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EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 401k Plan overview

Plan NameEMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC.
Plan identification number 501

EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. Benefits

401k Plan TypeWelfare 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

401k Sponsoring company profile

COMMUNITY HEALTH GROUP has sponsored the creation of one or more 401k plans.

Company Name:COMMUNITY HEALTH GROUP
Employer identification number (EIN):953766170
NAIC Classification:524140

Additional information about COMMUNITY HEALTH GROUP

Jurisdiction of Incorporation: California Department of State
Incorporation Date: 1982-05-28
Company Identification Number: C1074270
Legal Registered Office Address: 2420 Fenton St Ste 100

Chula Vista
United States of America (USA)
91914-3516

More information about COMMUNITY HEALTH GROUP

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01NORMA DIAZ2021-10-15 SCOTT CARROLL2021-10-15
5012019-01-01NORMA DIAZ2020-10-20 SCOTT CARROLL2020-10-20
5012018-01-01NORMA DIAZ2020-09-14 SCOTT CARROLL2020-09-14
5012017-01-01NORMA DIAZ2020-09-14 SCOTT CARROLL2020-09-14
5012016-01-01SCOTT CARROLL
5012015-01-01SCOTT CARROLL
5012015-01-01SCOTT CARROLL
5012014-01-01NORMA DIAZ
5012013-01-01NORMA DIAZ
5012012-01-01NORMA DIAZ
5012011-01-01NORMA DIAZ
5012010-01-01NORMA DIAZ
5012009-01-01NORMA DIAZ

Plan Statistics for EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC.

401k plan membership statisitcs for EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC.

Measure Date Value
2022: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2022 401k membership
Total participants, beginning-of-year2022-01-01301
Total number of active participants reported on line 7a of the Form 55002022-01-01301
Total of all active and inactive participants2022-01-01301
2021: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2021 401k membership
Total participants, beginning-of-year2021-01-01289
Total number of active participants reported on line 7a of the Form 55002021-01-01301
Total of all active and inactive participants2021-01-01301
2020: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2020 401k membership
Total participants, beginning-of-year2020-01-01276
Total number of active participants reported on line 7a of the Form 55002020-01-01289
Total of all active and inactive participants2020-01-01289
2019: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2019 401k membership
Total participants, beginning-of-year2019-01-01289
Total number of active participants reported on line 7a of the Form 55002019-01-01282
Number of retired or separated participants receiving benefits2019-01-011
Total of all active and inactive participants2019-01-01283
2018: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2018 401k membership
Total participants, beginning-of-year2018-01-01288
Total number of active participants reported on line 7a of the Form 55002018-01-01289
Total of all active and inactive participants2018-01-01289
2017: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2017 401k membership
Total participants, beginning-of-year2017-01-01265
Total number of active participants reported on line 7a of the Form 55002017-01-01289
Total of all active and inactive participants2017-01-01289
2016: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2016 401k membership
Total participants, beginning-of-year2016-01-01218
Total number of active participants reported on line 7a of the Form 55002016-01-01270
Number of retired or separated participants receiving benefits2016-01-011
Total of all active and inactive participants2016-01-01271
2015: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2015 401k membership
Total participants, beginning-of-year2015-01-01175
Total number of active participants reported on line 7a of the Form 55002015-01-01217
Number of retired or separated participants receiving benefits2015-01-011
Total of all active and inactive participants2015-01-01218
2014: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2014 401k membership
Total participants, beginning-of-year2014-01-01157
Total number of active participants reported on line 7a of the Form 55002014-01-01211
Total of all active and inactive participants2014-01-01211
Total participants2014-01-010
2013: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2013 401k membership
Total participants, beginning-of-year2013-01-01134
Total number of active participants reported on line 7a of the Form 55002013-01-01157
Total of all active and inactive participants2013-01-01157
Total participants2013-01-010
2012: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2012 401k membership
Total participants, beginning-of-year2012-01-01125
Total number of active participants reported on line 7a of the Form 55002012-01-01134
Total of all active and inactive participants2012-01-01134
Total participants2012-01-010
2011: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2011 401k membership
Total participants, beginning-of-year2011-01-01114
Total number of active participants reported on line 7a of the Form 55002011-01-01125
Total of all active and inactive participants2011-01-01125
Total participants2011-01-01125
2010: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2010 401k membership
Total participants, beginning-of-year2010-01-01109
Total number of active participants reported on line 7a of the Form 55002010-01-01120
Total of all active and inactive participants2010-01-01120
Total participants2010-01-01120
2009: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2009 401k membership
Total participants, beginning-of-year2009-01-01107
Total number of active participants reported on line 7a of the Form 55002009-01-01109
Total of all active and inactive participants2009-01-01109
Total participants2009-01-01109

