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CARROLL COUNTY MEMORIAL HOSPITAL HEALTH BENEFIT PLAN 401k Plan overview

Plan NameCARROLL COUNTY MEMORIAL HOSPITAL HEALTH BENEFIT PLAN
Plan identification number 501

CARROLL COUNTY MEMORIAL HOSPITAL HEALTH BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Other welfare benefit cover

401k Sponsoring company profile

CARROLL COUNTY MEMORIAL HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name:CARROLL COUNTY MEMORIAL HOSPITAL
Employer identification number (EIN):440629397
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CARROLL COUNTY MEMORIAL HOSPITAL HEALTH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01MICHAEL SCHUBACH2022-07-13
5012020-01-01MICHAEL SCHUBACH2021-07-15
5012019-01-01MICHAEL SCHUBACH2020-07-23
5012018-01-01MICHAEL SCHUBACH2019-10-04
5012017-01-01MICHAEL SCHUBACH MICHAEL SCHUBACH2019-01-17

Plan Statistics for CARROLL COUNTY MEMORIAL HOSPITAL HEALTH BENEFIT PLAN

401k plan membership statisitcs for CARROLL COUNTY MEMORIAL HOSPITAL HEALTH BENEFIT PLAN

Measure Date Value
2022: CARROLL COUNTY MEMORIAL HOSPITAL HEALTH BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01217
Total number of active participants reported on line 7a of the Form 55002022-01-01221
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01221
2021: CARROLL COUNTY MEMORIAL HOSPITAL HEALTH BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01201
Total number of active participants reported on line 7a of the Form 55002021-01-01216
Number of retired or separated participants receiving benefits2021-01-011
Total of all active and inactive participants2021-01-01217
2020: CARROLL COUNTY MEMORIAL HOSPITAL HEALTH BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01159
Total number of active participants reported on line 7a of the Form 55002020-01-01201
Total of all active and inactive participants2020-01-01201
2019: CARROLL COUNTY MEMORIAL HOSPITAL HEALTH BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01138
Total number of active participants reported on line 7a of the Form 55002019-01-01159
Total of all active and inactive participants2019-01-01159
2018: CARROLL COUNTY MEMORIAL HOSPITAL HEALTH BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01128
Total number of active participants reported on line 7a of the Form 55002018-01-01137
Number of retired or separated participants receiving benefits2018-01-011
Total of all active and inactive participants2018-01-01138
2017: CARROLL COUNTY MEMORIAL HOSPITAL HEALTH BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01112
Total number of active participants reported on line 7a of the Form 55002017-01-01116
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 participants2017-01-01116

Form 5500 Responses for CARROLL COUNTY MEMORIAL HOSPITAL HEALTH BENEFIT PLAN

2022: CARROLL COUNTY MEMORIAL HOSPITAL HEALTH BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: CARROLL COUNTY MEMORIAL HOSPITAL HEALTH BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: CARROLL COUNTY MEMORIAL HOSPITAL HEALTH BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: CARROLL COUNTY MEMORIAL HOSPITAL HEALTH BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: CARROLL COUNTY MEMORIAL HOSPITAL HEALTH BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: CARROLL COUNTY MEMORIAL HOSPITAL HEALTH BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01First time form 5500 has been submittedYes
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number936451
Policy instance 1
Insurance contract or identification number936451
Number of Individuals Covered221
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $38,919
Total amount of fees paid to insurance companyUSD $5,727
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, ACCIDENT, CANCER, CRIT. ILLNE
Welfare Benefit Premiums Paid to CarrierUSD $263,354
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,919
Amount paid for insurance broker fees5727
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number936451
Policy instance 1
Insurance contract or identification number936451
Number of Individuals Covered217
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $35,467
Total amount of fees paid to insurance companyUSD $15,873
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D,ACCIDENT,CANCER,CRIT ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $238,884
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,284
Amount paid for insurance broker fees15873
Additional information about fees paid to insurance brokerBONUS PAID DURING 2021 TO PRODUCER FOR CONTRACT PERIOD 1/1/2020 TO 12
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number936451
Policy instance 1
Insurance contract or identification number936451
Number of Individuals Covered206
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $38,111
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D,ACCIDENT,CANCER,CRIT ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $207,307
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,444
Insurance broker organization code?3
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5482639
Policy instance 1
Insurance contract or identification number5482639
Number of Individuals Covered159
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $24,775
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D,ACCIDENT,CANCER,CRIT ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $162,635
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,775
Insurance broker organization code?3

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