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BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN 401k Plan overview

Plan NameBRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN
Plan identification number 502

BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

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

Company Name:BRODSTONE MEMORIAL HOSPITAL
Employer identification number (EIN):470388012
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022017-04-01
5022016-04-01
5022015-04-01
5022014-04-01
5022013-04-01
5022012-04-01SANDRA J. BORDEN
5022011-04-01SANDRA BORDEN
5022010-04-01SANDRA BORDEN
5022009-04-01SANDRA BORDEN
5022008-04-01SANDRA BORDEN
5022007-04-01SANDRA BORDEN

Plan Statistics for BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN

401k plan membership statisitcs for BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN

Measure Date Value
2017: BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year2017-04-01162
Total number of active participants reported on line 7a of the Form 55002017-04-010
Total of all active and inactive participants2017-04-010
2016: BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year2016-04-01132
Total number of active participants reported on line 7a of the Form 55002016-04-01161
Total of all active and inactive participants2016-04-01161
2015: BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-04-01133
Total number of active participants reported on line 7a of the Form 55002015-04-01132
Total of all active and inactive participants2015-04-01132
2014: BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-04-01125
Total number of active participants reported on line 7a of the Form 55002014-04-01133
Total of all active and inactive participants2014-04-01133
2013: BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-04-01135
Total number of active participants reported on line 7a of the Form 55002013-04-01125
Total of all active and inactive participants2013-04-01125
2012: BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-04-01141
Total number of active participants reported on line 7a of the Form 55002012-04-01135
Total of all active and inactive participants2012-04-01135
2011: BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-04-01127
Total number of active participants reported on line 7a of the Form 55002011-04-01141
Total of all active and inactive participants2011-04-01141
Total participants2011-04-01141
2010: BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year2010-04-01126
Total number of active participants reported on line 7a of the Form 55002010-04-01127
Total of all active and inactive participants2010-04-01127
Total participants2010-04-01127
2009: BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-04-01126
Total number of active participants reported on line 7a of the Form 55002009-04-01126
Total of all active and inactive participants2009-04-01126
Total participants2009-04-01126
2008: BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN 2008 401k membership
Total participants, beginning-of-year2008-04-01101
Total number of active participants reported on line 7a of the Form 55002008-04-01126
Total of all active and inactive participants2008-04-01126
Total participants2008-04-01126
2007: BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN 2007 401k membership
Total participants, beginning-of-year2007-04-01101
Total number of active participants reported on line 7a of the Form 55002007-04-01101
Total of all active and inactive participants2007-04-01101
Total participants2007-04-01101