Financial Data on EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC.

Measure Date Value
2022 : EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2022 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$446,545
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$1,341,157
Total income from all sources (including contributions)2022-12-31$5,361,553
Total of all expenses incurred2022-12-31$5,238,287
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$4,639,562
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$4,675,132
Value of total assets at end of year2022-12-31$721,356
Value of total assets at beginning of year2022-12-31$1,492,702
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$598,725
Total interest from all sources2022-12-31$139
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$1,000,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$708,188
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$563,156
Other income not declared elsewhere2022-12-31$686,282
Administrative expenses (other) incurred2022-12-31$598,725
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$123,266
Value of net assets at end of year (total assets less liabilities)2022-12-31$274,811
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$151,545
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$721,356
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$929,546
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$929,546
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$139
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$1,543,756
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$3,966,944
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$3,095,806
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32022-12-31No
Liabilities. Value of benefit claims payable at end of year2022-12-31$446,545
Liabilities. Value of benefit claims payable at beginning of year2022-12-31$1,341,157
Did the plan have assets held for investment2022-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31DUFFY KRUSPODIN, LLP
Accountancy firm EIN2022-12-31954244393
2021 : EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2021 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$1,341,157
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$568,990
Total income from all sources (including contributions)2021-12-31$3,372,049
Total of all expenses incurred2021-12-31$3,611,240
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$3,039,146
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$4,022,742
Value of total assets at end of year2021-12-31$1,492,702
Value of total assets at beginning of year2021-12-31$959,726
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$572,094
Total interest from all sources2021-12-31$97
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$1,000,000
If this is an individual account plan, was there a blackout period2021-12-31No
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$725,897
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$563,156
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$32,804
Other income not declared elsewhere2021-12-31$-650,790
Administrative expenses (other) incurred2021-12-31$572,094
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$-239,191
Value of net assets at end of year (total assets less liabilities)2021-12-31$151,545
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$390,736
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-12-31$929,546
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-12-31$926,922
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-12-31$926,922
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-12-31$97
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$1,345,658
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$3,296,845
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$1,693,488
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32021-12-31No
Liabilities. Value of benefit claims payable at end of year2021-12-31$1,341,157
Liabilities. Value of benefit claims payable at beginning of year2021-12-31$568,990
Did the plan have assets held for investment2021-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31DUFFY KRUSPODIN, LLP
Accountancy firm EIN2021-12-31954244393
2020 : EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2020 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$568,990
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$299,000
Total income from all sources (including contributions)2020-12-31$4,064,178
Total of all expenses incurred2020-12-31$4,205,012
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$3,638,143
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$4,301,196
Value of total assets at end of year2020-12-31$959,726
Value of total assets at beginning of year2020-12-31$830,570
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$566,869
Total interest from all sources2020-12-31$168
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$1,000,000
If this is an individual account plan, was there a blackout period2020-12-31No
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$726,432
Participant contributions at end of year2020-12-31$0
Participant contributions at beginning of year2020-12-31$8,931
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$32,804
Other income not declared elsewhere2020-12-31$-237,186
Administrative expenses (other) incurred2020-12-31$566,869
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$-140,834
Value of net assets at end of year (total assets less liabilities)2020-12-31$390,736
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$531,570
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-12-31$926,922
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-12-31$821,639
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-12-31$821,639
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-12-31$168
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$1,304,513
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$3,574,764
