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COPLEY HOSPITAL WEEKLY INCOME PLAN 401k Plan overview

Plan NameCOPLEY HOSPITAL WEEKLY INCOME PLAN
Plan identification number 507

COPLEY HOSPITAL WEEKLY INCOME PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Temporary disability (accident and sickness)

401k Sponsoring company profile

COPLEY HOSPITAL, INC. has sponsored the creation of one or more 401k plans.

Company Name:COPLEY HOSPITAL, INC.
Employer identification number (EIN):030179423
NAIC Classification:622000
NAIC Description: Hospitals

Additional information about COPLEY HOSPITAL, INC.

Jurisdiction of Incorporation: Vermont Secretary of State Corporations Division
Incorporation Date: 1930-02-03
Company Identification Number: 41963
Legal Registered Office Address: 528 WASHINGTON HIGHWAY

MORRISVILLE
United States of America (USA)
05661

More information about COPLEY HOSPITAL, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COPLEY HOSPITAL WEEKLY INCOME PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5072019-01-01
5072018-01-01
5072017-01-01AMY FITZGERALD
5072016-01-01AMY FITZGERALD
5072015-01-01AMY FITZGERALD
5072014-01-01AMY FITZGERALD
5072013-01-01JENNIFER ARCHAMBAULT
5072012-01-01JENNIFER ARCHAMBAULT
5072011-01-01APRIL TUCK
5072010-01-01APRIL TUCK
5072009-01-01APRIL TUCK

Plan Statistics for COPLEY HOSPITAL WEEKLY INCOME PLAN

401k plan membership statisitcs for COPLEY HOSPITAL WEEKLY INCOME PLAN

Measure Date Value
2019: COPLEY HOSPITAL WEEKLY INCOME PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01206
Total number of active participants reported on line 7a of the Form 55002019-01-010
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-010
2018: COPLEY HOSPITAL WEEKLY INCOME PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01220
Total number of active participants reported on line 7a of the Form 55002018-01-01206
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01206
2017: COPLEY HOSPITAL WEEKLY INCOME PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01201
Total number of active participants reported on line 7a of the Form 55002017-01-01220
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01220
2016: COPLEY HOSPITAL WEEKLY INCOME PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01186
Total number of active participants reported on line 7a of the Form 55002016-01-01201
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01201
2015: COPLEY HOSPITAL WEEKLY INCOME PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01199
Total number of active participants reported on line 7a of the Form 55002015-01-01186
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01186
2014: COPLEY HOSPITAL WEEKLY INCOME PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01199
Total number of active participants reported on line 7a of the Form 55002014-01-01199
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01199
2013: COPLEY HOSPITAL WEEKLY INCOME PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01197
Total number of active participants reported on line 7a of the Form 55002013-01-01199
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01199
2012: COPLEY HOSPITAL WEEKLY INCOME PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01193
Total number of active participants reported on line 7a of the Form 55002012-01-01197
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01197
2011: COPLEY HOSPITAL WEEKLY INCOME PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01177
Total number of active participants reported on line 7a of the Form 55002011-01-01193
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01193
2010: COPLEY HOSPITAL WEEKLY INCOME PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01173
Total number of active participants reported on line 7a of the Form 55002010-01-01177
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-01177
2009: COPLEY HOSPITAL WEEKLY INCOME PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01155
Total number of active participants reported on line 7a of the Form 55002009-01-01173
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01173

Form 5500 Responses for COPLEY HOSPITAL WEEKLY INCOME PLAN

2019: COPLEY HOSPITAL WEEKLY INCOME PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingYes
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: COPLEY HOSPITAL WEEKLY INCOME PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: COPLEY HOSPITAL WEEKLY INCOME PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: COPLEY HOSPITAL WEEKLY INCOME PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: COPLEY HOSPITAL WEEKLY INCOME PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: COPLEY HOSPITAL WEEKLY INCOME PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: COPLEY HOSPITAL WEEKLY INCOME PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: COPLEY HOSPITAL WEEKLY INCOME PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: COPLEY HOSPITAL WEEKLY INCOME PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: COPLEY HOSPITAL WEEKLY INCOME PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: COPLEY HOSPITAL WEEKLY INCOME PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberG 165192
Policy instance 1
Insurance contract or identification numberG 165192
Number of Individuals Covered219
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $6,601
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $95,102
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,839
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberG 165192
Policy instance 1
Insurance contract or identification numberG 165192
Number of Individuals Covered220
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,194
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $68,423
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,194
Insurance broker organization code?3
Insurance broker nameTHE SEGAL CO (EASTERN STATES) INC.

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