401k Plan data: DEACONESS HEALTH SYSTEM, INC. FLEXIBLE BENEFITS PLAN plan

DEACONESS HEALTH SYSTEM, INC. FLEXIBLE BENEFITS PLAN 401k Plan overview

Plan Name	DEACONESS HEALTH SYSTEM, INC. FLEXIBLE BENEFITS PLAN
Plan identification number	510

DEACONESS HEALTH SYSTEM, INC. FLEXIBLE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Other welfare benefit cover

401k Sponsoring company profile

DEACONESS HEALTH SYSTEM, INC. has sponsored the creation of one or more 401k plans.

Company Name: DEACONESS HEALTH SYSTEM, INC.

Employer identification number (EIN): 351532889

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DEACONESS HEALTH SYSTEM, INC. FLEXIBLE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
510 2023-10-01 SHERI BROWN
510 2022-10-01
510 2022-10-01 SHERI BROWN
510 2021-10-01 SHERI BROWN 2023-04-12
510 2020-10-01 SHERI BROWN 2022-03-29
510 2019-10-01 SHERI BROWN 2021-04-10
510 2018-10-01 SHERI BROWN 2020-04-06
510 2017-10-01
510 2016-10-01 SHERI BROWN
510 2015-10-01 SHERI BROWN
510 2014-10-01 SHERI BROWN
510 2013-10-01 SHERI BROWN
510 2012-10-01 SHERI BROWN
510 2011-10-01 SHERI L. BROWN
510 2009-10-01 LARRY F. PILE LARRY F. PILE 2011-04-21

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
510	2023-10-01	SHERI BROWN
510	2022-10-01
510	2022-10-01	SHERI BROWN
510	2021-10-01	SHERI BROWN	2023-04-12
510	2020-10-01	SHERI BROWN	2022-03-29
510	2019-10-01	SHERI BROWN	2021-04-10
510	2018-10-01	SHERI BROWN	2020-04-06
510	2017-10-01
510	2016-10-01	SHERI BROWN
510	2015-10-01	SHERI BROWN
510	2014-10-01	SHERI BROWN
510	2013-10-01	SHERI BROWN
510	2012-10-01	SHERI BROWN
510	2011-10-01	SHERI L. BROWN
510	2009-10-01	LARRY F. PILE		LARRY F. PILE	2011-04-21

Form 5500 Responses for DEACONESS HEALTH SYSTEM, INC. FLEXIBLE BENEFITS PLAN

2022: DEACONESS HEALTH SYSTEM, INC. FLEXIBLE BENEFITS PLAN 2022 form 5500 responses
2022-10-01	Type of plan entity	Single employer plan
2022-10-01	Submission has been amended	No
2022-10-01	This submission is the final filing	No
2022-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-10-01	Plan is a collectively bargained plan	No
2022-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: DEACONESS HEALTH SYSTEM, INC. FLEXIBLE BENEFITS PLAN 2021 form 5500 responses
2021-10-01	Type of plan entity	Single employer plan
2021-10-01	Submission has been amended	No
2021-10-01	This submission is the final filing	No
2021-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-10-01	Plan is a collectively bargained plan	No
2021-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: DEACONESS HEALTH SYSTEM, INC. FLEXIBLE BENEFITS PLAN 2020 form 5500 responses
2020-10-01	Type of plan entity	Single employer plan
2020-10-01	Submission has been amended	No
2020-10-01	This submission is the final filing	No
2020-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-10-01	Plan is a collectively bargained plan	No
2020-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: DEACONESS HEALTH SYSTEM, INC. FLEXIBLE BENEFITS PLAN 2019 form 5500 responses
2019-10-01	Type of plan entity	Single employer plan
2019-10-01	Submission has been amended	No
2019-10-01	This submission is the final filing	No
2019-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-10-01	Plan is a collectively bargained plan	No
2019-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: DEACONESS HEALTH SYSTEM, INC. FLEXIBLE BENEFITS PLAN 2018 form 5500 responses
2018-10-01	Type of plan entity	Single employer plan
2018-10-01	Submission has been amended	No
2018-10-01	This submission is the final filing	No
2018-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-10-01	Plan is a collectively bargained plan	No
2018-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: DEACONESS HEALTH SYSTEM, INC. FLEXIBLE BENEFITS PLAN 2017 form 5500 responses
2017-10-01	Type of plan entity	Single employer plan
2017-10-01	Submission has been amended	No
2017-10-01	This submission is the final filing	No
2017-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-10-01	Plan is a collectively bargained plan	No
2017-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: DEACONESS HEALTH SYSTEM, INC. FLEXIBLE BENEFITS PLAN 2016 form 5500 responses
2016-10-01	Type of plan entity	Single employer plan
2016-10-01	Submission has been amended	No
2016-10-01	This submission is the final filing	No
2016-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-10-01	Plan is a collectively bargained plan	No
2016-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: DEACONESS HEALTH SYSTEM, INC. FLEXIBLE BENEFITS PLAN 2015 form 5500 responses
2015-10-01	Type of plan entity	Single employer plan
2015-10-01	Submission has been amended	No
2015-10-01	This submission is the final filing	No
2015-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-10-01	Plan is a collectively bargained plan	No
2015-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: DEACONESS HEALTH SYSTEM, INC. FLEXIBLE BENEFITS PLAN 2014 form 5500 responses
2014-10-01	Type of plan entity	Single employer plan
2014-10-01	Submission has been amended	No
2014-10-01	This submission is the final filing	No
2014-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-10-01	Plan is a collectively bargained plan	No
2014-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: DEACONESS HEALTH SYSTEM, INC. FLEXIBLE BENEFITS PLAN 2013 form 5500 responses
2013-10-01	Type of plan entity	Single employer plan
2013-10-01	Submission has been amended	No
2013-10-01	This submission is the final filing	No
2013-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-10-01	Plan is a collectively bargained plan	No
2013-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: DEACONESS HEALTH SYSTEM, INC. FLEXIBLE BENEFITS PLAN 2012 form 5500 responses
2012-10-01	Type of plan entity	Single employer plan
2012-10-01	Submission has been amended	No
2012-10-01	This submission is the final filing	No
2012-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-10-01	Plan is a collectively bargained plan	No
2012-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: DEACONESS HEALTH SYSTEM, INC. FLEXIBLE BENEFITS PLAN 2011 form 5500 responses
2011-10-01	Type of plan entity	Single employer plan
2011-10-01	Submission has been amended	No
2011-10-01	This submission is the final filing	No
2011-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-10-01	Plan is a collectively bargained plan	No
2011-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: DEACONESS HEALTH SYSTEM, INC. FLEXIBLE BENEFITS PLAN 2009 form 5500 responses
2009-10-01	Type of plan entity	Single employer plan
2009-10-01	Submission has been amended	No
2009-10-01	This submission is the final filing	No
2009-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-10-01	Plan is a collectively bargained plan	No
2009-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-10-01	Plan benefit arrangement – General assets of the sponsor	Yes

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Company Name:	DEACONESS HEALTH SYSTEM, INC.
Employer identification number (EIN):	351532889
NAIC Classification:	622000
NAIC Description:	Hospitals