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$2,333,630
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-12-31No
Liabilities. Value of benefit claims payable at end of year2020-12-31$568,990
Liabilities. Value of benefit claims payable at beginning of year2020-12-31$299,000
Did the plan have assets held for investment2020-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31JGD & ASSOCIATES LLP
Accountancy firm EIN2020-12-31953132551
2019 : EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$299,000
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$299,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$880,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$880,000
Total income from all sources (including contributions)2019-12-31$5,082,255
Total income from all sources (including contributions)2019-12-31$5,082,255
Total of all expenses incurred2019-12-31$4,541,278
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$4,253,415
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$4,253,415
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$4,500,873
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$4,500,873
Value of total assets at end of year2019-12-31$830,570
Value of total assets at end of year2019-12-31$830,570
Value of total assets at beginning of year2019-12-31$870,593
Value of total assets at beginning of year2019-12-31$870,593
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$287,863
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$287,863
Total interest from all sources2019-12-31$382
Total interest from all sources2019-12-31$382
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31Yes
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$1,000,000
Value of fidelity bond cover2019-12-31$1,000,000
If this is an individual account plan, was there a blackout period2019-12-31No
If this is an individual account plan, was there a blackout period2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$699,428
Contributions received from participants2019-12-31$699,428
Participant contributions at end of year2019-12-31$8,931
Participant contributions at end of year2019-12-31$8,931
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$178,767
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$178,767
Other income not declared elsewhere2019-12-31$581,000
Other income not declared elsewhere2019-12-31$581,000
Administrative expenses (other) incurred2019-12-31$287,863
Administrative expenses (other) incurred2019-12-31$287,863
Total non interest bearing cash at beginning of year2019-12-31$0
Total non interest bearing cash at beginning of year2019-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$540,977
Value of net income/loss2019-12-31$540,977
Value of net assets at end of year (total assets less liabilities)2019-12-31$531,570
Value of net assets at end of year (total assets less liabilities)2019-12-31$531,570
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$-9,407
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$-9,407
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-12-31$821,639
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-12-31$821,639
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-12-31$691,826
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-12-31$691,826
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-12-31$691,826
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-12-31$691,826
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-12-31$382
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-12-31$382
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$1,366,150
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$1,366,150
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$3,801,445
Contributions received in cash from employer2019-12-31$3,801,445
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$2,887,265
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$2,887,265
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-12-31No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-12-31No
Liabilities. Value of benefit claims payable at end of year2019-12-31$299,000
Liabilities. Value of benefit claims payable at end of year2019-12-31$299,000
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$880,000
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$880,000
Did the plan have assets held for investment2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Accountancy firm name2019-12-31JGD & ASSOCIATES LLP
Accountancy firm name2019-12-31JGD & ASSOCIATES LLP
Accountancy firm EIN2019-12-31953132551
Accountancy firm EIN2019-12-31953132551
2018 : EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$880,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$724,000
Total income from all sources (including contributions)2018-12-31$4,422,529
Total of all expenses incurred2018-12-31$4,066,197
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$3,920,897
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$4,422,376
Value of total assets at end of year2018-12-31$870,593
Value of total assets at beginning of year2018-12-31$358,261
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$145,300
Total interest from all sources2018-12-31$153
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$1,000,000
If this is an individual account plan, was there a blackout period2018-12-31No
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$298,973
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$178,767
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2018-12-31$253,109
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-12-31$178,767
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-12-31$279,784
Administrative expenses (other) incurred2018-12-31$145,300
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$356,332
Value of net assets at end of year (total assets less liabilities)2018-12-31$-9,407
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$-365,739
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-12-31$691,826
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-12-31$78,477
