401k Plan data: FOX CHASE CANCER CENTER GROUP LIFE AND ACCIDENTAL DEATH DISMEMBERMENT PLAN plan

FOX CHASE CANCER CENTER GROUP LIFE AND ACCIDENTAL DEATH DISMEMBERMENT PLAN 401k Plan overview

Plan Name	FOX CHASE CANCER CENTER GROUP LIFE AND ACCIDENTAL DEATH DISMEMBERMENT PLAN
Plan identification number	503

FOX CHASE CANCER CENTER GROUP LIFE AND ACCIDENTAL DEATH DISMEMBERMENT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance

401k Sponsoring company profile

THE AMERICAN ONCOLOGIC HOSPITAL D/B/A THE HOSPITAL OF FOX CHASE has sponsored the creation of one or more 401k plans.

Company Name: THE AMERICAN ONCOLOGIC HOSPITAL D/B/A THE HOSPITAL OF FOX CHASE

Employer identification number (EIN): 231352156

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FOX CHASE CANCER CENTER GROUP LIFE AND ACCIDENTAL DEATH DISMEMBERMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2013-03-01 PAUL A. CSIGI ROBERT H. LUX 2014-04-15
503 2012-03-01 PAUL A. CSIGI ROBERT H. LUX 2013-10-15

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2013-03-01	PAUL A. CSIGI		ROBERT H. LUX	2014-04-15
503	2012-03-01	PAUL A. CSIGI		ROBERT H. LUX	2013-10-15

Plan Statistics for FOX CHASE CANCER CENTER GROUP LIFE AND ACCIDENTAL DEATH DISMEMBERMENT PLAN

401k plan membership statisitcs for FOX CHASE CANCER CENTER GROUP LIFE AND ACCIDENTAL DEATH DISMEMBERMENT PLAN

Measure Date Value
2013: FOX CHASE CANCER CENTER GROUP LIFE AND ACCIDENTAL DEATH DISMEMBERMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-03-01 2,198
Total number of active participants reported on line 7a of the Form 5500 2013-03-01 0
Number of retired or separated participants receiving benefits 2013-03-01 0
Number of other retired or separated participants entitled to future benefits 2013-03-01 0
Total of all active and inactive participants 2013-03-01 0
2012: FOX CHASE CANCER CENTER GROUP LIFE AND ACCIDENTAL DEATH DISMEMBERMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-03-01 2,190
Total number of active participants reported on line 7a of the Form 5500 2012-03-01 1,971
Number of retired or separated participants receiving benefits 2012-03-01 227
Number of other retired or separated participants entitled to future benefits 2012-03-01 0
Total of all active and inactive participants 2012-03-01 2,198

Measure	Date	Value
2013: FOX CHASE CANCER CENTER GROUP LIFE AND ACCIDENTAL DEATH DISMEMBERMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-03-01	2,198
Total number of active participants reported on line 7a of the Form 5500	2013-03-01	0
Number of retired or separated participants receiving benefits	2013-03-01	0
Number of other retired or separated participants entitled to future benefits	2013-03-01	0
Total of all active and inactive participants	2013-03-01	0
2012: FOX CHASE CANCER CENTER GROUP LIFE AND ACCIDENTAL DEATH DISMEMBERMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-03-01	2,190
Total number of active participants reported on line 7a of the Form 5500	2012-03-01	1,971
Number of retired or separated participants receiving benefits	2012-03-01	227
Number of other retired or separated participants entitled to future benefits	2012-03-01	0
Total of all active and inactive participants	2012-03-01	2,198

Form 5500 Responses for FOX CHASE CANCER CENTER GROUP LIFE AND ACCIDENTAL DEATH DISMEMBERMENT PLAN

2013: FOX CHASE CANCER CENTER GROUP LIFE AND ACCIDENTAL DEATH DISMEMBERMENT PLAN 2013 form 5500 responses
2013-03-01	Type of plan entity	Single employer plan
2013-03-01	Submission has been amended	No
2013-03-01	This submission is the final filing	Yes
2013-03-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2013-03-01	Plan is a collectively bargained plan	No
2013-03-01	Plan funding arrangement – Insurance	Yes
2013-03-01	Plan benefit arrangement – Insurance	Yes
2012: FOX CHASE CANCER CENTER GROUP LIFE AND ACCIDENTAL DEATH DISMEMBERMENT PLAN 2012 form 5500 responses
2012-03-01	Type of plan entity	Single employer plan
2012-03-01	Submission has been amended	No
2012-03-01	This submission is the final filing	No
2012-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-03-01	Plan is a collectively bargained plan	No
2012-03-01	Plan funding arrangement – Insurance	Yes
2012-03-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VAR 051597

Policy instance

Insurance contract or identification number	VAR 051597
Number of Individuals Covered	1953
Insurance policy start date	2013-03-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $978
Total amount of fees paid to insurance company	USD $428
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH DISMEMBERMENT
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 Carrier	USD $12,226
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $978
Amount paid for insurance broker fees	428
Additional information about fees paid to insurance broker	ADMINISTRATIVE
Insurance broker organization code?	3
Insurance broker name	INSURANCE POINT LLC

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 022933

Policy instance

Insurance contract or identification number	GL 022933
Number of Individuals Covered	2780
Insurance policy start date	2013-03-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $5,019
Total amount of fees paid to insurance company	USD $2,196
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $62,742
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,019
Amount paid for insurance broker fees	2196
Additional information about fees paid to insurance broker	ADMINISTRATIVE
Insurance broker organization code?	3
Insurance broker name	INSURANCE POINT LLC

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 022933

Policy instance

Insurance contract or identification number	GL 022933
Number of Individuals Covered	2198
Insurance policy start date	2012-03-01
Insurance policy end date	2013-02-28
Total amount of commissions paid to insurance broker	USD $11,095
Total amount of fees paid to insurance company	USD $2,754
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $232,392
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,711
Amount paid for insurance broker fees	2061
Additional information about fees paid to insurance broker	ADMINISTRATIVE
Insurance broker organization code?	3
Insurance broker name	INSURANCE POINT LLC

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VAR 051597

Policy instance

Insurance contract or identification number	VAR 051597
Number of Individuals Covered	1971
Insurance policy start date	2012-03-01
Insurance policy end date	2013-02-28
Total amount of commissions paid to insurance broker	USD $2,031
Total amount of fees paid to insurance company	USD $338
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH DISMEMBERMENT
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 Carrier	USD $34,822
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,258
Insurance broker organization code?	5
Amount paid for insurance broker fees	226
Additional information about fees paid to insurance broker	ADMINISTRATIVE
Insurance broker name	INSURANCE POINT LLC

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Company Name:	THE AMERICAN ONCOLOGIC HOSPITAL D/B/A THE HOSPITAL OF FOX CHASE
Employer identification number (EIN):	231352156
NAIC Classification:	622000
NAIC Description:	Hospitals