401k Plan data: HOLYOKE HEALTH CENTER, INC. WELFARE PLAN plan

HOLYOKE HEALTH CENTER, INC. WELFARE PLAN 401k Plan overview

Plan Name	HOLYOKE HEALTH CENTER, INC. WELFARE PLAN
Plan identification number	502

HOLYOKE HEALTH CENTER, INC. WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

HOLYOKE HEALTH CENTER INC has sponsored the creation of one or more 401k plans.

Company Name: HOLYOKE HEALTH CENTER INC

Employer identification number (EIN): 042492730

NAIC Classification: 621498
NAIC Description: All Other Outpatient Care Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HOLYOKE HEALTH CENTER, INC. WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2009-07-01 TERESA A. LAVELLE
502 2009-07-01 TERESA LAVELLE 2022-01-10

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2009-07-01	TERESA A. LAVELLE
502	2009-07-01	TERESA LAVELLE	2022-01-10

Plan Statistics for HOLYOKE HEALTH CENTER, INC. WELFARE PLAN

401k plan membership statisitcs for HOLYOKE HEALTH CENTER, INC. WELFARE PLAN

Measure Date Value
2009: HOLYOKE HEALTH CENTER, INC. WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-07-01 213
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 221
Number of retired or separated participants receiving benefits 2009-07-01 0
Number of other retired or separated participants entitled to future benefits 2009-07-01 0
Total of all active and inactive participants 2009-07-01 221
Number of employers contributing to the scheme 2009-07-01 0

Measure	Date	Value
2009: HOLYOKE HEALTH CENTER, INC. WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-07-01	213
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	221
Number of retired or separated participants receiving benefits	2009-07-01	0
Number of other retired or separated participants entitled to future benefits	2009-07-01	0
Total of all active and inactive participants	2009-07-01	221
Number of employers contributing to the scheme	2009-07-01	0

Form 5500 Responses for HOLYOKE HEALTH CENTER, INC. WELFARE PLAN

2009: HOLYOKE HEALTH CENTER, INC. WELFARE PLAN 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	Submission has been amended	No
2009-07-01	This submission is the final filing	No
2009-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-07-01	Plan is a collectively bargained plan	No
2009-07-01	Plan funding arrangement – Insurance	Yes
2009-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4009524

Policy instance

Insurance contract or identification number	4009524
Number of Individuals Covered	267
Insurance policy start date	2009-04-01
Insurance policy end date	2010-03-31
Total amount of commissions paid to insurance broker	USD $4,364
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,364
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4009524

Policy instance

Insurance contract or identification number	4009524
Number of Individuals Covered	365
Insurance policy start date	2009-04-01
Insurance policy end date	2010-03-31
Total amount of commissions paid to insurance broker	USD $87,339
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $87,339
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10042983

Policy instance

Insurance contract or identification number	10042983
Number of Individuals Covered	222
Insurance policy start date	2009-04-01
Insurance policy end date	2010-03-31
Total amount of commissions paid to insurance broker	USD $4,238
Total amount of fees paid to insurance company	USD $1,003
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $28,251
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,238
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	BROKER BONUS

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10042984

Policy instance

Insurance contract or identification number	10042984
Number of Individuals Covered	223
Insurance policy start date	2009-04-01
Insurance policy end date	2010-03-31
Total amount of commissions paid to insurance broker	USD $5,438
Total amount of fees paid to insurance company	USD $1,255
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,256
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,438
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	BROKER BONUS

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Company Name:	HOLYOKE HEALTH CENTER INC
Employer identification number (EIN):	042492730
NAIC Classification:	621498
NAIC Description:	All Other Outpatient Care Centers