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-12-31$78,477
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-12-31$153
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$1,361,282
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$3,944,636
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$2,306,506
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-12-31No
Liabilities. Value of benefit claims payable at end of year2018-12-31$880,000
Liabilities. Value of benefit claims payable at beginning of year2018-12-31$724,000
Did the plan have assets held for investment2018-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31No
Opinion of an independent qualified public accountant for this plan2018-12-31Unqualified
Accountancy firm name2018-12-31JGD & ASSOCIATES LLP
Accountancy firm EIN2018-12-31953132551
2017 : EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2017 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$724,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$449,826
Total income from all sources (including contributions)2017-12-31$3,102,958
Total of all expenses incurred2017-12-31$3,453,715
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$3,345,010
Value of total corrective distributions2017-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$2,823,157
Value of total assets at end of year2017-12-31$358,261
Value of total assets at beginning of year2017-12-31$434,844
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$108,705
Total interest from all sources2017-12-31$17
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$1,000,000
If this is an individual account plan, was there a blackout period2017-12-31No
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$267,687
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2017-12-31$372,705
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-12-31$279,784
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-12-31$223,739
Other income not declared elsewhere2017-12-31$279,784
Administrative expenses (other) incurred2017-12-31$108,705
Total non interest bearing cash at beginning of year2017-12-31$211,105
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$-350,757
Value of net assets at end of year (total assets less liabilities)2017-12-31$-365,739
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$-14,982
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-12-31$78,477
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-12-31$17
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$1,243,571
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$2,555,470
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$1,728,734
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-12-31No
Liabilities. Value of benefit claims payable at end of year2017-12-31$724,000
Liabilities. Value of benefit claims payable at beginning of year2017-12-31$449,826
Did the plan have assets held for investment2017-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31No
Opinion of an independent qualified public accountant for this plan2017-12-31Unqualified
Accountancy firm name2017-12-31JGD & ASSOCIATES LLP
Accountancy firm EIN2017-12-31953132551
2016 : EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2016 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$449,826
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$218,184
Total income from all sources (including contributions)2016-12-31$2,861,849
Total of all expenses incurred2016-12-31$3,084,306
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$2,986,669
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$2,638,110
Value of total assets at end of year2016-12-31$434,844
Value of total assets at beginning of year2016-12-31$425,659
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$97,637
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$5,000,000
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$480,458
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$18,410
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2016-12-31$332,479
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$223,739
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$200,542
Other income not declared elsewhere2016-12-31$223,739
Administrative expenses (other) incurred2016-12-31$97,637
Total non interest bearing cash at end of year2016-12-31$211,105
Total non interest bearing cash at beginning of year2016-12-31$225,117
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$-222,457
Value of net assets at end of year (total assets less liabilities)2016-12-31$-14,982
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$207,475
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$1,018,224
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$2,139,242
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$1,635,966
Liabilities. Value of benefit claims payable at end of year2016-12-31$449,826
Liabilities. Value of benefit claims payable at beginning of year2016-12-31$218,184
Did the plan have assets held for investment2016-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31No
Opinion of an independent qualified public accountant for this plan2016-12-31Unqualified
Accountancy firm name2016-12-31MOSS ADAMS LLP
Accountancy firm EIN2016-12-31910189318
2015 : EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2015 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$234,030
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$249,757
Total income from all sources (including contributions)2015-12-31$2,602,621
Total of all expenses incurred2015-12-31$2,410,992
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$2,329,043
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$2,402,079
Value of total assets at end of year2015-12-31$425,659
Value of total assets at beginning of year2015-12-31$249,757
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$81,949
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$5,000,000
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$397,837
