| Plan Name | FORT MADISON COMMUNITY HOSPITAL GROUP INSURANCE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | FORT MADISON COMMUNITY HOSPITAL |
| Employer identification number (EIN): | 421081055 |
| NAIC Classification: | 622000 |
| NAIC Description: | Hospitals |
Additional information about FORT MADISON COMMUNITY HOSPITAL
| Jurisdiction of Incorporation: | Iowa Secretary of State Business Entities |
| Incorporation Date: | 1977-03-16 |
| Company Identification Number: | 057782 |
| Legal Registered Office Address: |
5445 AVE O FORT MADISON United States of America (USA) 52627 |
More information about FORT MADISON COMMUNITY HOSPITAL
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2020-10-01 | KAYLA RILEY | 2021-07-12 | ||
| 501 | 2019-10-01 | KAYLA RILEY | 2021-07-12 | ||
| 501 | 2018-10-01 | KAYLA RILEY | 2020-04-22 | ||
| 501 | 2017-10-01 | ||||
| 501 | 2016-10-01 | VICKI KOKJOHN | |||
| 501 | 2015-10-01 | VICKI KOKJOHN | |||
| 501 | 2014-10-01 | VICKI KOKJOHN | VICKI KOKJOHN | 2016-04-28 | |
| 501 | 2013-10-01 | VICKI KOKJOHN | VICKI KOKJOHN | 2015-04-14 | |
| 501 | 2012-10-01 | VICKI KOKJOHN | |||
| 501 | 2011-10-01 | VICKI KOKJOHN | |||
| 501 | 2010-10-01 | VICKI KOKJOHN | |||
| 501 | 2009-10-01 | VICKI KOKJOHN |
| 2020: FORT MADISON COMMUNITY HOSPITAL GROUP INSURANCE PLAN 2020 form 5500 responses | ||
|---|---|---|
| 2020-10-01 | Type of plan entity | Single employer plan |
| 2020-10-01 | Submission has been amended | No |
| 2020-10-01 | This submission is the final filing | Yes |
| 2020-10-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2020-10-01 | Plan is a collectively bargained plan | No |
| 2020-10-01 | Plan funding arrangement – Insurance | Yes |
| 2020-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: FORT MADISON COMMUNITY HOSPITAL GROUP INSURANCE PLAN 2019 form 5500 responses | ||
| 2019-10-01 | Type of plan entity | Single employer plan |
| 2019-10-01 | Submission has been amended | No |
| 2019-10-01 | This submission is the final filing | No |
| 2019-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-10-01 | Plan is a collectively bargained plan | No |
| 2019-10-01 | Plan funding arrangement – Insurance | Yes |
| 2019-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: FORT MADISON COMMUNITY HOSPITAL GROUP INSURANCE PLAN 2018 form 5500 responses | ||
| 2018-10-01 | Type of plan entity | Single employer plan |
| 2018-10-01 | Submission has been amended | No |
| 2018-10-01 | This submission is the final filing | No |
| 2018-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-10-01 | Plan is a collectively bargained plan | No |
| 2018-10-01 | Plan funding arrangement – Insurance | Yes |
| 2018-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: FORT MADISON COMMUNITY HOSPITAL GROUP INSURANCE PLAN 2017 form 5500 responses | ||
| 2017-10-01 | Type of plan entity | Single employer plan |
| 2017-10-01 | Submission has been amended | No |
| 2017-10-01 | This submission is the final filing | No |
| 2017-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-10-01 | Plan is a collectively bargained plan | No |
| 2017-10-01 | Plan funding arrangement – Insurance | Yes |
| 2017-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: FORT MADISON COMMUNITY HOSPITAL GROUP INSURANCE PLAN 2016 form 5500 responses | ||
| 2016-10-01 | Type of plan entity | Single employer plan |
| 2016-10-01 | Submission has been amended | No |
| 2016-10-01 | This submission is the final filing | No |
| 2016-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-10-01 | Plan is a collectively bargained plan | No |
| 2016-10-01 | Plan funding arrangement – Insurance | Yes |
| 2016-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: FORT MADISON COMMUNITY HOSPITAL GROUP INSURANCE PLAN 2015 form 5500 responses | ||
| 2015-10-01 | Type of plan entity | Single employer plan |
| 2015-10-01 | Submission has been amended | No |
| 2015-10-01 | This submission is the final filing | No |
| 2015-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-10-01 | Plan is a collectively bargained plan | No |
| 2015-10-01 | Plan funding arrangement – Insurance | Yes |
| 2015-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: FORT MADISON COMMUNITY HOSPITAL GROUP INSURANCE PLAN 2014 form 5500 responses | ||
| 2014-10-01 | Type of plan entity | Single employer plan |
| 2014-10-01 | Submission has been amended | No |
| 2014-10-01 | This submission is the final filing | No |
| 2014-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-10-01 | Plan is a collectively bargained plan | No |
| 2014-10-01 | Plan funding arrangement – Insurance | Yes |
| 2014-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: FORT MADISON COMMUNITY HOSPITAL GROUP INSURANCE PLAN 2013 form 5500 responses | ||
| 2013-10-01 | Type of plan entity | Single employer plan |
| 2013-10-01 | Submission has been amended | No |
| 2013-10-01 | This submission is the final filing | No |
| 2013-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-10-01 | Plan is a collectively bargained plan | No |
| 2013-10-01 | Plan funding arrangement – Insurance | Yes |
| 2013-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: FORT MADISON COMMUNITY HOSPITAL GROUP INSURANCE PLAN 2012 form 5500 responses | ||
| 2012-10-01 | Type of plan entity | Single employer plan |
| 2012-10-01 | Submission has been amended | No |
| 2012-10-01 | This submission is the final filing | No |
| 2012-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-10-01 | Plan is a collectively bargained plan | No |
| 2012-10-01 | Plan funding arrangement – Insurance | Yes |
| 2012-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: FORT MADISON COMMUNITY HOSPITAL GROUP INSURANCE PLAN 2011 form 5500 responses | ||
| 2011-10-01 | Type of plan entity | Single employer plan |
| 2011-10-01 | Submission has been amended | Yes |
| 2011-10-01 | This submission is the final filing | No |
| 2011-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-10-01 | Plan is a collectively bargained plan | No |
| 2011-10-01 | Plan funding arrangement – Insurance | Yes |
| 2011-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: FORT MADISON COMMUNITY HOSPITAL GROUP INSURANCE 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 benefit arrangement – Insurance | Yes |
