401k Plan data: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA plan

LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 401k Plan overview

Plan Name	LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA
Plan identification number	503

LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA Benefits

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

401k Sponsoring company profile

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

Company Name: LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, INC.

Employer identification number (EIN): 410811697

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2018-01-01 DOUG JOHNSON DOUG JOHNSON 2019-06-29
503 2017-01-01 DOUG JOHNSON 2018-10-11 DOUG JOHNSON 2018-10-11
503 2016-01-01 DOUG JOHNSON 2017-07-17 DOUG JOHNSON 2017-07-17
503 2015-01-01 DOUG JOHNSON 2016-10-14 DOUG JOHNSON 2016-10-14
503 2014-01-01 DOUG JOHNSON 2015-10-13 DOUG JOHNSON 2015-10-13
503 2013-01-01 DOUG JOHNSON 2014-07-24 DOUG JOHNSON 2014-07-24
503 2012-01-01 DOUG JOHNSON 2013-10-07 DOUG JOHNSON 2013-10-07
503 2011-10-01 DOUG JOHNSON 2013-10-07 DOUG JOHNSON 2013-10-07
503 2009-07-01 DOUGLAS JOHNSON

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2018-01-01	DOUG JOHNSON		DOUG JOHNSON	2019-06-29
503	2017-01-01	DOUG JOHNSON	2018-10-11	DOUG JOHNSON	2018-10-11
503	2016-01-01	DOUG JOHNSON	2017-07-17	DOUG JOHNSON	2017-07-17
503	2015-01-01	DOUG JOHNSON	2016-10-14	DOUG JOHNSON	2016-10-14
503	2014-01-01	DOUG JOHNSON	2015-10-13	DOUG JOHNSON	2015-10-13
503	2013-01-01	DOUG JOHNSON	2014-07-24	DOUG JOHNSON	2014-07-24
503	2012-01-01	DOUG JOHNSON	2013-10-07	DOUG JOHNSON	2013-10-07
503	2011-10-01	DOUG JOHNSON	2013-10-07	DOUG JOHNSON	2013-10-07
503	2009-07-01	DOUGLAS JOHNSON

Plan Statistics for LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA

401k plan membership statisitcs for LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA

Measure Date Value
2018: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 2018 401k membership
Total participants, beginning-of-year 2018-01-01 165
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 153
Total of all active and inactive participants 2018-01-01 153
2017: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 2017 401k membership
Total participants, beginning-of-year 2017-01-01 185
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 165
Total of all active and inactive participants 2017-01-01 165
2016: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 2016 401k membership
Total participants, beginning-of-year 2016-01-01 238
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 185
Number of retired or separated participants receiving benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 185
2015: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 2015 401k membership
Total participants, beginning-of-year 2015-01-01 232
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 238
Number of retired or separated participants receiving benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 238
2014: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 2014 401k membership
Total participants, beginning-of-year 2014-01-01 297
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 232
Total of all active and inactive participants 2014-01-01 232
2013: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 2013 401k membership
Total participants, beginning-of-year 2013-01-01 285
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 297
Total of all active and inactive participants 2013-01-01 297
2012: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 2012 401k membership
Total participants, beginning-of-year 2012-01-01 285
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 285
Total of all active and inactive participants 2012-01-01 285
2011: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 2011 401k membership
Total participants, beginning-of-year 2011-10-01 209
Total number of active participants reported on line 7a of the Form 5500 2011-10-01 209
Total of all active and inactive participants 2011-10-01 209
2009: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 2009 401k membership
Total participants, beginning-of-year 2009-07-01 138
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 163
Total of all active and inactive participants 2009-07-01 163
Total participants 2009-07-01 0

Measure	Date	Value
2018: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 2018 401k membership
Total participants, beginning-of-year	2018-01-01	165
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	153
Total of all active and inactive participants	2018-01-01	153
2017: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 2017 401k membership
Total participants, beginning-of-year	2017-01-01	185
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	165
Total of all active and inactive participants	2017-01-01	165
2016: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 2016 401k membership
Total participants, beginning-of-year	2016-01-01	238
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	185
Number of retired or separated participants receiving benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	185
2015: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 2015 401k membership
Total participants, beginning-of-year	2015-01-01	232
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	238
Number of retired or separated participants receiving benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	238
2014: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 2014 401k membership
Total participants, beginning-of-year	2014-01-01	297
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	232
Total of all active and inactive participants	2014-01-01	232
2013: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 2013 401k membership
Total participants, beginning-of-year	2013-01-01	285
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	297
Total of all active and inactive participants	2013-01-01	297
2012: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 2012 401k membership
Total participants, beginning-of-year	2012-01-01	285
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	285
Total of all active and inactive participants	2012-01-01	285
2011: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 2011 401k membership
Total participants, beginning-of-year	2011-10-01	209
Total number of active participants reported on line 7a of the Form 5500	2011-10-01	209
Total of all active and inactive participants	2011-10-01	209
2009: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 2009 401k membership
Total participants, beginning-of-year	2009-07-01	138
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	163
Total of all active and inactive participants	2009-07-01	163
Total participants	2009-07-01	0

Form 5500 Responses for LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA

2018: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	This submission is the final filing	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 2011 form 5500 responses
2011-10-01	Type of plan entity	Single employer plan
2011-10-01	This return/report is a short plan year return/report (less than 12 months)	Yes
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: LAKEVIEW MEMORIAL HOSPITAL SALARY CONVERSION PLAN HEALTH FSA 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	Submission has been amended	No
2009-07-01	This submission is the final filing	No
2009-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-07-01	Plan is a collectively bargained plan	No
2009-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-07-01	Plan benefit arrangement – General assets of the sponsor	Yes

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Company Name:	LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, INC.
Employer identification number (EIN):	410811697
NAIC Classification:	622000
NAIC Description:	Hospitals