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BON SECOURS MERCY HEALTH WELFARE BENEFITS PLAN 401k Plan overview

Plan NameBON SECOURS MERCY HEALTH WELFARE BENEFITS PLAN
Plan identification number 520

BON SECOURS MERCY HEALTH WELFARE BENEFITS PLAN Benefits

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

401k Sponsoring company profile

BON SECOURS MERCY HEALTH, INC. has sponsored the creation of one or more 401k plans.

Company Name:BON SECOURS MERCY HEALTH, INC.
Employer identification number (EIN):521301088
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BON SECOURS MERCY HEALTH WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5202022-01-01NICOLE MARTEL2023-10-09
5202021-01-01NICOLE MARTEL2022-10-12
5202020-01-01NICOLE MARTEL2021-10-15 NICOLE MARTEL2021-10-15

Plan Statistics for BON SECOURS MERCY HEALTH WELFARE BENEFITS PLAN

401k plan membership statisitcs for BON SECOURS MERCY HEALTH WELFARE BENEFITS PLAN

Measure Date Value
2022: BON SECOURS MERCY HEALTH WELFARE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0144,927
Total number of active participants reported on line 7a of the Form 55002022-01-0144,266
Number of retired or separated participants receiving benefits2022-01-012,137
Total of all active and inactive participants2022-01-0146,403
Total participants2022-01-010
2021: BON SECOURS MERCY HEALTH WELFARE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0145,921
Total number of active participants reported on line 7a of the Form 55002021-01-0142,760
Number of retired or separated participants receiving benefits2021-01-012,167
Total of all active and inactive participants2021-01-0144,927
Total participants2021-01-010
2020: BON SECOURS MERCY HEALTH WELFARE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0145,907
Total number of active participants reported on line 7a of the Form 55002020-01-0143,665
Number of retired or separated participants receiving benefits2020-01-012,497
Total of all active and inactive participants2020-01-0146,162
Total participants2020-01-0146,162

Form 5500 Responses for BON SECOURS MERCY HEALTH WELFARE BENEFITS PLAN

2022: BON SECOURS MERCY HEALTH WELFARE BENEFITS PLAN 2022 form 5500 responses
2022-01-01Type of plan entityMulitple 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: BON SECOURS MERCY HEALTH WELFARE BENEFITS PLAN 2021 form 5500 responses
2021-01-01Type of plan entityMulitple 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: BON SECOURS MERCY HEALTH WELFARE BENEFITS PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01First time form 5500 has been submittedYes
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

Insurance Providers Used on plan

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract number212096
Policy instance 4
Insurance contract or identification number212096
Number of Individuals Covered32435
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,144
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10233621001
Policy instance 3
Insurance contract or identification number10233621001
Number of Individuals Covered423
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,530
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $37,361
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,530
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10233611001
Policy instance 2
Insurance contract or identification number10233611001
Number of Individuals Covered58508
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $197,609
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,952,175
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $197,609
Insurance broker organization code?3
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-350992
Policy instance 1
Insurance contract or identification number010-350992
Number of Individuals Covered69876
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,088,649
Dental Insurance Welfare BenefitYes
Other welfare benefits providedHEARING
Welfare Benefit Premiums Paid to CarrierUSD $21,772,983
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,088,649
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number
Policy instance 4
Number of Individuals Covered51856
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D; NY DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $17,865,464
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10233621001
Policy instance 3
Insurance contract or identification number10233621001
Number of Individuals Covered540
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $2,367
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $34,274
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,410
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10233611001
Policy instance 2
Insurance contract or identification number10233611001
Number of Individuals Covered59444
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $249,837
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,156,969
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $153,406
Insurance broker organization code?3
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-350992
Policy instance 1
Insurance contract or identification number010-350992
Number of Individuals Covered69748
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,049,105
Dental Insurance Welfare BenefitYes
Other welfare benefits providedHEARING
Welfare Benefit Premiums Paid to CarrierUSD $20,982,105
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,049,105
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number
Policy instance 4
Number of Individuals Covered44450
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D; NY DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $19,640,404
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10233621001
Policy instance 3
Insurance contract or identification number10233621001
Number of Individuals Covered528
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $700
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,070
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $700
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10233611001
Policy instance 2
Insurance contract or identification number10233611001
Number of Individuals Covered65467
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $118,909
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,690,938
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $118,909
Insurance broker organization code?3
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-350992
Policy instance 1
Insurance contract or identification number010-350992
Number of Individuals Covered75743
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,040,255
Dental Insurance Welfare BenefitYes
Other welfare benefits providedHEARING
Welfare Benefit Premiums Paid to CarrierUSD $20,805,089
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,040,255
Insurance broker organization code?3

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