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| Plan Name | CROSSING RIVERS HEALTH WELFARE BENEFITS PLAN |
| Plan identification number | 515 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | PRAIRIE DU CHIEN MEMORIAL HOSPITAL ASSOCIATION INC |
| Employer identification number (EIN): | 390926284 |
| NAIC Classification: | 622000 |
| NAIC Description: | Hospitals |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 515 | 2022-01-01 | CHRISTOPHER BROPHY | 2023-07-28 | CHRISTOPHER BROPHY | 2023-07-28 |
| Measure | Date | Value |
|---|---|---|
| 2022: CROSSING RIVERS HEALTH WELFARE BENEFITS PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-01-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 290 |
| Total of all active and inactive participants | 2022-01-01 | 290 |
| Total participants | 2022-01-01 | 290 |
| 2022: CROSSING RIVERS HEALTH WELFARE BENEFITS PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | First time form 5500 has been submitted | Yes |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |||||||||||||||||||||||||||||||||
| Policy contract number | 947089 | ||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||
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| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) | |||||||||||||||||||||||||||||||||
| Policy contract number | 01-017365-00 | ||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||
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| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) | |||||||||||||||||||||||||||||||||
| Policy contract number | 51396 | ||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||
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