| 2009: FORT MADISON COMMUNITY HOSPITAL GROUP INSURANCE 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 benefit arrangement – Insurance | Yes |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | LTD 129453 |
| Policy instance | 3 |
| DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 ) | |
| Policy contract number | 35583 |
| Policy instance | 1 |
| VERATRUS BUSINESS SOLUTIONS (National Association of Insurance Commissioners NAIC id number: 13742 ) | |
| Policy contract number | 35583 |
| Policy instance | 2 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | GL 158449 |
| Policy instance | 4 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | GL 158449 |
| Policy instance | 4 |
| DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 ) | |
| Policy contract number | 35583 |
| Policy instance | 1 |
| VERATRUS BUSINESS SOLUTIONS (National Association of Insurance Commissioners NAIC id number: 13742 ) | |
| Policy contract number | 35583 |
| Policy instance | 2 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | LTD 129453 |
| Policy instance | 3 |
| DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 ) | |
| Policy contract number | 35583 |
| Policy instance | 2 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | GL 158449 |
| Policy instance | 5 |
| VERATRUS BUSINESS SOLUTIONS (National Association of Insurance Commissioners NAIC id number: 13742 ) | |
| Policy contract number | 35583 |
| Policy instance | 3 |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) | |
| Policy contract number | 0108005 |
| Policy instance | 1 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) | |
| Policy contract number | LTD 129453 |
| Policy instance | 4 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 910375 |
| Policy instance | 1 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 000010201201 |
| Policy instance | 6 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 40000100019450 |
| Policy instance | 5 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 000010201202 |
| Policy instance | 4 |
| VERATRUS BUSINESS SOLUTIONS (National Association of Insurance Commissioners NAIC id number: 13742 ) | |
| Policy contract number | 35583 |
| Policy instance | 3 |
| DELTA DENTAL OF IOWA (National Association of Insurance Commissioners NAIC id number: 55786 ) | |
| Policy contract number | 35583 |
| Policy instance | 2 |
| UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 ) | |
| Policy contract number | OYBK |
| Policy instance | 7 |
| UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 ) | |
| Policy contract number | OYBJ |
| Policy instance | 6 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | KM05582746 |
| Policy instance | 5 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 19450 |
| Policy instance | 4 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 10201201 |
| Policy instance | 3 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 10201202 |
| Policy instance | 2 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) | |
| Policy contract number | 9776956 |
| Policy instance | 1 |
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) | |
| Policy contract number | 5456109 |
| Policy instance | 1 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) | |
| Policy contract number | 9776956 |
| Policy instance | 2 |
| UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 ) | |
| Policy contract number | OYBJ |
| Policy instance | 4 |
| UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 ) | |
| Policy contract number | OYBK |
| Policy instance | 5 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | KM05582746 |
| Policy instance | 3 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) | |
| Policy contract number | 9776956 |
| Policy instance | 3 |
| UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 ) | |
| Policy contract number | OYBK |
| Policy instance | 5 |
| UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 ) | |
| Policy contract number | OYBJ |
| Policy instance | 4 |
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) | |
| Policy contract number | 5456109 |
| Policy instance | 2 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | KM05582746 |
| Policy instance | 1 |
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) | |
| Policy contract number | 5456109 |
| Policy instance | 2 |
| UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 ) | |
| Policy contract number | OYBK |
| Policy instance | 5 |
| UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 ) | |
| Policy contract number | OYBJ |
| Policy instance | 4 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) | |
| Policy contract number | 9776956 |
| Policy instance | 3 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | KM05582746 |
| Policy instance | 1 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | KM05582746 |
| Policy instance | 4 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) | |
| Policy contract number | 60790-1261 |
| Policy instance | 3 |
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) | |
| Policy contract number | 5456109 |
| Policy instance | 1 |
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) | |
| Policy contract number | H43065 |
| Policy instance | 5 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) | |
| Policy contract number | 9776956 |
| Policy instance | 2 |
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) | |
| Policy contract number | H34449 |
| Policy instance | 5 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) | |
| Policy contract number | 60790-1261 |
| Policy instance | 2 |
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) | |
| Policy contract number | 048-5904-00 |
| Policy instance | 7 |
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) | |
| Policy contract number | H43065 |
| Policy instance | 6 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 5582746 |
| Policy instance | 4 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) | |
| Policy contract number | 9776956 |
| Policy instance | 3 |
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) | |
| Policy contract number | 100-1006422 |
| Policy instance | 1 |