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2015-12-31$49,335
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-12-31$200,542
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-12-31$1,303
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-12-31$15,846
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-12-31$21,605
Other income not declared elsewhere2015-12-31$200,542
Administrative expenses (other) incurred2015-12-31$81,949
Total non interest bearing cash at end of year2015-12-31$225,117
Total non interest bearing cash at beginning of year2015-12-31$852
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$191,629
Value of net assets at end of year (total assets less liabilities)2015-12-31$191,629
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$727,895
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$2,004,242
Employer contributions (assets) at end of year2015-12-31$0
Employer contributions (assets) at beginning of year2015-12-31$247,602
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$1,551,813
Liabilities. Value of benefit claims payable at end of year2015-12-31$218,184
Liabilities. Value of benefit claims payable at beginning of year2015-12-31$228,152
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31No
Opinion of an independent qualified public accountant for this plan2015-12-31Unqualified
Accountancy firm name2015-12-31MOSS ADAMS LLP
Accountancy firm EIN2015-12-31910189318
2014 : EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$249,757
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$221,885
Total income from all sources (including contributions)2014-12-31$2,589,764
Total of all expenses incurred2014-12-31$2,589,764
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$2,464,880
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$2,589,764
Value of total assets at end of year2014-12-31$249,757
Value of total assets at beginning of year2014-12-31$221,885
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$124,884
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Administrative expenses professional fees incurred2014-12-31$6,740
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$5,000,000
If this is an individual account plan, was there a blackout period2014-12-31No
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$393,712
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$591,339
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2014-12-31$1,828,604
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-12-31$1,303
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-12-31$1,530
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-12-31$21,605
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-12-31$10,452
Administrative expenses (other) incurred2014-12-31$118,144
Total non interest bearing cash at end of year2014-12-31$852
Total non interest bearing cash at beginning of year2014-12-31$1,387
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Value of interest in common/collective trusts at end of year2014-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2014-12-31$540,144
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$1,604,713
Employer contributions (assets) at end of year2014-12-31$247,602
Employer contributions (assets) at beginning of year2014-12-31$218,968
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$96,132
Liabilities. Value of benefit claims payable at end of year2014-12-31$228,152
Liabilities. Value of benefit claims payable at beginning of year2014-12-31$211,433
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31No
Opinion of an independent qualified public accountant for this plan2014-12-31Unqualified
Accountancy firm name2014-12-31LEAF & COLE, LLP
Accountancy firm EIN2014-12-31952076568
2013 : EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$221,885
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$63,457
Total income from all sources (including contributions)2013-12-31$1,651,383
Total of all expenses incurred2013-12-31$1,651,383
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$1,536,167
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$1,651,383
Value of total assets at end of year2013-12-31$221,885
Value of total assets at beginning of year2013-12-31$63,457
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$115,216
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Administrative expenses professional fees incurred2013-12-31$6,644
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$5,000,000
If this is an individual account plan, was there a blackout period2013-12-31No
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$395,815
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2013-12-31$927,384
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-12-31$1,530
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-12-31$2,040
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-12-31$10,452
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-12-31$4,425
Administrative expenses (other) incurred2013-12-31$108,572
Total non interest bearing cash at end of year2013-12-31$1,387
Total non interest bearing cash at beginning of year2013-12-31$5,244
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Value of interest in common/collective trusts at end of year2013-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2013-12-31$476,253
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$1,255,568
Employer contributions (assets) at end of year2013-12-31$218,968
Employer contributions (assets) at beginning of year2013-12-31$56,173
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$132,530
Liabilities. Value of benefit claims payable at end of year2013-12-31$211,433
Liabilities. Value of benefit claims payable at beginning of year2013-12-31$59,032
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31No
Opinion of an independent qualified public accountant for this plan2013-12-31Unqualified
Accountancy firm name2013-12-31LEAF & COLE, LLP
Accountancy firm EIN2013-12-31952076568
2012 : EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$63,457
