401k Plan data: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY plan

ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 401k Plan overview

Plan Name	ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY
Plan identification number	511

ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

CROUSE HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name: CROUSE HOSPITAL

Employer identification number (EIN): 160960470

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
511 2017-01-01 JOHN BERGEMANN
511 2016-01-01 JOHN BERGEMANN
511 2015-01-01 JOHN BERGEMANN
511 2014-01-01 JOHN BERGEMANN
511 2013-01-01 JOHN BERGEMANN
511 2012-01-01 JOHN BERGEMANN
511 2011-01-01 JOHN BERGEMANN
511 2010-01-01 JOHN BERGEMANN
511 2009-01-01 JOHN BERGEMANN

Plan id#	Filing Submission Date	Name of Administrator
511	2017-01-01	JOHN BERGEMANN
511	2016-01-01	JOHN BERGEMANN
511	2015-01-01	JOHN BERGEMANN
511	2014-01-01	JOHN BERGEMANN
511	2013-01-01	JOHN BERGEMANN
511	2012-01-01	JOHN BERGEMANN
511	2011-01-01	JOHN BERGEMANN
511	2010-01-01	JOHN BERGEMANN
511	2009-01-01	JOHN BERGEMANN

Plan Statistics for ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY

401k plan membership statisitcs for ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY

Measure Date Value
2017: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2017 401k membership
Total participants, beginning-of-year 2017-01-01 590
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 567
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 567
2016: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2016 401k membership
Total participants, beginning-of-year 2016-01-01 630
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 590
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 590
2015: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2015 401k membership
Total participants, beginning-of-year 2015-01-01 596
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 629
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 629
2014: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2014 401k membership
Total participants, beginning-of-year 2014-01-01 559
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 580
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 580
2013: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2013 401k membership
Total participants, beginning-of-year 2013-01-01 599
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 559
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 559
2012: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2012 401k membership
Total participants, beginning-of-year 2012-01-01 591
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 599
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 599
2011: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2011 401k membership
Total participants, beginning-of-year 2011-01-01 570
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 591
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 591
2010: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2010 401k membership
Total participants, beginning-of-year 2010-01-01 757
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 781
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 781
2009: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2009 401k membership
Total participants, beginning-of-year 2009-01-01 569
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 558
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 558

Measure	Date	Value
2017: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2017 401k membership
Total participants, beginning-of-year	2017-01-01	590
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	567
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	567
2016: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2016 401k membership
Total participants, beginning-of-year	2016-01-01	630
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	590
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	590
2015: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2015 401k membership
Total participants, beginning-of-year	2015-01-01	596
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	629
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	629
2014: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2014 401k membership
Total participants, beginning-of-year	2014-01-01	559
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	580
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	580
2013: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2013 401k membership
Total participants, beginning-of-year	2013-01-01	599
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	559
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	559
2012: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2012 401k membership
Total participants, beginning-of-year	2012-01-01	591
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	599
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	599
2011: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2011 401k membership
Total participants, beginning-of-year	2011-01-01	570
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	591
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	591
2010: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2010 401k membership
Total participants, beginning-of-year	2010-01-01	757
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	781
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	781
2009: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2009 401k membership
Total participants, beginning-of-year	2009-01-01	569
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	558
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	558

Form 5500 Responses for ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY

2017: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: ALL NON-UNION EMPLOYEES BASIC LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, OPTIONAL LIFE, DEPENDENT OPTIONAL LIFE AND LONG TERM DISABILITY 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	52765
Policy instance	1

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Company Name:	CROUSE HOSPITAL
Employer identification number (EIN):	160960470
NAIC Classification:	622000
NAIC Description:	Hospitals