAL |
| Employer identification number (EIN): | 020226774 |
| NAIC Classification: | 622000 |
| NAIC Description: | Hospitals |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 506 | 2020-07-01 | JENNIFER OLDENBURG | 2021-12-28 | ||
| 506 | 2020-07-01 | JENNIFER OLDENBURG | 2022-05-20 | ||
| 506 | 2019-07-01 | JENNIFER OLDENBURG | 2020-09-29 |
| Measure | Date | Value |
|---|---|---|
| 2020: ACCIDENTAL INJURY 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-07-01 | 154 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-07-01 | 149 |
| Number of retired or separated participants receiving benefits | 2020-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-07-01 | 0 |
| Total of all active and inactive participants | 2020-07-01 | 149 |
| Number of employers contributing to the scheme | 2020-07-01 | 0 |
| 2019: ACCIDENTAL INJURY 2019 401k membership | ||
| Total participants, beginning-of-year | 2019-07-01 | 146 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-07-01 | 147 |
| Number of retired or separated participants receiving benefits | 2019-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-07-01 | 0 |
| Total of all active and inactive participants | 2019-07-01 | 147 |
| Number of employers contributing to the scheme | 2019-07-01 | 0 |
| 2020: ACCIDENTAL INJURY 2020 form 5500 responses | ||
|---|---|---|
| 2020-07-01 | Type of plan entity | Single employer plan |
| 2020-07-01 | Submission has been amended | Yes |
| 2020-07-01 | This submission is the final filing | Yes |
| 2020-07-01 | Plan funding arrangement – Insurance | Yes |
| 2020-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: ACCIDENTAL INJURY 2019 form 5500 responses | ||
| 2019-07-01 | Type of plan entity | Single employer plan |
| 2019-07-01 | Plan funding arrangement – Insurance | Yes |
| 2019-07-01 | Plan benefit arrangement – Insurance | Yes |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) | |
| Policy contract number | AI960700 |
| Policy instance | 1 |
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