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$140,247
Total income from all sources (including contributions)2012-12-31$1,324,617
Total of all expenses incurred2012-12-31$1,324,617
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$1,224,202
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$1,324,548
Value of total assets at end of year2012-12-31$63,457
Value of total assets at beginning of year2012-12-31$140,247
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$100,415
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$5,000,000
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$372,950
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2012-12-31$668,549
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-12-31$2,040
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-12-31$101,489
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-12-31$4,425
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-12-31$2,588
Other income not declared elsewhere2012-12-31$69
Administrative expenses (other) incurred2012-12-31$100,415
Total non interest bearing cash at end of year2012-12-31$5,244
Total non interest bearing cash at beginning of year2012-12-31$165
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Value of interest in common/collective trusts at end of year2012-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2012-12-31$399,919
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$951,598
Employer contributions (assets) at end of year2012-12-31$56,173
Employer contributions (assets) at beginning of year2012-12-31$38,593
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$155,734
Liabilities. Value of benefit claims payable at end of year2012-12-31$59,032
Liabilities. Value of benefit claims payable at beginning of year2012-12-31$137,659
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31No
Opinion of an independent qualified public accountant for this plan2012-12-31Unqualified
Accountancy firm name2012-12-31LEAF & COLE, LLP
Accountancy firm EIN2012-12-31952076568
2011 : EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$140,247
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$77,886
Total income from all sources (including contributions)2011-12-31$1,521,002
Total of all expenses incurred2011-12-31$1,521,002
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$1,422,413
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$1,421,960
Value of total assets at end of year2011-12-31$140,247
Value of total assets at beginning of year2011-12-31$77,886
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$98,589
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$5,000,000
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$347,616
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2011-12-31$891,422
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-12-31$101,489
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-12-31$2,887
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-12-31$2,588
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-12-31$3,701
Other income not declared elsewhere2011-12-31$99,042
Administrative expenses (other) incurred2011-12-31$98,589
Total non interest bearing cash at end of year2011-12-31$165
Total non interest bearing cash at beginning of year2011-12-31$3,278
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2011-12-31$392,934
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$1,074,344
Employer contributions (assets) at end of year2011-12-31$38,593
Employer contributions (assets) at beginning of year2011-12-31$71,721
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$138,057
Liabilities. Value of benefit claims payable at end of year2011-12-31$137,659
Liabilities. Value of benefit claims payable at beginning of year2011-12-31$74,185
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31No
Opinion of an independent qualified public accountant for this plan2011-12-31Unqualified
Accountancy firm name2011-12-31LEAF & COLE, LLP
Accountancy firm EIN2011-12-31952076568
2010 : EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2010 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$77,886
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$39,913
Total income from all sources (including contributions)2010-12-31$1,414,330
Total of all expenses incurred2010-12-31$1,414,330
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$1,325,630
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$1,414,330
Value of total assets at end of year2010-12-31$77,886
Value of total assets at beginning of year2010-12-31$39,913
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$88,700
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$5,000,000
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$358,641
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2010-12-31$767,638
Value of other receiveables (less allowance for doubtful accounts) at end of year2010-12-31$2,887
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2010-12-31$2,566
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2010-12-31$3,701
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2010-12-31$1,781
Administrative expenses (other) incurred2010-12-31$88,700
Total non interest bearing cash at end of year2010-12-31$3,278
Total non interest bearing cash at beginning of year2010-12-31$9,916
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2010-12-31$395,992
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$1,055,689
Employer contributions (assets) at end of year2010-12-31$71,721
Employer contributions (assets) at beginning of year2010-12-31$27,431
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$162,000
Liabilities. Value of benefit claims payable at end of year2010-12-31$74,185
Liabilities. Value of benefit claims payable at beginning of year2010-12-31$38,132
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31No
Opinion of an independent qualified public accountant for this plan2010-12-31Unqualified
Accountancy firm name2010-12-31LEAF & COLE, LLP
Accountancy firm EIN2010-12-31952076568

