401k Plan data: DCH MANATI LTD plan

DCH MANATI LTD 401k Plan overview

Plan Name	DCH MANATI LTD
Plan identification number	504

DCH MANATI LTD Benefits

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

401k Sponsoring company profile

DOCTOR CENTER HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name: DOCTOR CENTER HOSPITAL

Employer identification number (EIN): 660665595

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DCH MANATI LTD

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2022-07-01
504 2021-07-01

Plan Statistics for DCH MANATI LTD

401k plan membership statisitcs for DCH MANATI LTD

Measure Date Value
2022: DCH MANATI LTD 2022 401k membership
Total participants, beginning-of-year 2022-07-01 1,121
Total number of active participants reported on line 7a of the Form 5500 2022-07-01 885
Total of all active and inactive participants 2022-07-01 885
Total participants 2022-07-01 885
2021: DCH MANATI LTD 2021 401k membership
Total participants, beginning-of-year 2021-07-01 1,364
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 1,121
Total of all active and inactive participants 2021-07-01 1,121
Total participants 2021-07-01 1,121

Measure	Date	Value
2022: DCH MANATI LTD 2022 401k membership
Total participants, beginning-of-year	2022-07-01	1,121
Total number of active participants reported on line 7a of the Form 5500	2022-07-01	885
Total of all active and inactive participants	2022-07-01	885
Total participants	2022-07-01	885
2021: DCH MANATI LTD 2021 401k membership
Total participants, beginning-of-year	2021-07-01	1,364
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	1,121
Total of all active and inactive participants	2021-07-01	1,121
Total participants	2021-07-01	1,121

Form 5500 Responses for DCH MANATI LTD

2022: DCH MANATI LTD 2022 form 5500 responses
2022-07-01	Type of plan entity	Single employer plan
2022-07-01	Submission has been amended	No
2022-07-01	This submission is the final filing	No
2022-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-07-01	Plan is a collectively bargained plan	No
2022-07-01	Plan funding arrangement – Insurance	Yes
2022-07-01	Plan benefit arrangement – Insurance	Yes
2021: DCH MANATI LTD 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Submission has been amended	No
2021-07-01	This submission is the final filing	No
2021-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-07-01	Plan is a collectively bargained plan	No
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

TRIPLE-S, VIDA, INC. (National Association of Insurance Commissioners NAIC id number: 73814 )

Policy contract number

LTDR2-2207003-2

Policy instance

Insurance contract or identification number	LTDR2-2207003-2
Number of Individuals Covered	885
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $12,256
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,256
Additional information about fees paid to insurance broker	BROKER
Insurance broker organization code?	3

MULTINATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 72087 )

Policy contract number

60-3044

Policy instance

Insurance contract or identification number	60-3044
Number of Individuals Covered	1121
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $13,432
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,432
Additional information about fees paid to insurance broker	BROKER
Insurance broker organization code?	3

Potentially related plans

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Company Name:	DOCTOR CENTER HOSPITAL
Employer identification number (EIN):	660665595
NAIC Classification:	622000
NAIC Description:	Hospitals