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COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 401k Plan overview

Plan NameCOLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN
Plan identification number 509

COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance

401k Sponsoring company profile

PRAIRIE RIDGE HEALTH has sponsored the creation of one or more 401k plans.

Company Name:PRAIRIE RIDGE HEALTH
Employer identification number (EIN):391140373
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5092022-04-01ERIK SCHUELKE2023-10-05
5092021-04-01ANN M ROUNDY2022-12-21 ANN M ROUNDY2022-12-21
5092020-04-01ANN M ROUNDY2021-10-27 ANN M ROUNDY2021-10-27
5092019-04-01ANN M ROUNDY2020-10-26 ANN M ROUNDY2020-10-26
5092018-04-01ANN M ROUNDY2019-10-14 ANN M ROUNDY2019-10-14
5092017-04-01
5092016-04-01
5092016-04-01ANN M ROUNDY2017-09-20
5092015-04-01
5092014-04-01
5092013-04-01
5092012-04-01ANN M ROUNDY
5092011-04-01ANN ROUNDY
5092010-04-01ANN ROUNDY
5092009-04-01ANN ROUNDY

Plan Statistics for COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN

401k plan membership statisitcs for COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN

Measure Date Value
2022: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2022 401k membership
Total participants, beginning-of-year2022-04-01291
Total number of active participants reported on line 7a of the Form 55002022-04-01176
Total of all active and inactive participants2022-04-01176
Total participants2022-04-01176
2021: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2021 401k membership
Total participants, beginning-of-year2021-04-01235
Total number of active participants reported on line 7a of the Form 55002021-04-01291
Total of all active and inactive participants2021-04-01291
Total participants2021-04-01291
2020: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2020 401k membership
Total participants, beginning-of-year2020-04-01267
Total number of active participants reported on line 7a of the Form 55002020-04-01235
Total of all active and inactive participants2020-04-01235
Total participants2020-04-01235
2019: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2019 401k membership
Total participants, beginning-of-year2019-04-01258
Total number of active participants reported on line 7a of the Form 55002019-04-01267
Total of all active and inactive participants2019-04-01267
Total participants2019-04-01267
2018: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2018 401k membership
Total participants, beginning-of-year2018-04-01257
Total number of active participants reported on line 7a of the Form 55002018-04-01258
Total of all active and inactive participants2018-04-01258
Total participants2018-04-01258
2017: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2017 401k membership
Total participants, beginning-of-year2017-04-01248
Total number of active participants reported on line 7a of the Form 55002017-04-01257
Total of all active and inactive participants2017-04-01257
Total participants2017-04-01257
2016: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2016 401k membership
Total participants, beginning-of-year2016-04-01223
Total number of active participants reported on line 7a of the Form 55002016-04-01248
Total of all active and inactive participants2016-04-01248
Total participants2016-04-01248
2015: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2015 401k membership
Total participants, beginning-of-year2015-04-01108
Total number of active participants reported on line 7a of the Form 55002015-04-01223
Total of all active and inactive participants2015-04-01223
Total participants2015-04-01223
2014: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2014 401k membership
Total participants, beginning-of-year2014-04-01102
Total number of active participants reported on line 7a of the Form 55002014-04-01108
Total of all active and inactive participants2014-04-01108
Total participants2014-04-01108
2013: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2013 401k membership
Total participants, beginning-of-year2013-04-0193
Total number of active participants reported on line 7a of the Form 55002013-04-01102
Total of all active and inactive participants2013-04-01102
Total participants2013-04-01102
2012: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2012 401k membership
Total participants, beginning-of-year2012-04-01113
Total number of active participants reported on line 7a of the Form 55002012-04-0193
Total of all active and inactive participants2012-04-0193
Total participants2012-04-0193
2011: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2011 401k membership
Total participants, beginning-of-year2011-04-0172
Total number of active participants reported on line 7a of the Form 55002011-04-01113
Total of all active and inactive participants2011-04-01113
Total participants2011-04-01113
2010: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2010 401k membership
Total participants, beginning-of-year2010-04-01115
Total number of active participants reported on line 7a of the Form 55002010-04-0172
Number of retired or separated participants receiving benefits2010-04-010
Number of other retired or separated participants entitled to future benefits2010-04-010
Total of all active and inactive participants2010-04-0172
2009: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2009 401k membership
Total participants, beginning-of-year2009-04-01110
Total number of active participants reported on line 7a of the Form 55002009-04-01115
Number of retired or separated participants receiving benefits2009-04-010
Number of other retired or separated participants entitled to future benefits2009-04-010
Total of all active and inactive participants2009-04-01115