Form 5500 Responses for EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC.

2022: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedYes
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedYes
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: EMPLOYEE BENEFIT TRUST FOR COMMUNITY HEALTH GROUP, INC. 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number800091404
Policy instance 2
Insurance contract or identification number800091404
Number of Individuals Covered293
Insurance policy start date2022-06-01
Insurance policy end date2023-06-01
Total amount of commissions paid to insurance brokerUSD $12,569
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $476,234
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,569
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3075538
Policy instance 1
Insurance contract or identification numberE3075538
Number of Individuals Covered208
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $43,004
Total amount of fees paid to insurance companyUSD $4,483
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $248,523
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,647
Amount paid for insurance broker fees616
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number800091404
Policy instance 2
Insurance contract or identification number800091404
Insurance policy start date2020-12-01
Insurance policy end date2021-12-01
Total amount of commissions paid to insurance brokerUSD $362,995
Total amount of fees paid to insurance companyUSD $28,598
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,858
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3075538
Policy instance 1
Insurance contract or identification numberE3075538
Number of Individuals Covered205
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $44,351
Total amount of fees paid to insurance companyUSD $3,706
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $261,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,492
Amount paid for insurance broker fees123
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3075538
Policy instance 2
Insurance contract or identification numberE3075538
Number of Individuals Covered34
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $45,442
Total amount of fees paid to insurance companyUSD $7,753
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $266,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,041
Amount paid for insurance broker fees1941
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number356363
Policy instance 1
Insurance contract or identification number356363
Number of Individuals Covered289
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $12,000
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $311,368
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,000
Amount paid for insurance broker fees0
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number091404
Policy instance 3
Insurance contract or identification number091404
Number of Individuals Covered320
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $9,500
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D LONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $50,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,500
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number356363
Policy instance 1
Insurance contract or identification number356363
Number of Individuals Covered188
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $11,818
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $355,941
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,818
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3075538
Policy instance 2
Insurance contract or identification numberE3075538
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $49,723
Total amount of fees paid to insurance companyUSD $8,260
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $282,416
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,299
Amount paid for insurance broker fees7332
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number091404
Policy instance 3
Insurance contract or identification number091404
Number of Individuals Covered316
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $9,294
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D LONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $49,522
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,636
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number091404
Policy instance 1
Insurance contract or identification number091404
Number of Individuals Covered337
Insurance policy start date2018-01-01
Insurance policy end date2019-01-01
Total amount of commissions paid to insurance brokerUSD $8,164
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D LONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $45,317
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,164
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3075538
Policy instance 2
Insurance contract or identification numberE3075538
Number of Individuals Covered182
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $52,777
Total amount of fees paid to insurance companyUSD $4,509
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $237,243
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,294
Amount paid for insurance broker fees4439
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number356363
Policy instance 3
Insurance contract or identification number356363
Number of Individuals Covered294
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $11,604
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $315,943
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,604
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number091404
Policy instance 3
Insurance contract or identification number091404
Number of Individuals Covered313
Insurance policy start date2017-01-01
Insurance policy end date2018-01-01
Total amount of commissions paid to insurance brokerUSD $7,531
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D LONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $48,888
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract number570144607
Policy instance 2
Insurance contract or identification number570144607
Number of Individuals Covered194
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $87,397
Total amount of fees paid to insurance companyUSD $9,664
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $247,383
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number356363
Policy instance 1
Insurance contract or identification number356363
Number of Individuals Covered283
Insurance policy start date2017-01-01
Insurance policy end date2018-01-01
Total amount of commissions paid to insurance brokerUSD $10,670
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $270,221
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
USBENEFITS INSURANCE SERVICES, LLC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberANTX-44094
Policy instance 3
Insurance contract or identification numberANTX-44094
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number091404/356363
Policy instance 1
Insurance contract or identification number091404/356363
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3075538
Policy instance 2
