401k Plan data: THIBODAUX REGIONAL HEALTH SYSTEM EMPLOYEE BENEFIT PLAN plan

THIBODAUX REGIONAL HEALTH SYSTEM EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	THIBODAUX REGIONAL HEALTH SYSTEM EMPLOYEE BENEFIT PLAN
Plan identification number	501

THIBODAUX REGIONAL HEALTH SYSTEM 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) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

THIBODAUX REGIONAL HEALTH SYSTEM has sponsored the creation of one or more 401k plans.

Company Name: THIBODAUX REGIONAL HEALTH SYSTEM

Employer identification number (EIN): 842046902

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THIBODAUX REGIONAL HEALTH SYSTEM 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 CASEY PELTIER 2023-07-24
501 2021-01-01 CASEY PELTIER 2022-07-24
501 2020-01-01 CASEY PELTIER 2021-10-15
501 2020-01-01 CASEY PELTIER 2022-07-24
501 2019-10-01 CASEY PELTIER 2020-10-09

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-01-01	CASEY PELTIER	2023-07-24
501	2021-01-01	CASEY PELTIER	2022-07-24
501	2020-01-01	CASEY PELTIER	2021-10-15
501	2020-01-01	CASEY PELTIER	2022-07-24
501	2019-10-01	CASEY PELTIER	2020-10-09

Plan Statistics for THIBODAUX REGIONAL HEALTH SYSTEM EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for THIBODAUX REGIONAL HEALTH SYSTEM EMPLOYEE BENEFIT PLAN

Measure Date Value
2022: THIBODAUX REGIONAL HEALTH SYSTEM EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 1,092
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 1,062
Number of retired or separated participants receiving benefits 2022-01-01 6
Number of other retired or separated participants entitled to future benefits 2022-01-01 30
Total of all active and inactive participants 2022-01-01 1,098
Number of employers contributing to the scheme 2022-01-01 0
2021: THIBODAUX REGIONAL HEALTH SYSTEM EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 1,026
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 1,080
Number of retired or separated participants receiving benefits 2021-01-01 9
Number of other retired or separated participants entitled to future benefits 2021-01-01 12
Total of all active and inactive participants 2021-01-01 1,101
Number of employers contributing to the scheme 2021-01-01 0
2020: THIBODAUX REGIONAL HEALTH SYSTEM EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 979
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 1,022
Number of retired or separated participants receiving benefits 2020-01-01 9
Number of other retired or separated participants entitled to future benefits 2020-01-01 22
Total of all active and inactive participants 2020-01-01 1,053
Number of employers contributing to the scheme 2020-01-01 0
2019: THIBODAUX REGIONAL HEALTH SYSTEM EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-10-01 990
Total number of active participants reported on line 7a of the Form 5500 2019-10-01 978
Number of retired or separated participants receiving benefits 2019-10-01 9
Number of other retired or separated participants entitled to future benefits 2019-10-01 0
Total of all active and inactive participants 2019-10-01 987

Measure	Date	Value
2022: THIBODAUX REGIONAL HEALTH SYSTEM EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	1,092
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	1,062
Number of retired or separated participants receiving benefits	2022-01-01	6
Number of other retired or separated participants entitled to future benefits	2022-01-01	30
Total of all active and inactive participants	2022-01-01	1,098
Number of employers contributing to the scheme	2022-01-01	0
2021: THIBODAUX REGIONAL HEALTH SYSTEM EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	1,026
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	1,080
Number of retired or separated participants receiving benefits	2021-01-01	9
Number of other retired or separated participants entitled to future benefits	2021-01-01	12
Total of all active and inactive participants	2021-01-01	1,101
Number of employers contributing to the scheme	2021-01-01	0
2020: THIBODAUX REGIONAL HEALTH SYSTEM EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	979
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	1,022
Number of retired or separated participants receiving benefits	2020-01-01	9
Number of other retired or separated participants entitled to future benefits	2020-01-01	22
Total of all active and inactive participants	2020-01-01	1,053
Number of employers contributing to the scheme	2020-01-01	0
2019: THIBODAUX REGIONAL HEALTH SYSTEM EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-10-01	990
Total number of active participants reported on line 7a of the Form 5500	2019-10-01	978
Number of retired or separated participants receiving benefits	2019-10-01	9
Number of other retired or separated participants entitled to future benefits	2019-10-01	0
Total of all active and inactive participants	2019-10-01	987

