401k Plan data: MERCY COMMUNITY HEALTHCARE LIFE & DISABILITY PLAN plan

MERCY COMMUNITY HEALTHCARE LIFE & DISABILITY PLAN 401k Plan overview

Plan Name	MERCY COMMUNITY HEALTHCARE LIFE & DISABILITY PLAN
Plan identification number	501

MERCY COMMUNITY HEALTHCARE LIFE & DISABILITY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

MERCY COMMUNITY HEALTHCARE has sponsored the creation of one or more 401k plans.

Company Name: MERCY COMMUNITY HEALTHCARE

Employer identification number (EIN): 621781969

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about MERCY COMMUNITY HEALTHCARE

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 1991-03-25

Company Identification Number: S40151

Legal Registered Office Address: 2524 N SR 7

HOLLYWOOD

33021

More information about MERCY COMMUNITY HEALTHCARE

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MERCY COMMUNITY HEALTHCARE LIFE & DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-04-01 CINDY SILER 2024-01-12
501 2021-04-01 CINDY SILER 2022-10-19
501 2020-04-01 CINDY SILER 2022-01-13
501 2019-04-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-04-01	CINDY SILER	2024-01-12
501	2021-04-01	CINDY SILER	2022-10-19
501	2020-04-01	CINDY SILER	2022-01-13
501	2019-04-01

Plan Statistics for MERCY COMMUNITY HEALTHCARE LIFE & DISABILITY PLAN

401k plan membership statisitcs for MERCY COMMUNITY HEALTHCARE LIFE & DISABILITY PLAN

Measure Date Value
2022: MERCY COMMUNITY HEALTHCARE LIFE & DISABILITY PLAN 2022 401k membership
Total participants, beginning-of-year 2022-04-01 137
Total number of active participants reported on line 7a of the Form 5500 2022-04-01 141
Number of other retired or separated participants entitled to future benefits 2022-04-01 0
Total of all active and inactive participants 2022-04-01 141
Total participants 2022-04-01 141
2021: MERCY COMMUNITY HEALTHCARE LIFE & DISABILITY PLAN 2021 401k membership
Total participants, beginning-of-year 2021-04-01 109
Total number of active participants reported on line 7a of the Form 5500 2021-04-01 132
Number of retired or separated participants receiving benefits 2021-04-01 0
Number of other retired or separated participants entitled to future benefits 2021-04-01 0
Total of all active and inactive participants 2021-04-01 132
Number of employers contributing to the scheme 2021-04-01 0
2020: MERCY COMMUNITY HEALTHCARE LIFE & DISABILITY PLAN 2020 401k membership
Total participants, beginning-of-year 2020-04-01 121
Total number of active participants reported on line 7a of the Form 5500 2020-04-01 109
Number of retired or separated participants receiving benefits 2020-04-01 0
Number of other retired or separated participants entitled to future benefits 2020-04-01 0
Total of all active and inactive participants 2020-04-01 109
Number of employers contributing to the scheme 2020-04-01 0
2019: MERCY COMMUNITY HEALTHCARE LIFE & DISABILITY PLAN 2019 401k membership
Total participants, beginning-of-year 2019-04-01 108
Total number of active participants reported on line 7a of the Form 5500 2019-04-01 118
Number of retired or separated participants receiving benefits 2019-04-01 0
Number of other retired or separated participants entitled to future benefits 2019-04-01 0
Total of all active and inactive participants 2019-04-01 118