Form 5500 Responses for BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN

2017: BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01This submission is the final filingYes
2017-04-01This return/report is a short plan year return/report (less than 12 months)Yes
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan benefit arrangement – InsuranceYes
2016: BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan benefit arrangement – InsuranceYes
2015: BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN 2015 form 5500 responses
2015-04-01Type of plan entitySingle employer plan
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan benefit arrangement – InsuranceYes
2014: BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN 2014 form 5500 responses
2014-04-01Type of plan entitySingle employer plan
2014-04-01Plan funding arrangement – InsuranceYes
2014-04-01Plan benefit arrangement – InsuranceYes
2013: BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN 2013 form 5500 responses
2013-04-01Type of plan entitySingle employer plan
2013-04-01Plan funding arrangement – InsuranceYes
2013-04-01Plan benefit arrangement – InsuranceYes
2012: BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN 2012 form 5500 responses
2012-04-01Type of plan entitySingle employer plan
2012-04-01Plan funding arrangement – InsuranceYes
2012-04-01Plan benefit arrangement – InsuranceYes
2011: BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN 2011 form 5500 responses
2011-04-01Type of plan entitySingle employer plan
2011-04-01Submission has been amendedNo
2011-04-01This submission is the final filingNo
2011-04-01This return/report is a short plan year return/report (less than 12 months)No
2011-04-01Plan is a collectively bargained planNo
2011-04-01Plan funding arrangement – InsuranceYes
2011-04-01Plan benefit arrangement – InsuranceYes
2010: BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN 2010 form 5500 responses
2010-04-01Type of plan entitySingle employer plan
2010-04-01Submission has been amendedNo
2010-04-01This submission is the final filingNo
2010-04-01This return/report is a short plan year return/report (less than 12 months)No
2010-04-01Plan is a collectively bargained planNo
2010-04-01Plan funding arrangement – InsuranceYes
2010-04-01Plan benefit arrangement – InsuranceYes
2009: BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN 2009 form 5500 responses
2009-04-01Type of plan entitySingle employer plan
2009-04-01Submission has been amendedNo
2009-04-01This submission is the final filingNo
2009-04-01This return/report is a short plan year return/report (less than 12 months)No
2009-04-01Plan is a collectively bargained planNo
2009-04-01Plan funding arrangement – InsuranceYes
2009-04-01Plan benefit arrangement – InsuranceYes
2008: BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN 2008 form 5500 responses
2008-04-01Type of plan entitySingle employer plan
2008-04-01Submission has been amendedNo
2008-04-01This submission is the final filingNo
2008-04-01This return/report is a short plan year return/report (less than 12 months)No
2008-04-01Plan is a collectively bargained planNo
2008-04-01Plan funding arrangement – InsuranceYes
2008-04-01Plan benefit arrangement – InsuranceYes
2007: BRODSTONE MEMORIAL HOSPITAL LIFE INSURANCE PLAN 2007 form 5500 responses
2007-04-01Type of plan entitySingle employer plan
2007-04-01First time form 5500 has been submittedYes
2007-04-01Submission has been amendedNo
2007-04-01This submission is the final filingNo
2007-04-01This return/report is a short plan year return/report (less than 12 months)No
2007-04-01Plan is a collectively bargained planNo
2007-04-01Plan funding arrangement – InsuranceYes
2007-04-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number113142
Policy instance 1
Insurance contract or identification number113142
Number of Individuals Covered171
Insurance policy start date2017-04-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,931
Total amount of fees paid to insurance companyUSD $302
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $24,136
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,931
Insurance broker organization code?3
Amount paid for insurance broker fees302
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker nameTIM OLSON, INC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number113142
Policy instance 1
Insurance contract or identification number113142
Number of Individuals Covered132
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $859
Total amount of fees paid to insurance companyUSD $134
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $10,731
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $859
Amount paid for insurance broker fees134
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameTIM OLSON, INC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number113142
Policy instance 1
Insurance contract or identification number113142
Number of Individuals Covered133
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $454
Total amount of fees paid to insurance companyUSD $71
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $5,670
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $454
Amount paid for insurance broker fees71
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameTIM OLSON, INC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number113142
Policy instance 1
Insurance contract or identification number113142
Number of Individuals Covered125
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $428
Total amount of fees paid to insurance companyUSD $67
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $5,350
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $428
Amount paid for insurance broker fees67
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameTIM OLSON, INC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number113142
Policy instance 1
Insurance contract or identification number113142
Number of Individuals Covered135
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $469
Total amount of fees paid to insurance companyUSD $73
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $5,859
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $469
Amount paid for insurance broker fees73
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameTIM OLSON, INC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number113142
Policy instance 1
Insurance contract or identification number113142
Number of Individuals Covered141
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $458
Total amount of fees paid to insurance companyUSD $61
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number113142
Policy instance 1
Insurance contract or identification number113142
Number of Individuals Covered127
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $428
Total amount of fees paid to insurance companyUSD $44
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,351
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number113142
Policy instance 1
Insurance contract or identification number113142
Number of Individuals Covered126
Insurance policy start date2008-04-01
Insurance policy end date2009-03-31
Total amount of commissions paid to insurance brokerUSD $439
Total amount of fees paid to insurance companyUSD $41
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,488
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number113142
Policy instance 1
Insurance contract or identification number113142
Number of Individuals Covered101
Insurance policy start date2007-04-01
Insurance policy end date2008-03-31
Total amount of commissions paid to insurance brokerUSD $336
Total amount of fees paid to insurance companyUSD $39
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,200
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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