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EPISCOPAL CHURCH HOME HEALTH INSURANCE PLAN 401k Plan overview

Plan NameEPISCOPAL CHURCH HOME HEALTH INSURANCE PLAN
Plan identification number 504

EPISCOPAL CHURCH HOME HEALTH INSURANCE PLAN Benefits

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

401k Sponsoring company profile

THE CHURCH HOME OF THE PROTESTANT EPISCOPAL CHURCH IN THE CITY OF ROCH has sponsored the creation of one or more 401k plans.

Company Name:THE CHURCH HOME OF THE PROTESTANT EPISCOPAL CHURCH IN THE CITY OF ROCH
Employer identification number (EIN):160743962
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EPISCOPAL CHURCH HOME HEALTH INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5042015-01-01LAURA DE LUCCIO
5042014-01-01BENJAMIN LEWIS
5042013-01-01DARLENE MAGRIN
5042012-01-01DARLENE MAGRIN
5042011-01-01DARLENE MAGRIN
5042009-01-01DARLENE MAGRIN

Plan Statistics for EPISCOPAL CHURCH HOME HEALTH INSURANCE PLAN

401k plan membership statisitcs for EPISCOPAL CHURCH HOME HEALTH INSURANCE PLAN

Measure Date Value
2015: EPISCOPAL CHURCH HOME HEALTH INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01225
Total number of active participants reported on line 7a of the Form 55002015-01-01207
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 participants2015-01-01207
Total participants2015-01-01207
2014: EPISCOPAL CHURCH HOME HEALTH INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01208
Total number of active participants reported on line 7a of the Form 55002014-01-01228
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-013
Total of all active and inactive participants2014-01-01231
Total participants2014-01-01231
2013: EPISCOPAL CHURCH HOME HEALTH INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01193
Total number of active participants reported on line 7a of the Form 55002013-01-01197
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 participants2013-01-01197
Total participants2013-01-01197
2012: EPISCOPAL CHURCH HOME HEALTH INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01210
Total number of active participants reported on line 7a of the Form 55002012-01-01191
Number of retired or separated participants receiving benefits2012-01-012
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01193
Total participants2012-01-01193
2011: EPISCOPAL CHURCH HOME HEALTH INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01308
Total number of active participants reported on line 7a of the Form 55002011-01-01194
Number of retired or separated participants receiving benefits2011-01-014
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01198
2009: EPISCOPAL CHURCH HOME HEALTH INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01182
Total number of active participants reported on line 7a of the Form 55002009-01-01303
Number of retired or separated participants receiving benefits2009-01-012
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01305

Form 5500 Responses for EPISCOPAL CHURCH HOME HEALTH INSURANCE PLAN

2015: EPISCOPAL CHURCH HOME HEALTH INSURANCE PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: EPISCOPAL CHURCH HOME HEALTH INSURANCE PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: EPISCOPAL CHURCH HOME HEALTH INSURANCE PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: EPISCOPAL CHURCH HOME HEALTH INSURANCE PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: EPISCOPAL CHURCH HOME HEALTH INSURANCE 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
2009: EPISCOPAL CHURCH HOME HEALTH INSURANCE 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

EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )
Policy contract number00017393
Policy instance 1
Insurance contract or identification number00017393
Number of Individuals Covered216
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $39,661
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,661
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES
EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )
Policy contract number00017393
Policy instance 1
Insurance contract or identification number00017393
Number of Individuals Covered228
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $33,850
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,850
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES
EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )
Policy contract number00017393
Policy instance 1
Insurance contract or identification number00017393
Number of Individuals Covered197
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $24,619
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,619
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES
EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )
Policy contract number00017393
Policy instance 1
Insurance contract or identification number00017393
Number of Individuals Covered193
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $26,580
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,580
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker namePROVIDIUM CONSULTING GROUP, LLC
EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )
Policy contract number00017393
Policy instance 1
Insurance contract or identification number00017393
Number of Individuals Covered198
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $27,384
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 BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )
Policy contract number00017393
Policy instance 1
Insurance contract or identification number00017393
Number of Individuals Covered308
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $25,667
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 BenefitYes
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
Welfare Benefit Premiums Paid to CarrierUSD $1,314,666
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,667
Insurance broker organization code?3
Insurance broker namePROVIDIUM CONSULTING GROUP, LLC

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