Insurance contract or identification numberE3075538
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
USBENEFITS INSURANCE SERVICES, LLC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberANTX-44094
Policy instance 3
Insurance contract or identification numberANTX-44094
Number of Individuals Covered211
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $269,890
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3075538
Policy instance 2
Insurance contract or identification numberE3075538
Number of Individuals Covered91
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $14,107
Total amount of fees paid to insurance companyUSD $3,355
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $95,363
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,264
Additional information about fees paid to insurance brokerBONUS AND NON CASH INCENTIVES
Insurance broker organization code?3
Amount paid for insurance broker fees1573
Insurance broker nameMICHAEL J MINNEY
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number091404/356363
Policy instance 1
Insurance contract or identification number091404/356363
Number of Individuals Covered211
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $17,779
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $174,891
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,779
Insurance broker organization code?3
Insurance broker nameKINGHORN & ASSOCIATES
USBENEFITS INSURANCE SERVICES, LLC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberANTX-44094
Policy instance 4
Insurance contract or identification numberANTX-44094
Number of Individuals Covered155
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3075538
Policy instance 3
Insurance contract or identification numberE3075538
Number of Individuals Covered80
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $16,275
Total amount of fees paid to insurance companyUSD $3,298
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,033
Additional information about fees paid to insurance brokerBONUS AND NON CASH INCENTIVES
Insurance broker organization code?3
Amount paid for insurance broker fees674
Insurance broker nameMICHAEL J MINNEY
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number091403
Policy instance 2
Insurance contract or identification number091403
Number of Individuals Covered157
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $441
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $441
Insurance broker organization code?3
Insurance broker nameKINGHORN & ASSOCIATES
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number356363
Policy instance 1
Insurance contract or identification number356363
Number of Individuals Covered157
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $7,888
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedLONG-TERM CARE
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,888
Additional information about fees paid to insurance brokerBONUS AND NON CASH INCENTIVES
Insurance broker organization code?3
Insurance broker nameCRAIG KINGHORN
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3075538
Policy instance 2
Insurance contract or identification numberE3075538
Number of Individuals Covered83
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,924
Total amount of fees paid to insurance companyUSD $126
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3
Insurance broker organization code?3
Amount paid for insurance broker fees1
Additional information about fees paid to insurance brokerBONUS AND NON CASH INCENTIVES
Insurance broker nameKINGHORN & ASSOCIATES
USBENEFITS INSURANCE SERVICES, LLC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberANTX-44094
Policy instance 1
Insurance contract or identification numberANTX-44094
Number of Individuals Covered134
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number091403
Policy instance 3
Insurance contract or identification number091403
Number of Individuals Covered134
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $543
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $543
Insurance broker organization code?3
Insurance broker nameKINGHORN & ASSOCIATES
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number356363
Policy instance 4
Insurance contract or identification number356363
Number of Individuals Covered134
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $7,719
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedLONG-TERM CARE
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,719
Insurance broker organization code?3
Insurance broker nameCRAIG F KINGHORN
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number356363
Policy instance 4
Insurance contract or identification number356363
Number of Individuals Covered125
Total amount of commissions paid to insurance brokerUSD $371
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedLONG-TERM CARE
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3075538
Policy instance 2
Insurance contract or identification numberE3075538
Number of Individuals Covered39
Total amount of commissions paid to insurance brokerUSD $5,139
Total amount of fees paid to insurance companyUSD $190
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
USBENEFITS INSURANCE SERVICES, LLC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberANTX-44094
Policy instance 1
Insurance contract or identification numberANTX-44094
Number of Individuals Covered125
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number091403
Policy instance 3
Insurance contract or identification number091403
Number of Individuals Covered125
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number091403
Policy instance 3
Insurance contract or identification number091403
Number of Individuals Covered10
Insurance policy start date2010-04-01
Insurance policy end date2011-04-01
Total amount of commissions paid to insurance brokerUSD $391
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $391
Insurance broker organization code?3
Insurance broker nameKINGHORN & ASSOCIATES
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL16349
Policy instance 1
Insurance contract or identification numberHCL16349
Number of Individuals Covered120
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number356363
Policy instance 4
Insurance contract or identification number356363
Number of Individuals Covered106
Insurance policy start date2009-06-01
Insurance policy end date2010-06-01
Total amount of commissions paid to insurance brokerUSD $7,148
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedLONG-TERM CARE
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,148
Insurance broker organization code?3
Insurance broker nameCRAIG F KINGHORN
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3075538
Policy instance 2
Insurance contract or identification numberE3075538
Number of Individuals Covered120
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $5,817
Total amount of fees paid to insurance companyUSD $242
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3
Insurance broker organization code?3
Amount paid for insurance broker fees2
Additional information about fees paid to insurance brokerBONUS AND NON CASH INCENTIVES
Insurance broker nameKINGHORN & ASSOCIATES

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