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LEXINGTON HEALTH INC. (DBA LEXINGTON MEDICAL CENTER) HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameLEXINGTON HEALTH INC. (DBA LEXINGTON MEDICAL CENTER) HEALTH AND WELFARE PLAN
Plan identification number 501

LEXINGTON HEALTH INC. (DBA LEXINGTON MEDICAL CENTER) HEALTH AND WELFARE PLAN Benefits

401k Plan TypeWelfare 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)
  • Other welfare benefit cover

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LEXINGTON HEALTH INC. (DBA LEXINGTON MEDICAL CENTER) HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01BRIAN D. SMITH2023-07-26
5012021-01-24BRIAN D. SMITH2022-07-18

Plan Statistics for LEXINGTON HEALTH INC. (DBA LEXINGTON MEDICAL CENTER) HEALTH AND WELFARE PLAN

401k plan membership statisitcs for LEXINGTON HEALTH INC. (DBA LEXINGTON MEDICAL CENTER) HEALTH AND WELFARE PLAN

Measure Date Value
2022: LEXINGTON HEALTH INC. (DBA LEXINGTON MEDICAL CENTER) HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-011,740
Total number of active participants reported on line 7a of the Form 55002022-01-011,806
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-011,806
Number of employers contributing to the scheme2022-01-010
2021: LEXINGTON HEALTH INC. (DBA LEXINGTON MEDICAL CENTER) HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-24898
Total number of active participants reported on line 7a of the Form 55002021-01-241,686
Number of retired or separated participants receiving benefits2021-01-2440
Number of other retired or separated participants entitled to future benefits2021-01-2414
Total of all active and inactive participants2021-01-241,740
Number of employers contributing to the scheme2021-01-240

Form 5500 Responses for LEXINGTON HEALTH INC. (DBA LEXINGTON MEDICAL CENTER) HEALTH AND WELFARE PLAN

2022: LEXINGTON HEALTH INC. (DBA LEXINGTON MEDICAL CENTER) HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: LEXINGTON HEALTH INC. (DBA LEXINGTON MEDICAL CENTER) HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-01-24Type of plan entitySingle employer plan
2021-01-24First time form 5500 has been submittedYes
2021-01-24This return/report is a short plan year return/report (less than 12 months)Yes
2021-01-24Plan funding arrangement – InsuranceYes
2021-01-24Plan funding arrangement – General assets of the sponsorYes
2021-01-24Plan benefit arrangement – InsuranceYes
2021-01-24Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number626
Policy instance 1
Insurance contract or identification number626
Number of Individuals Covered3026
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $33,351
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $333,510
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $33,351
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4705976
Policy instance 2
Insurance contract or identification numberE4705976
Number of Individuals Covered970
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $88,898
Total amount of fees paid to insurance companyUSD $15,112
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $686,179
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $50,001
Amount paid for insurance broker fees1199
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
FIRST SUN EAP ALLIANCE, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number566
Policy instance 3
Insurance contract or identification number566
Number of Individuals Covered1806
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $126,322
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 number851943
Policy instance 4
Insurance contract or identification number851943
Number of Individuals Covered2686
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $18,367
Total amount of fees paid to insurance companyUSD $10,377
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $830,172
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,367
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number626
Policy instance 1
Insurance contract or identification number626
Number of Individuals Covered1769
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $17,240
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $172,402
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $17,240
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4705976
Policy instance 2
Insurance contract or identification numberE4705976
Number of Individuals Covered1061
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $94,929
Total amount of fees paid to insurance companyUSD $20,006
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $683,157
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $53,812
Amount paid for insurance broker fees2468
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
FIRST SUN EAP ALLIANCE, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number566
Policy instance 3
Insurance contract or identification number566
Number of Individuals Covered4690
Insurance policy start date2021-01-24
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $132,720
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 number851943
Policy instance 4
Insurance contract or identification number851943
Number of Individuals Covered1644
Insurance policy start date2021-01-24
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $10,981
Total amount of fees paid to insurance companyUSD $12,665
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $506,590
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees12665
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3

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