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RETIREMENT PLAN FOR EMPLOYEES OF MINERS HOSPITAL 401k Plan overview

Plan NameRETIREMENT PLAN FOR EMPLOYEES OF MINERS HOSPITAL
Plan identification number 002

RETIREMENT PLAN FOR EMPLOYEES OF MINERS HOSPITAL Benefits

401k Plan TypeDefined Benefit Pension
Plan Features/Benefits
  • Benefits are primarily pay related
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

1889-CHS FOUNDATION, INC. has sponsored the creation of one or more 401k plans.

Company Name:1889-CHS FOUNDATION, INC.
Employer identification number (EIN):232801799
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RETIREMENT PLAN FOR EMPLOYEES OF MINERS HOSPITAL

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022015-07-01WENDY REITNAUER SUSAN M. MANN2017-02-01
0022014-07-01CHRISTINA GATEHOUSE

Plan Statistics for RETIREMENT PLAN FOR EMPLOYEES OF MINERS HOSPITAL

401k plan membership statisitcs for RETIREMENT PLAN FOR EMPLOYEES OF MINERS HOSPITAL

Measure Date Value
2015: RETIREMENT PLAN FOR EMPLOYEES OF MINERS HOSPITAL 2015 401k membership
Total participants, beginning-of-year2015-07-01314
Total number of active participants reported on line 7a of the Form 55002015-07-010
Number of retired or separated participants receiving benefits2015-07-010
Number of other retired or separated participants entitled to future benefits2015-07-010
Total of all active and inactive participants2015-07-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-07-010
Total participants2015-07-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-07-010
2014: RETIREMENT PLAN FOR EMPLOYEES OF MINERS HOSPITAL 2014 401k membership
Total participants, beginning-of-year2014-07-01319
Total number of active participants reported on line 7a of the Form 55002014-07-0188
Number of retired or separated participants receiving benefits2014-07-01141
Number of other retired or separated participants entitled to future benefits2014-07-0177
Total of all active and inactive participants2014-07-01306
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-07-018
Total participants2014-07-01314
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-07-010

