401k Plan data: UVA COMMUNITY HEALTH, INC EMPLOYEE BENEFIT PLAN plan

UVA COMMUNITY HEALTH, INC EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	UVA COMMUNITY HEALTH, INC EMPLOYEE BENEFIT PLAN
Plan identification number	501

UVA COMMUNITY HEALTH, INC EMPLOYEE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

NOVANT HEALTH UVA HEALTH SYSTEM has sponsored the creation of one or more 401k plans.

Company Name: NOVANT HEALTH UVA HEALTH SYSTEM

Employer identification number (EIN): 810868533

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UVA COMMUNITY HEALTH, INC EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 DIANNA CRAWFORD 2023-10-11

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	DIANNA CRAWFORD	2023-10-11

Plan Statistics for UVA COMMUNITY HEALTH, INC EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for UVA COMMUNITY HEALTH, INC EMPLOYEE BENEFIT PLAN

Measure Date Value
2022: UVA COMMUNITY HEALTH, INC EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 2,038
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 2,168
Number of retired or separated participants receiving benefits 2022-01-01 15
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 2,183
Number of employers contributing to the scheme 2022-01-01 0

Measure	Date	Value
2022: UVA COMMUNITY HEALTH, INC EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	2,038
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	2,168
Number of retired or separated participants receiving benefits	2022-01-01	15
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	2,183
Number of employers contributing to the scheme	2022-01-01	0

Form 5500 Responses for UVA COMMUNITY HEALTH, INC EMPLOYEE BENEFIT PLAN

2022: UVA COMMUNITY HEALTH, INC EMPLOYEE BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	First time form 5500 has been submitted	Yes
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26298 )

Policy contract number

9905034

Policy instance

Insurance contract or identification number	9905034
Number of Individuals Covered	239
Insurance policy start date	2022-01-01
Insurance policy end date	2022-07-31
Total amount of commissions paid to insurance broker	USD $3,466
Total amount of fees paid to insurance company	USD $362
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $40,200
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,287
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION

METROPOLITAN GENERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 39950 )

Policy contract number

9905034

Policy instance

Insurance contract or identification number	9905034
Number of Individuals Covered	238
Insurance policy start date	2022-08-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,880
Total amount of fees paid to insurance company	USD $142
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $22,800
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,880
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION

DELTA DENTAL OF VIRGINIA (National Association of Insurance Commissioners NAIC id number: 55611 )

Policy contract number

694

Policy instance

Insurance contract or identification number	694
Number of Individuals Covered	3244
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

EAP

Policy instance

Insurance contract or identification number	EAP
Number of Individuals Covered	2654
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $81,101
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

476430

Policy instance

Insurance contract or identification number	476430
Number of Individuals Covered	2080
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $152,036
Total amount of fees paid to insurance company	USD $40,137
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, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $1,605,463
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $152,036
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )

Policy contract number

476429

Policy instance

Insurance contract or identification number	476429
Number of Individuals Covered	622
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $185,469
Total amount of fees paid to insurance company	USD $16,531
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,HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $364,802
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $185,469
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION

STRYDEN (National Association of Insurance Commissioners NAIC id number: 16606 )

Policy contract number

694

Policy instance

Insurance contract or identification number	694
Number of Individuals Covered	2766
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $204,218
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	NOVANT HEALTH UVA HEALTH SYSTEM
Employer identification number (EIN):	810868533
NAIC Classification:	622000
NAIC Description:	Hospitals