Measure	Date	Value
2022: MERCY COMMUNITY HEALTHCARE LIFE & DISABILITY PLAN 2022 401k membership
Total participants, beginning-of-year	2022-04-01	137
Total number of active participants reported on line 7a of the Form 5500	2022-04-01	141
Number of other retired or separated participants entitled to future benefits	2022-04-01	0
Total of all active and inactive participants	2022-04-01	141
Total participants	2022-04-01	141
2021: MERCY COMMUNITY HEALTHCARE LIFE & DISABILITY PLAN 2021 401k membership
Total participants, beginning-of-year	2021-04-01	109
Total number of active participants reported on line 7a of the Form 5500	2021-04-01	132
Number of retired or separated participants receiving benefits	2021-04-01	0
Number of other retired or separated participants entitled to future benefits	2021-04-01	0
Total of all active and inactive participants	2021-04-01	132
Number of employers contributing to the scheme	2021-04-01	0
2020: MERCY COMMUNITY HEALTHCARE LIFE & DISABILITY PLAN 2020 401k membership
Total participants, beginning-of-year	2020-04-01	121
Total number of active participants reported on line 7a of the Form 5500	2020-04-01	109
Number of retired or separated participants receiving benefits	2020-04-01	0
Number of other retired or separated participants entitled to future benefits	2020-04-01	0
Total of all active and inactive participants	2020-04-01	109
Number of employers contributing to the scheme	2020-04-01	0
2019: MERCY COMMUNITY HEALTHCARE LIFE & DISABILITY PLAN 2019 401k membership
Total participants, beginning-of-year	2019-04-01	108
Total number of active participants reported on line 7a of the Form 5500	2019-04-01	118
Number of retired or separated participants receiving benefits	2019-04-01	0
Number of other retired or separated participants entitled to future benefits	2019-04-01	0
Total of all active and inactive participants	2019-04-01	118

Form 5500 Responses for MERCY COMMUNITY HEALTHCARE LIFE & DISABILITY PLAN

2022: MERCY COMMUNITY HEALTHCARE LIFE & DISABILITY PLAN 2022 form 5500 responses
2022-04-01	Type of plan entity	Single employer plan
2022-04-01	Submission has been amended	Yes
2022-04-01	This submission is the final filing	No
2022-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-04-01	Plan is a collectively bargained plan	No
2022-04-01	Plan funding arrangement – Insurance	Yes
2022-04-01	Plan benefit arrangement – Insurance	Yes
2021: MERCY COMMUNITY HEALTHCARE LIFE & DISABILITY PLAN 2021 form 5500 responses
2021-04-01	Type of plan entity	Single employer plan
2021-04-01	Plan funding arrangement – Insurance	Yes
2021-04-01	Plan benefit arrangement – Insurance	Yes
2020: MERCY COMMUNITY HEALTHCARE LIFE & DISABILITY PLAN 2020 form 5500 responses
2020-04-01	Type of plan entity	Single employer plan
2020-04-01	Plan funding arrangement – Insurance	Yes
2020-04-01	Plan benefit arrangement – Insurance	Yes
2019: MERCY COMMUNITY HEALTHCARE LIFE & DISABILITY PLAN 2019 form 5500 responses
2019-04-01	Type of plan entity	Single employer plan
2019-04-01	First time form 5500 has been submitted	Yes
2019-04-01	Submission has been amended	No
2019-04-01	This submission is the final filing	No
2019-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-04-01	Plan is a collectively bargained plan	No
2019-04-01	Plan funding arrangement – Insurance	Yes
2019-04-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000BQ78

Policy instance

Insurance contract or identification number	G000BQ78
Number of Individuals Covered	137
Insurance policy start date	2022-04-01
Insurance policy end date	2023-04-01
Total amount of commissions paid to insurance broker	USD $9,013
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
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 $78,959
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,818
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER OF RECORD
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BQ78

Policy instance

Insurance contract or identification number	GLUG0BQ78
Number of Individuals Covered	132
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $8,250
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $72,351
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,250
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

233672

Policy instance

Insurance contract or identification number	233672
Number of Individuals Covered	59
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $2,284
Total amount of fees paid to insurance company	USD $386
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	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENT,CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $14,786
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,284
Amount paid for insurance broker fees	142
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

573476

Policy instance

Insurance contract or identification number	573476
Number of Individuals Covered	35
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $7,951
Total amount of fees paid to insurance company	USD $217
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $10,683
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,932
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BQ78

Policy instance

Insurance contract or identification number	GLUG0BQ78
Number of Individuals Covered	109
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $8,246
Total amount of fees paid to insurance company	USD $3,977
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $72,271
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,997
Amount paid for insurance broker fees	2142
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1034392

Policy instance

Insurance contract or identification number	1034392
Number of Individuals Covered	165
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $10,293
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	CRITICAL ILLNESS AND ACCIDENT
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 $80,147
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,080
Insurance broker organization code?	3

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Company Name:	MERCY COMMUNITY HEALTHCARE
Employer identification number (EIN):	621781969
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	1991-03-25
Company Identification Number:	S40151
Legal Registered Office Address:	2524 N SR 7 HOLLYWOOD 33021