Form 5500 Responses for THIBODAUX REGIONAL HEALTH SYSTEM EMPLOYEE BENEFIT PLAN

2022: THIBODAUX REGIONAL HEALTH SYSTEM EMPLOYEE BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
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
2021: THIBODAUX REGIONAL HEALTH SYSTEM EMPLOYEE BENEFIT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: THIBODAUX REGIONAL HEALTH SYSTEM EMPLOYEE BENEFIT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: THIBODAUX REGIONAL HEALTH SYSTEM EMPLOYEE BENEFIT PLAN 2019 form 5500 responses
2019-10-01	Type of plan entity	Single employer plan
2019-10-01	First time form 5500 has been submitted	Yes
2019-10-01	Submission has been amended	No
2019-10-01	This submission is the final filing	No
2019-10-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2019-10-01	Plan is a collectively bargained plan	No
2019-10-01	Plan funding arrangement – Insurance	Yes
2019-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-10-01	Plan benefit arrangement – Insurance	Yes
2019-10-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

760762

Policy instance

Insurance contract or identification number	760762
Number of Individuals Covered	328
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $132,069
Total amount of fees paid to insurance company	USD $8,155
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $212,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $132,069
Amount paid for insurance broker fees	8155
Additional information about fees paid to insurance broker	CONTINGENT COMPENSATION
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

760762

Policy instance

Insurance contract or identification number	760762
Number of Individuals Covered	1052
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $108,908
Total amount of fees paid to insurance company	USD $48,707
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $108,908
Amount paid for insurance broker fees	48707
Additional information about fees paid to insurance broker	CONTINGENT COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

211226

Policy instance

Insurance contract or identification number	211226
Number of Individuals Covered	1802
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $80,897
Total amount of fees paid to insurance company	USD $19,409
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $944,692
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $66,384
Amount paid for insurance broker fees	16894
Additional information about fees paid to insurance broker	NON-MONETARY/ SUPPLEMENTAL COMPENSATION, MARKETING FEES
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30055256

Policy instance

Insurance contract or identification number	30055256
Number of Individuals Covered	610
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $8,178
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $89,381
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,187
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

211226

Policy instance

Insurance contract or identification number	211226
Number of Individuals Covered	1710
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $82,844
Total amount of fees paid to insurance company	USD $12,408
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $897,324
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $82,844
Amount paid for insurance broker fees	12408
Additional information about fees paid to insurance broker	NON-MONTARY COMPENSATION SUPPLEMENTAL COMPENSATION MARKETING FEES
Insurance broker organization code?	3

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

Policy contract number

211226

Policy instance

Insurance contract or identification number	211226
Number of Individuals Covered	1609
Insurance policy start date	2019-10-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $30,397
Total amount of fees paid to insurance company	USD $71
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	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH & 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 $211,736
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $30,397
Amount paid for insurance broker fees	71
Additional information about fees paid to insurance broker	ADMINISTRATION FEES NON-MONETARY FEES
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30055256

Policy instance

Insurance contract or identification number	30055256
Number of Individuals Covered	521
Insurance policy start date	2019-10-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $663
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	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
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 $19,937
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $663
Insurance broker organization code?	3

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Company Name:	THIBODAUX REGIONAL HEALTH SYSTEM
Employer identification number (EIN):	842046902
NAIC Classification:	622000
NAIC Description:	Hospitals