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JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL PLAN 401k Plan overview

Plan NameJOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL PLAN
Plan identification number 503

JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

401k Sponsoring company profile

JOHN T. MATHER MEMORIAL HOSPITAL OF PORT JEFFERSON, INC. has sponsored the creation of one or more 401k plans.

Company Name:JOHN T. MATHER MEMORIAL HOSPITAL OF PORT JEFFERSON, INC.
Employer identification number (EIN):111639818
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032022-01-01
5032021-01-01
5032020-01-01
5032019-01-01
5032018-01-01
5032017-01-01JOSEPH WISNOSKI
5032016-01-01JOSEPH WISNOSKI
5032015-01-01JOSEPH WISNOSKI
5032014-01-01JOSEPH WISNOSKI
5032013-01-01JOSEPH WISNOSKI
5032012-01-01JOSEPH WISNOSKI
5032011-01-01JOSEPH WISNOSKI
5032009-01-01JOSEPH WISNOSKI

Plan Statistics for JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL PLAN

401k plan membership statisitcs for JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL PLAN

Measure Date Value
2022: JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-011,568
Total number of active participants reported on line 7a of the Form 55002022-01-011,508
Total of all active and inactive participants2022-01-011,508
Total participants2022-01-011,508
2021: JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-011,533
Total number of active participants reported on line 7a of the Form 55002021-01-011,568
Total of all active and inactive participants2021-01-011,568
Total participants2021-01-011,568
2020: JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-011,530
Total number of active participants reported on line 7a of the Form 55002020-01-011,533
Total of all active and inactive participants2020-01-011,533
Total participants2020-01-011,533
2019: JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-011,598
Total number of active participants reported on line 7a of the Form 55002019-01-011,530
Total of all active and inactive participants2019-01-011,530
Total participants2019-01-011,530
2018: JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-011,662
Total number of active participants reported on line 7a of the Form 55002018-01-011,598
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 participants2018-01-011,598
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-011,598
Number of participants with account balances2018-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
Number of employers contributing to the scheme2018-01-010
2017: JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-011,633
Total number of active participants reported on line 7a of the Form 55002017-01-011,662
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 participants2017-01-011,662
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-011,662
Number of participants with account balances2017-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
Number of employers contributing to the scheme2017-01-010
2016: JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-011,421
Total number of active participants reported on line 7a of the Form 55002016-01-011,633
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 participants2016-01-011,633
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-011,633
Number of participants with account balances2016-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
Number of employers contributing to the scheme2016-01-010
2015: JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-011,655
Total number of active participants reported on line 7a of the Form 55002015-01-011,421
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-011,421
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-011,421
Number of participants with account balances2015-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
Number of employers contributing to the scheme2015-01-010
2014: JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-011,661
Total number of active participants reported on line 7a of the Form 55002014-01-011,655
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 participants2014-01-011,655
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-011,655
Number of participants with account balances2014-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-011,676
Total number of active participants reported on line 7a of the Form 55002013-01-011,661
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 participants2013-01-011,661
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-011,661
Number of participants with account balances2013-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
Number of employers contributing to the scheme2013-01-010
2012: JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-011,653
Total number of active participants reported on line 7a of the Form 55002012-01-011,676
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 participants2012-01-011,676
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-011,676
Number of participants with account balances2012-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
Number of employers contributing to the scheme2012-01-010
2011: JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-011,685
Total number of active participants reported on line 7a of the Form 55002011-01-011,653
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 participants2011-01-011,653
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-011,653
Number of participants with account balances2011-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
Number of employers contributing to the scheme2011-01-010
2009: JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-011,622
Total number of active participants reported on line 7a of the Form 55002009-01-011,723
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 participants2009-01-011,723
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-011,723
Number of participants with account balances2009-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010
Number of employers contributing to the scheme2009-01-010

Form 5500 Responses for JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL PLAN

2022: JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL 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 filingNo
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 – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL 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 – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL 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 – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL 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 – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL 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 – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL 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 – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL 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 funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL 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 funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL 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 funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: JOHN T. MATHER MEMORIAL HOSPITAL HOSPITALIZATION MAJ MEDICAL 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 funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

WELLCHOICE HMO OF NEW JERSEY (National Association of Insurance Commissioners NAIC id number: 95433 )
Policy contract numberG1922
Policy instance 1
Insurance contract or identification numberG1922
Number of Individuals Covered87
Insurance policy start date2013-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $28,896
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 BenefitNo
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
WELLCHOICE HMO OF NEW JERSEY (National Association of Insurance Commissioners NAIC id number: 95433 )
Policy contract numberG1922
Policy instance 1
Insurance contract or identification numberG1922
Number of Individuals Covered109
Insurance policy start date2012-02-01
Insurance policy end date2013-01-31
Total amount of commissions paid to insurance brokerUSD $33,211
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,031,582
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,211
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES LLC
WELLCHOICE HMO OF NEW JERSEY (National Association of Insurance Commissioners NAIC id number: 95433 )
Policy contract numberG1922
Policy instance 1
Insurance contract or identification numberG1922
Number of Individuals Covered121
Insurance policy start date2011-02-01
Insurance policy end date2012-01-31
Total amount of commissions paid to insurance brokerUSD $59,670
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,964,550
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE INSURANCE AND ANNUITY COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number080022
Policy instance 1
Insurance contract or identification number080022
Number of Individuals Covered1175
Insurance policy start date2009-09-01
Insurance policy end date2010-08-31
Total amount of commissions paid to insurance brokerUSD $65,307
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $435,381
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WELLCHOICE HMO OF NEW JERSEY (National Association of Insurance Commissioners NAIC id number: 95433 )
Policy contract numberG1922
Policy instance 2
Insurance contract or identification numberG1922
Number of Individuals Covered405
Insurance policy start date2010-02-01
Insurance policy end date2011-01-31
Total amount of commissions paid to insurance brokerUSD $109,477
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,305,931
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 )
Policy contract number4010692000
Policy instance 3
Insurance contract or identification number4010692000
Number of Individuals Covered0
Insurance policy start date2010-01-01
Insurance policy end date2010-03-31
Total amount of commissions paid to insurance brokerUSD $1,933
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $48,334
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberJT5759
Policy instance 4
Insurance contract or identification numberJT5759
Number of Individuals Covered105
Insurance policy start date2010-01-01
Insurance policy end date2010-01-31
Total amount of commissions paid to insurance brokerUSD $2,006
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $36,572
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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