401k Plan data: FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN plan

FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN 401k Plan overview

Plan Name	FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN
Plan identification number	507

FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Vision

401k Sponsoring company profile

FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. has sponsored the creation of one or more 401k plans.

Company Name: FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC.

Employer identification number (EIN): 350900741

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
507 2017-01-01
507 2016-01-01 HAYLEE CAVINS
507 2015-01-01 RHONDA MCPHERSON
507 2014-01-01 RHONDA MCPHERSON
507 2013-01-01 RHONDA MCPHERSON
507 2012-01-01 RHONDA MCPHERSON RHONDA MCPHERSON 2013-05-10
507 2011-01-01 RHONDA MCPHERSON RHONDA MCPHERSON 2012-07-19
507 2009-01-01 RHONDA MCPHERSON

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
507	2017-01-01
507	2016-01-01	HAYLEE CAVINS
507	2015-01-01	RHONDA MCPHERSON
507	2014-01-01	RHONDA MCPHERSON
507	2013-01-01	RHONDA MCPHERSON
507	2012-01-01	RHONDA MCPHERSON	RHONDA MCPHERSON	2013-05-10
507	2011-01-01	RHONDA MCPHERSON	RHONDA MCPHERSON	2012-07-19
507	2009-01-01	RHONDA MCPHERSON

Plan Statistics for FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN

401k plan membership statisitcs for FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN

Measure Date Value
2017: FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 133
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 133
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 2017-01-01 133
2016: FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 139
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 133
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 2016-01-01 133
2015: FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 175
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 139
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 2015-01-01 139
2014: FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 211
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 216
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 2014-01-01 216
2013: FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 199
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 211
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 2013-01-01 211
2012: FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 183
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 198
Number of retired or separated participants receiving benefits 2012-01-01 1
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 199
2011: FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 195
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 181
Number of retired or separated participants receiving benefits 2011-01-01 2
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 183
2009: FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 207
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 206
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 2009-01-01 206
Total participants 2009-01-01 206

Measure	Date	Value
2017: FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	133
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	133
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	133
2016: FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	139
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	133
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	133
2015: FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	175
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	139
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	139
2014: FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	211
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	216
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	216
2013: FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	199
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	211
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	211
2012: FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	183
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	198
Number of retired or separated participants receiving benefits	2012-01-01	1
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	199
2011: FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	195
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	181
Number of retired or separated participants receiving benefits	2011-01-01	2
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	183
2009: FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	207
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	206
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	206
Total participants	2009-01-01	206

Form 5500 Responses for FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN

2017: FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN 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: FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN 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: FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN 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: FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN 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: FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN 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: FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN 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
2009: FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC. GROUP VISION PLAN 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

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

30790-1684

Policy instance

Insurance contract or identification number	30790-1684
Number of Individuals Covered	309
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,321
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,461
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $746
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	EPIC INSURANCE SOLUTIONS

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Company Name:	FAYETTE MEMORIAL HOSPITAL ASSOCIATION, INC.
Employer identification number (EIN):	350900741
NAIC Classification:	622000
NAIC Description:	Hospitals