401k Plan data: MARTHA JEFFERSON HOSPITAL GROUP LONG TERM DISABILITY PLAN plan

MARTHA JEFFERSON HOSPITAL GROUP LONG TERM DISABILITY PLAN 401k Plan overview

Plan Name	MARTHA JEFFERSON HOSPITAL GROUP LONG TERM DISABILITY PLAN
Plan identification number	501

MARTHA JEFFERSON HOSPITAL GROUP LONG TERM DISABILITY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Long-term disability cover

401k Sponsoring company profile

MARTHA JEFFERSON HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name: MARTHA JEFFERSON HOSPITAL

Employer identification number (EIN): 540261840

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about MARTHA JEFFERSON HOSPITAL

Jurisdiction of Incorporation: Virginia Secretary of State

Incorporation Date: 1929-12-16

Company Identification Number: 0035022

Legal Registered Office Address: MARTHA JEFFERSON HOSPITAL

CHARLOTTESVILLE
United States of America (USA)
22911

More information about MARTHA JEFFERSON HOSPITAL

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MARTHA JEFFERSON HOSPITAL GROUP LONG TERM DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2012-01-01 SUSAN CABELL MAINS
501 2011-01-01 SUSAN CABELL MAINS
501 2010-01-01 SUSAN CABELL MAINS
501 2009-01-01 SUSAN CABELL MAINS

Plan id#	Filing Submission Date	Name of Administrator
501	2012-01-01	SUSAN CABELL MAINS
501	2011-01-01	SUSAN CABELL MAINS
501	2010-01-01	SUSAN CABELL MAINS
501	2009-01-01	SUSAN CABELL MAINS

Plan Statistics for MARTHA JEFFERSON HOSPITAL GROUP LONG TERM DISABILITY PLAN

401k plan membership statisitcs for MARTHA JEFFERSON HOSPITAL GROUP LONG TERM DISABILITY PLAN

Measure Date Value
2012: MARTHA JEFFERSON HOSPITAL GROUP LONG TERM DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1,456
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1,536
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 1,536
2011: MARTHA JEFFERSON HOSPITAL GROUP LONG TERM DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,420
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1,456
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 1,456
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
2010: MARTHA JEFFERSON HOSPITAL GROUP LONG TERM DISABILITY PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 1,456
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 1,420
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 1,420
2009: MARTHA JEFFERSON HOSPITAL GROUP LONG TERM DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1,336
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1,437
Number of retired or separated participants receiving benefits 2009-01-01 19
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 1,456

Measure	Date	Value
2012: MARTHA JEFFERSON HOSPITAL GROUP LONG TERM DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1,456
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1,536
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	1,536
2011: MARTHA JEFFERSON HOSPITAL GROUP LONG TERM DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,420
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1,456
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	1,456
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
2010: MARTHA JEFFERSON HOSPITAL GROUP LONG TERM DISABILITY PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	1,456
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	1,420
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	1,420
2009: MARTHA JEFFERSON HOSPITAL GROUP LONG TERM DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,336
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,437
Number of retired or separated participants receiving benefits	2009-01-01	19
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	1,456

Form 5500 Responses for MARTHA JEFFERSON HOSPITAL GROUP LONG TERM DISABILITY PLAN

2012: MARTHA JEFFERSON HOSPITAL GROUP LONG TERM DISABILITY PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	Yes
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: MARTHA JEFFERSON HOSPITAL GROUP LONG TERM DISABILITY PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: MARTHA JEFFERSON HOSPITAL GROUP LONG TERM DISABILITY PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	Yes
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: MARTHA JEFFERSON HOSPITAL GROUP LONG TERM DISABILITY PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLK980034

Policy instance

Insurance contract or identification number	FLK980034
Number of Individuals Covered	1546
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,647
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $232,364
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,647
Insurance broker organization code?	3
Insurance broker name	SUMMIT GROUP OF VIRGINIA

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010133340

Policy instance

Insurance contract or identification number	000010133340
Number of Individuals Covered	1459
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $19,531
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $340,395
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

64196-1

Policy instance

Insurance contract or identification number	64196-1
Number of Individuals Covered	1433
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $19,973
Total amount of fees paid to insurance company	USD $5,808
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $363,029
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,973
Amount paid for insurance broker fees	5808
Additional information about fees paid to insurance broker	OVERWRITE
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

Potentially related plans

MARTHA JEFFERSON MEDICAL ENTERPRISES, INC. 401(K) RETIREMENT PLAN [EIN = 541841528]

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Company Name:	MARTHA JEFFERSON HOSPITAL
Employer identification number (EIN):	540261840
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	Virginia Secretary of State
Incorporation Date:	1929-12-16
Company Identification Number:	0035022
Legal Registered Office Address:	MARTHA JEFFERSON HOSPITAL CHARLOTTESVILLE United States of America (USA) 22911