401k Plan data: WINONA HEALTH DENTAL BENEFIT PLAN plan

WINONA HEALTH DENTAL BENEFIT PLAN 401k Plan overview

Plan Name	WINONA HEALTH DENTAL BENEFIT PLAN
Plan identification number	505

WINONA HEALTH DENTAL BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental

401k Sponsoring company profile

WINONA HEALTH SERVICES has sponsored the creation of one or more 401k plans.

Company Name: WINONA HEALTH SERVICES

Employer identification number (EIN): 410713914

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WINONA HEALTH DENTAL BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2020-10-01 REBECCA LAMBERTY 2022-04-08
505 2019-10-01
505 2018-10-01
505 2017-10-01
505 2016-10-01 REBECCA LAMBERTY
505 2015-10-01 KATHY WADE
505 2014-10-01
505 2013-10-01 KATHY WADE
505 2012-10-01 ASHLEY ANDERSON
505 2011-10-01 MICHAEL SKROCH
505 2010-10-01 MICHAEL SKROCH WILLIAM GOULD 2012-04-26
505 2009-10-01 MICHAEL SKROCH WILLIAM GOULD 2011-04-11

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
505	2020-10-01	REBECCA LAMBERTY	2022-04-08
505	2019-10-01
505	2018-10-01
505	2017-10-01
505	2016-10-01	REBECCA LAMBERTY
505	2015-10-01	KATHY WADE
505	2014-10-01
505	2013-10-01	KATHY WADE
505	2012-10-01	ASHLEY ANDERSON
505	2011-10-01	MICHAEL SKROCH
505	2010-10-01	MICHAEL SKROCH		WILLIAM GOULD	2012-04-26
505	2009-10-01	MICHAEL SKROCH		WILLIAM GOULD	2011-04-11

Plan Statistics for WINONA HEALTH DENTAL BENEFIT PLAN

401k plan membership statisitcs for WINONA HEALTH DENTAL BENEFIT PLAN

Measure Date Value
2020: WINONA HEALTH DENTAL BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-10-01 581
Total number of active participants reported on line 7a of the Form 5500 2020-10-01 0
Number of retired or separated participants receiving benefits 2020-10-01 0
Number of other retired or separated participants entitled to future benefits 2020-10-01 0
Total of all active and inactive participants 2020-10-01 0
Number of employers contributing to the scheme 2020-10-01 0
2019: WINONA HEALTH DENTAL BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-10-01 601
Total number of active participants reported on line 7a of the Form 5500 2019-10-01 574
Number of retired or separated participants receiving benefits 2019-10-01 7
Total of all active and inactive participants 2019-10-01 581
2018: WINONA HEALTH DENTAL BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-10-01 623
Total number of active participants reported on line 7a of the Form 5500 2018-10-01 601
Number of retired or separated participants receiving benefits 2018-10-01 7
Total of all active and inactive participants 2018-10-01 608
2017: WINONA HEALTH DENTAL BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-10-01 704
Total number of active participants reported on line 7a of the Form 5500 2017-10-01 613
Number of retired or separated participants receiving benefits 2017-10-01 10
Total of all active and inactive participants 2017-10-01 623
2016: WINONA HEALTH DENTAL BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-10-01 697
Total number of active participants reported on line 7a of the Form 5500 2016-10-01 694
Number of retired or separated participants receiving benefits 2016-10-01 10
Total of all active and inactive participants 2016-10-01 704
2015: WINONA HEALTH DENTAL BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-10-01 681
Total number of active participants reported on line 7a of the Form 5500 2015-10-01 685
Number of retired or separated participants receiving benefits 2015-10-01 12
Total of all active and inactive participants 2015-10-01 697
2014: WINONA HEALTH DENTAL BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-10-01 718
Total number of active participants reported on line 7a of the Form 5500 2014-10-01 670
Number of retired or separated participants receiving benefits 2014-10-01 11
Total of all active and inactive participants 2014-10-01 681
2013: WINONA HEALTH DENTAL BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-10-01 713
Total number of active participants reported on line 7a of the Form 5500 2013-10-01 701
Number of retired or separated participants receiving benefits 2013-10-01 17
Total of all active and inactive participants 2013-10-01 718
2012: WINONA HEALTH DENTAL BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-10-01 665
Total number of active participants reported on line 7a of the Form 5500 2012-10-01 691
Number of retired or separated participants receiving benefits 2012-10-01 22
Total of all active and inactive participants 2012-10-01 713
2011: WINONA HEALTH DENTAL BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-10-01 703
Total number of active participants reported on line 7a of the Form 5500 2011-10-01 653
Number of retired or separated participants receiving benefits 2011-10-01 12
Total of all active and inactive participants 2011-10-01 665
2010: WINONA HEALTH DENTAL BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-10-01 694
Total number of active participants reported on line 7a of the Form 5500 2010-10-01 693
Number of retired or separated participants receiving benefits 2010-10-01 10
Number of other retired or separated participants entitled to future benefits 2010-10-01 0
Total of all active and inactive participants 2010-10-01 703
2009: WINONA HEALTH DENTAL BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-10-01 699
Total number of active participants reported on line 7a of the Form 5500 2009-10-01 675
Number of retired or separated participants receiving benefits 2009-10-01 19
Total of all active and inactive participants 2009-10-01 694
Total participants 2009-10-01 694