Financial Data on RETIREMENT PLAN FOR EMPLOYEES OF MINERS HOSPITAL

Measure Date Value
2016 : RETIREMENT PLAN FOR EMPLOYEES OF MINERS HOSPITAL 2016 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2016-06-30$-987,917
Total unrealized appreciation/depreciation of assets2016-06-30$-987,917
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-06-30$11,032
Total income from all sources (including contributions)2016-06-30$1,596,021
Total loss/gain on sale of assets2016-06-30$1,654,789
Total of all expenses incurred2016-06-30$23,987,018
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-06-30$23,896,102
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-06-30$845,000
Value of total assets at end of year2016-06-30$0
Value of total assets at beginning of year2016-06-30$22,402,029
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-06-30$90,916
Total interest from all sources2016-06-30$69,117
Total dividends received (eg from common stock, registered investment company shares)2016-06-30$15,032
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-06-30Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2016-06-30$0
Total dividends received from registered investment company shares (eg mutual funds)2016-06-30$15,032
Administrative expenses professional fees incurred2016-06-30$20,882
Was this plan covered by a fidelity bond2016-06-30Yes
Value of fidelity bond cover2016-06-30$500,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-06-30$0
Were there any nonexempt tranactions with any party-in-interest2016-06-30No
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-06-30$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-06-30$69,466
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-06-30$11,032
Administrative expenses (other) incurred2016-06-30$21,018
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-06-30No
Value of net income/loss2016-06-30$-22,390,997
Value of net assets at end of year (total assets less liabilities)2016-06-30$0
Value of net assets at beginning of year (total assets less liabilities)2016-06-30$22,390,997
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2016-06-30No
Were any leases to which the plan was party in default or uncollectible2016-06-30No
Investment advisory and management fees2016-06-30$5,271
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-06-30$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-06-30$383,887
Income. Interest from US Government securities2016-06-30$62,229
Income. Interest from corporate debt instruments2016-06-30$6,888
Expenses. Payments to insurance carriers foe the provision of benefits2016-06-30$15,046,040
Asset value of US Government securities at end of year2016-06-30$0
Asset value of US Government securities at beginning of year2016-06-30$21,572,639
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-06-30Yes
Was there a failure to transmit to the plan any participant contributions2016-06-30No
Has the plan failed to provide any benefit when due under the plan2016-06-30No
Contributions received in cash from employer2016-06-30$845,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-06-30$8,850,062
Asset. Corporate debt instrument debt (other) at end of year2016-06-30$0
Asset. Corporate debt instrument debt (other) at beginning of year2016-06-30$376,037
Contract administrator fees2016-06-30$43,745
Did the plan have assets held for investment2016-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-06-30Yes
Aggregate proceeds on sale of assets2016-06-30$22,988,239
Aggregate carrying amount (costs) on sale of assets2016-06-30$21,333,450
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-06-30Yes
Opinion of an independent qualified public accountant for this plan2016-06-30Disclaimer
Accountancy firm name2016-06-30BKD, LLP
Accountancy firm EIN2016-06-30440160260
2015 : RETIREMENT PLAN FOR EMPLOYEES OF MINERS HOSPITAL 2015 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2015-06-30$651,938
Total unrealized appreciation/depreciation of assets2015-06-30$651,938
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-06-30$11,032
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-06-30$7,542
Total income from all sources (including contributions)2015-06-30$870,165
Total loss/gain on sale of assets2015-06-30$-8,600
Total of all expenses incurred2015-06-30$1,261,489
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-06-30$1,001,958
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-06-30$0
Value of total assets at end of year2015-06-30$22,402,029
Value of total assets at beginning of year2015-06-30$22,789,863
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-06-30$259,531
Total interest from all sources2015-06-30$226,446
Total dividends received (eg from common stock, registered investment company shares)2015-06-30$381
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2015-06-30$381
Administrative expenses professional fees incurred2015-06-30$88,482
Was this plan covered by a fidelity bond2015-06-30Yes
Value of fidelity bond cover2015-06-30$500,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-06-30$0
Were there any nonexempt tranactions with any party-in-interest2015-06-30No
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-06-30$69,466
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-06-30$63,636
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-06-30$11,032
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-06-30$7,542
Administrative expenses (other) incurred2015-06-30$17,632
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-06-30No
Value of net income/loss2015-06-30$-391,324
Value of net assets at end of year (total assets less liabilities)2015-06-30$22,390,997
Value of net assets at beginning of year (total assets less liabilities)2015-06-30$22,782,321
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2015-06-30No
Were any leases to which the plan was party in default or uncollectible2015-06-30No
Investment advisory and management fees2015-06-30$82,224
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-06-30$383,887
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-06-30$787,056
Income. Interest from US Government securities2015-06-30$215,446
Income. Interest from corporate debt instruments2015-06-30$11,000
Asset value of US Government securities at end of year2015-06-30$21,572,639
Asset value of US Government securities at beginning of year2015-06-30$17,683,197
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-06-30Yes
Was there a failure to transmit to the plan any participant contributions2015-06-30No
Has the plan failed to provide any benefit when due under the plan2015-06-30No
Employer contributions (assets) at end of year2015-06-30$0
Employer contributions (assets) at beginning of year2015-06-30$3,790,417
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-06-30$1,001,958
Asset. Corporate debt instrument debt (other) at end of year2015-06-30$376,037
Asset. Corporate debt instrument debt (other) at beginning of year2015-06-30$465,557
Contract administrator fees2015-06-30$71,193
Assets. Corporate common stocks other than exployer securities at beginning of year2015-06-30$0
Did the plan have assets held for investment2015-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-06-30No
Aggregate proceeds on sale of assets2015-06-30$258,695
Aggregate carrying amount (costs) on sale of assets2015-06-30$267,295
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-06-30Yes
Opinion of an independent qualified public accountant for this plan2015-06-30Disclaimer
Accountancy firm name2015-06-30BKD, LLP
Accountancy firm EIN2015-06-30440160260

Form 5500 Responses for RETIREMENT PLAN FOR EMPLOYEES OF MINERS HOSPITAL

2015: RETIREMENT PLAN FOR EMPLOYEES OF MINERS HOSPITAL 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingYes
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – TrustYes
2015-07-01Plan benefit arrangement – InsuranceYes
2015-07-01Plan benefit arrangement - TrustYes
2014: RETIREMENT PLAN FOR EMPLOYEES OF MINERS HOSPITAL 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Submission has been amendedNo
2014-07-01This submission is the final filingNo
2014-07-01This return/report is a short plan year return/report (less than 12 months)No
2014-07-01Plan is a collectively bargained planNo
2014-07-01Plan funding arrangement – TrustYes
2014-07-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberSPG-20657
Policy instance 1
Insurance contract or identification numberSPG-20657
Number of Individuals Covered149
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $378,278
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedANNUITY CONTRACTS
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $12,609,247
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $252,198
Insurance broker organization code?3
Insurance broker nameVAN LUMBARD
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberSPG-21518
Policy instance 2
Insurance contract or identification numberSPG-21518
Number of Individuals Covered27
Insurance policy start date2016-01-01
Insurance policy end date2016-12-31
Total amount of commissions paid to insurance brokerUSD $73,104
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedANNUITY CONTRACTS
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $2,436,793
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $73,104
Insurance broker organization code?3
Insurance broker nameELLIOT DINKIN

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