Form 5500 Responses for COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN

2022: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2022 form 5500 responses
2022-04-01Type of plan entitySingle employer plan
2022-04-01Plan funding arrangement – InsuranceYes
2022-04-01Plan benefit arrangement – InsuranceYes
2021: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2021 form 5500 responses
2021-04-01Type of plan entitySingle employer plan
2021-04-01Plan funding arrangement – InsuranceYes
2021-04-01Plan benefit arrangement – InsuranceYes
2020: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2020 form 5500 responses
2020-04-01Type of plan entitySingle employer plan
2020-04-01Plan funding arrangement – InsuranceYes
2020-04-01Plan benefit arrangement – InsuranceYes
2019: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2019 form 5500 responses
2019-04-01Type of plan entitySingle employer plan
2019-04-01Plan funding arrangement – InsuranceYes
2019-04-01Plan benefit arrangement – InsuranceYes
2018: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2018 form 5500 responses
2018-04-01Type of plan entitySingle employer plan
2018-04-01Plan funding arrangement – InsuranceYes
2018-04-01Plan benefit arrangement – InsuranceYes
2017: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan benefit arrangement – InsuranceYes
2016: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan benefit arrangement – InsuranceYes
2015: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2015 form 5500 responses
2015-04-01Type of plan entitySingle employer plan
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan benefit arrangement – InsuranceYes
2014: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2014 form 5500 responses
2014-04-01Type of plan entitySingle employer plan
2014-04-01Plan funding arrangement – InsuranceYes
2014-04-01Plan benefit arrangement – InsuranceYes
2013: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2013 form 5500 responses
2013-04-01Type of plan entitySingle employer plan
2013-04-01Plan funding arrangement – InsuranceYes
2013-04-01Plan benefit arrangement – InsuranceYes
2012: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2012 form 5500 responses
2012-04-01Type of plan entitySingle employer plan
2012-04-01Plan funding arrangement – InsuranceYes
2012-04-01Plan benefit arrangement – InsuranceYes
2011: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2011 form 5500 responses
2011-04-01Type of plan entitySingle employer plan
2011-04-01Plan funding arrangement – InsuranceYes
2011-04-01Plan benefit arrangement – InsuranceYes
2010: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2010 form 5500 responses
2010-04-01Type of plan entitySingle employer plan
2010-04-01Submission has been amendedNo
2010-04-01This submission is the final filingNo
2010-04-01This return/report is a short plan year return/report (less than 12 months)No
2010-04-01Plan is a collectively bargained planNo
2010-04-01Plan funding arrangement – InsuranceYes
2010-04-01Plan benefit arrangement – InsuranceYes
2009: COLUMBUS COMMUNITY HOSPITAL VOLUNTARY LIFE PLAN 2009 form 5500 responses
2009-04-01Type of plan entitySingle employer plan
2009-04-01Submission has been amendedNo
2009-04-01This submission is the final filingNo
2009-04-01This return/report is a short plan year return/report (less than 12 months)No
2009-04-01Plan is a collectively bargained planNo
2009-04-01Plan funding arrangement – InsuranceYes
2009-04-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX968413
Policy instance 1
Insurance contract or identification numberFLX968413
Number of Individuals Covered348
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Total amount of commissions paid to insurance brokerUSD $2,625
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $65,634
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,625
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX968413
Policy instance 1
Insurance contract or identification numberFLX968413
Number of Individuals Covered291
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
Total amount of commissions paid to insurance brokerUSD $1,742
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $43,199
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,742
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX968413
Policy instance 1
Insurance contract or identification numberFLX968413
Number of Individuals Covered235
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Total amount of commissions paid to insurance brokerUSD $3,170
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $62,064
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,170
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX968413
Policy instance 1
Insurance contract or identification numberFLX968413
Number of Individuals Covered325
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Total amount of commissions paid to insurance brokerUSD $3,185
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $57,205
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,185
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number236316
Policy instance 2
Insurance contract or identification number236316
Number of Individuals Covered257
Insurance policy start date2018-04-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $755
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,974
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $755
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX968413
Policy instance 1
Insurance contract or identification numberFLX968413
Number of Individuals Covered318
Insurance policy start date2018-05-01
Insurance policy end date2019-03-31
Total amount of commissions paid to insurance brokerUSD $2,992
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $43,067
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,992
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number236316
Policy instance 1
Insurance contract or identification number236316
Number of Individuals Covered257
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $9,274
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $45,539
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,274
Insurance broker organization code?3
Insurance broker nameLAMAIR MULOCK CONDON CO
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number236316
Policy instance 1
Insurance contract or identification number236316
Number of Individuals Covered223
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $7,174
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $36,375
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,174
Insurance broker organization code?3
Insurance broker nameISG ADVISORS LLC
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number236316
Policy instance 2
Insurance contract or identification number236316
Number of Individuals Covered108
Insurance policy start date2014-05-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $5,382
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,324
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,382
Insurance broker organization code?3
Insurance broker nameISG ADVISORS LLC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 652269
Policy instance 1
Insurance contract or identification numberGL 652269
Number of Individuals Covered102
Insurance policy start date2014-04-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $473
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,367
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $473
Insurance broker organization code?3
Insurance broker nameISG ADVISORS LLC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 652269
Policy instance 1
Insurance contract or identification numberGL 652269
Number of Individuals Covered102
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $5,846
Total amount of fees paid to insurance companyUSD $1,022
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,229
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,846
Amount paid for insurance broker fees1022
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
Insurance broker nameISG ADVISORS LLC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 652269
Policy instance 1
Insurance contract or identification numberGL 652269
Number of Individuals Covered93
Insurance policy start date2012-05-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $4,889
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,446
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,889
Insurance broker organization code?3
Insurance broker nameISG ADVISORS LLC
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number4036072
Policy instance 2
Insurance contract or identification number4036072
Number of Individuals Covered116
Insurance policy start date2012-04-01
Insurance policy end date2012-04-30
Total amount of commissions paid to insurance brokerUSD $324
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,163
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $324
Insurance broker organization code?3
Insurance broker nameRICHARDS BENEFITS & FINANCIAL SERVI
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract numberG4036072
Policy instance 1
Insurance contract or identification numberG4036072
Number of Individuals Covered113
Insurance policy start date2011-04-01
Insurance policy end date2012-03-21
Total amount of commissions paid to insurance brokerUSD $3,618
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,119
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract numberG 4036072
Policy instance 1
Insurance contract or identification numberG 4036072
Number of Individuals Covered111
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $3,539
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $23,596
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,539
Insurance broker organization code?3
Insurance broker nameRICHARDS BENEFITS & FINANCIAL SERV

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