Measure	Date	Value
2020: WINONA HEALTH DENTAL BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-10-01	581
Total number of active participants reported on line 7a of the Form 5500	2020-10-01	0
Number of retired or separated participants receiving benefits	2020-10-01	0
Number of other retired or separated participants entitled to future benefits	2020-10-01	0
Total of all active and inactive participants	2020-10-01	0
Number of employers contributing to the scheme	2020-10-01	0
2019: WINONA HEALTH DENTAL BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-10-01	601
Total number of active participants reported on line 7a of the Form 5500	2019-10-01	574
Number of retired or separated participants receiving benefits	2019-10-01	7
Total of all active and inactive participants	2019-10-01	581
2018: WINONA HEALTH DENTAL BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-10-01	623
Total number of active participants reported on line 7a of the Form 5500	2018-10-01	601
Number of retired or separated participants receiving benefits	2018-10-01	7
Total of all active and inactive participants	2018-10-01	608
2017: WINONA HEALTH DENTAL BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-10-01	704
Total number of active participants reported on line 7a of the Form 5500	2017-10-01	613
Number of retired or separated participants receiving benefits	2017-10-01	10
Total of all active and inactive participants	2017-10-01	623
2016: WINONA HEALTH DENTAL BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-10-01	697
Total number of active participants reported on line 7a of the Form 5500	2016-10-01	694
Number of retired or separated participants receiving benefits	2016-10-01	10
Total of all active and inactive participants	2016-10-01	704
2015: WINONA HEALTH DENTAL BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-10-01	681
Total number of active participants reported on line 7a of the Form 5500	2015-10-01	685
Number of retired or separated participants receiving benefits	2015-10-01	12
Total of all active and inactive participants	2015-10-01	697
2014: WINONA HEALTH DENTAL BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-10-01	718
Total number of active participants reported on line 7a of the Form 5500	2014-10-01	670
Number of retired or separated participants receiving benefits	2014-10-01	11
Total of all active and inactive participants	2014-10-01	681
2013: WINONA HEALTH DENTAL BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-10-01	713
Total number of active participants reported on line 7a of the Form 5500	2013-10-01	701
Number of retired or separated participants receiving benefits	2013-10-01	17
Total of all active and inactive participants	2013-10-01	718
2012: WINONA HEALTH DENTAL BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-10-01	665
Total number of active participants reported on line 7a of the Form 5500	2012-10-01	691
Number of retired or separated participants receiving benefits	2012-10-01	22
Total of all active and inactive participants	2012-10-01	713
2011: WINONA HEALTH DENTAL BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-10-01	703
Total number of active participants reported on line 7a of the Form 5500	2011-10-01	653
Number of retired or separated participants receiving benefits	2011-10-01	12
Total of all active and inactive participants	2011-10-01	665
2010: WINONA HEALTH DENTAL BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-10-01	694
Total number of active participants reported on line 7a of the Form 5500	2010-10-01	693
Number of retired or separated participants receiving benefits	2010-10-01	10
Number of other retired or separated participants entitled to future benefits	2010-10-01	0
Total of all active and inactive participants	2010-10-01	703
2009: WINONA HEALTH DENTAL BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-10-01	699
Total number of active participants reported on line 7a of the Form 5500	2009-10-01	675
Number of retired or separated participants receiving benefits	2009-10-01	19
Total of all active and inactive participants	2009-10-01	694
Total participants	2009-10-01	694

Form 5500 Responses for WINONA HEALTH DENTAL BENEFIT PLAN

2020: WINONA HEALTH DENTAL BENEFIT PLAN 2020 form 5500 responses
2020-10-01	Type of plan entity	Single employer plan
2020-10-01	This submission is the final filing	Yes
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: WINONA HEALTH DENTAL BENEFIT PLAN 2019 form 5500 responses
2019-10-01	Type of plan entity	Single employer plan
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: WINONA HEALTH DENTAL BENEFIT PLAN 2018 form 5500 responses
2018-10-01	Type of plan entity	Single employer plan
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: WINONA HEALTH DENTAL BENEFIT PLAN 2017 form 5500 responses
2017-10-01	Type of plan entity	Single employer plan
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: WINONA HEALTH DENTAL BENEFIT PLAN 2016 form 5500 responses
2016-10-01	Type of plan entity	Single employer plan
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: WINONA HEALTH DENTAL BENEFIT PLAN 2015 form 5500 responses
2015-10-01	Type of plan entity	Single employer plan
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: WINONA HEALTH DENTAL BENEFIT PLAN 2014 form 5500 responses
2014-10-01	Type of plan entity	Single employer plan
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: WINONA HEALTH DENTAL BENEFIT PLAN 2013 form 5500 responses
2013-10-01	Type of plan entity	Single employer plan
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: WINONA HEALTH DENTAL BENEFIT PLAN 2012 form 5500 responses
2012-10-01	Type of plan entity	Single employer plan
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: WINONA HEALTH DENTAL BENEFIT PLAN 2011 form 5500 responses
2011-10-01	Type of plan entity	Single employer plan
2011-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: WINONA HEALTH DENTAL BENEFIT PLAN 2010 form 5500 responses
2010-10-01	Type of plan entity	Single employer plan
2010-10-01	Submission has been amended	No
2010-10-01	This submission is the final filing	No
2010-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-10-01	Plan is a collectively bargained plan	No
2010-10-01	Plan funding arrangement – Insurance	Yes
2010-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-10-01	Plan benefit arrangement – Insurance	Yes
2010-10-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: WINONA HEALTH DENTAL BENEFIT 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 – Insurance	Yes
2009-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-10-01	Plan benefit arrangement – Insurance	Yes
2009-10-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

DELTA DENTAL PLAN OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

050808

Policy instance

Insurance contract or identification number	050808
Number of Individuals Covered	703
Insurance policy start date	2010-10-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $18,118
Total amount of fees paid to insurance company	USD $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 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	Yes
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
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 $493,517
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	WINONA HEALTH SERVICES
Employer identification number (EIN):	410713914
NAIC Classification:	622000
NAIC Description:	Hospitals