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FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 401k Plan overview

Plan NameFAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT
Plan identification number 502

FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

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

Company Name:FAIRVIEW HEALTH SERVICES
Employer identification number (EIN):410991680
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022019-01-01
5022018-01-01
5022017-01-01CAROLYN JACOBSON CAROLYN JACOBSON2018-10-15
5022016-01-01CAROLYN JACOBSON CAROLYN JACOBSON2017-10-05
5022015-01-01CAROLYN JACOBSON CAROLYN JACOBSON2016-08-05
5022014-01-01CAROLYN JACOBSON CAROLYN JACOBSON2015-05-07
5022013-01-01CAROLYN JACOBSON CAROLYN JACOBSON2014-09-15
5022012-01-01PAULA PHILLIPPE
5022011-01-01PAULA PHILLIPPE
5022009-01-01PAULA PHILLIPPE

Plan Statistics for FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT

401k plan membership statisitcs for FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT

Measure Date Value
2019: FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2019 401k membership
Total participants, beginning-of-year2019-01-0117,473
Total number of active participants reported on line 7a of the Form 55002019-01-010
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-010
2018: FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2018 401k membership
Total participants, beginning-of-year2018-01-0117,342
Total number of active participants reported on line 7a of the Form 55002018-01-0117,473
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-0117,473
2017: FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2017 401k membership
Total participants, beginning-of-year2017-01-0118,987
Total number of active participants reported on line 7a of the Form 55002017-01-0117,342
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-0117,342
2016: FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2016 401k membership
Total participants, beginning-of-year2016-01-0118,532
Total number of active participants reported on line 7a of the Form 55002016-01-0118,987
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-0118,987
2015: FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2015 401k membership
Total participants, beginning-of-year2015-01-0117,914
Total number of active participants reported on line 7a of the Form 55002015-01-0118,532
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-0118,532
2014: FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2014 401k membership
Total participants, beginning-of-year2014-01-0118,350
Total number of active participants reported on line 7a of the Form 55002014-01-0117,914
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-0117,914
2013: FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2013 401k membership
Total participants, beginning-of-year2013-01-0117,652
Total number of active participants reported on line 7a of the Form 55002013-01-0118,350
Total of all active and inactive participants2013-01-0118,350
2012: FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2012 401k membership
Total participants, beginning-of-year2012-01-0114,827
Total number of active participants reported on line 7a of the Form 55002012-01-0117,652
Total of all active and inactive participants2012-01-0117,652
2011: FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2011 401k membership
Total participants, beginning-of-year2011-01-0110,000
Total number of active participants reported on line 7a of the Form 55002011-01-0114,827
Total of all active and inactive participants2011-01-0114,827
2009: FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2009 401k membership
Total participants, beginning-of-year2009-01-0110,895
Total number of active participants reported on line 7a of the Form 55002009-01-0111,000
Total of all active and inactive participants2009-01-0111,000

Financial Data on FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT

Measure Date Value
2012 : FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2012 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Was this plan covered by a fidelity bond2012-12-31No
If this is an individual account plan, was there a blackout period2012-12-31No
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-12-31No
Did the plan have assets held for investment2012-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
2011 : FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2011 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Was this plan covered by a fidelity bond2011-12-31No
If this is an individual account plan, was there a blackout period2011-12-31No
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-12-31No
Did the plan have assets held for investment2011-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
2010 : FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2010 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Was this plan covered by a fidelity bond2010-12-31No
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-12-31No
Did the plan have assets held for investment2010-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No

Form 5500 Responses for FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT

2019: FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01This submission is the final filingYes
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedYes
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: FAIRVIEW HEALTH SERVICES GROUP LIFE & ACCIDENTAL DEATH & DISMEMBERMENT 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number50101-1
Policy instance 1
Insurance contract or identification number50101-1
Number of Individuals Covered18146
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,308,879
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?5
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number50101-1
Policy instance 1
Insurance contract or identification number50101-1
Number of Individuals Covered17473
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,222,996
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?5
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number50101-1
Policy instance 1
Insurance contract or identification number50101-1
Number of Individuals Covered17342
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,127,423
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?5
Insurance broker namePRUDENTIAL
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number50101-2
Policy instance 1
Insurance contract or identification number50101-2
Number of Individuals Covered18532
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,764,823
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number50101-2
Policy instance 1
Insurance contract or identification number50101-2
Number of Individuals Covered17914
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,023,338
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number50101-2
Policy instance 1
Insurance contract or identification number50101-2
Number of Individuals Covered18350
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,249,702
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number50101-1
Policy instance 1
Insurance contract or identification number50101-1
Number of Individuals Covered17652
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,937,109
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number50101-1
Policy instance 1
Insurance contract or identification number50101-1
Number of Individuals Covered14827
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,683,343
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number675231G
Policy instance 1
Insurance contract or identification number675231G
Number of Individuals Covered10000
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $720,272
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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