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LAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN 401k Plan overview

Plan NameLAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN
Plan identification number 001

LAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
  • Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

LAKE SUPERIOR COMMUNITY HEALTH CENTER has sponsored the creation of one or more 401k plans.

Company Name:LAKE SUPERIOR COMMUNITY HEALTH CENTER
Employer identification number (EIN):237167576
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012023-01-01LEE HOMAN2024-03-27 LEE HOMAN2024-03-27
0012022-01-01
0012022-01-01JESSIE PETERSON
0012021-01-01
0012021-01-01JESSIE PETERSON
0012020-01-01
0012019-01-01
0012018-01-01DAYLE PATTERSON2019-09-30
0012017-01-01DAYLE PATTERSON2018-09-27
0012016-01-01DAYLE PATTERSON2017-05-22
0012015-01-01SARAH LEUCK2016-06-28
0012014-01-01SARAH LEUCK2015-09-30
0012013-01-01SARAH LEUCK2014-06-27
0012012-01-01SARAH LEUCK2014-06-27
0012011-01-01KATHY MILLER2012-04-16
0012010-01-01KATHY MILLER2011-05-19
0012009-01-01KATHY MILLER

Financial Data on LAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN

Measure Date Value
2025 : LAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN 2025 401k financial data
Total transfers to/from plan in this plan year2025-04-010
Total liabilities as of the end of the plan year2025-04-01569
Total liabilities as of the beginning of the plan year2025-04-01727
Total expenses incurred by plan in this plan year2025-04-01933932
Net assets as of the end of the plan year2025-04-016238158
Total assets as of the beginning of the plan year2025-04-015776026
Value of plan covered by a fidelity bond2025-04-01500000
Participant contributions to plan in this plan year2025-04-01472775
Other expenses paid from plan in this plan year2025-04-010
Other income to plan in this plan year2025-04-01734494
Plan net income in this plan year2025-04-01462290
Net assets as of the end of the plan year2025-04-016237589
Net assets as of the beginning of the plan year2025-04-015775299
Employer contributions to plan in this plan year2025-04-01188953
Fees paid to broker by Benefit Provider2025-04-0173
Expensese paid to adminstrative service provicers from plan in this plan year2025-04-0156510
2024 : LAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN 2024 401k financial data
Total transfers to/from plan in this plan year2024-03-270
Total liabilities as of the end of the plan year2024-03-27727
Total liabilities as of the beginning of the plan year2024-03-2795
Total expenses incurred by plan in this plan year2024-03-27350970
Net assets as of the end of the plan year2024-03-275776026
Total assets as of the beginning of the plan year2024-03-274637360
Value of plan covered by a fidelity bond2024-03-27500000
Participant contributions to plan in this plan year2024-03-27427540
Other expenses paid from plan in this plan year2024-03-270
Other contributions to plan in this plan year2024-03-2762239
Other income to plan in this plan year2024-03-27804257
Plan net income in this plan year2024-03-271138034
Net assets as of the end of the plan year2024-03-275775299
Net assets as of the beginning of the plan year2024-03-274637265
Employer contributions to plan in this plan year2024-03-27194968
Fees paid to broker by Benefit Provider2024-03-27139
Expensese paid to adminstrative service provicers from plan in this plan year2024-03-2736959
2022 : LAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$95
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$135,136
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$245,560
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$239,243
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$1,076,859
Value of total assets at end of year2022-12-31$4,637,508
Value of total assets at beginning of year2022-12-31$4,747,837
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$6,317
Total interest from all sources2022-12-31$724
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$1,621
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$1,621
Administrative expenses professional fees incurred2022-12-31$2,316
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31Yes
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$394,524
Participant contributions at end of year2022-12-31$0
Participant contributions at beginning of year2022-12-31$12,216
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$514,780
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$95
Other income not declared elsewhere2022-12-31$0
Administrative expenses (other) incurred2022-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-110,424
Value of net assets at end of year (total assets less liabilities)2022-12-31$4,637,413
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$4,747,837
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 in registered invesment companies (eg mutual funds) at end of year2022-12-31$4,607,039
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$4,699,563
Interest earned on other investments2022-12-31$724
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$30,469
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$29,781
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-944,068
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$167,555
Employer contributions (assets) at end of year2022-12-31$0
Employer contributions (assets) at beginning of year2022-12-31$6,277
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$239,243
Contract administrator fees2022-12-31$4,001
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32022-12-31Yes
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party 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 name2022-12-31CLIFTONLARSONALLEN LLP
Accountancy firm EIN2022-12-31410746749
Total unrealized appreciation/depreciation of assets2022-01-01$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-01-01$95
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-01-01$0
Total income from all sources (including contributions)2022-01-01$135,136
Total loss/gain on sale of assets2022-01-01$0
Total of all expenses incurred2022-01-01$245,560
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-01-01$239,243
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-01-01$1,076,859
Value of total assets at end of year2022-01-01$4,637,508
Value of total assets at beginning of year2022-01-01$4,747,837
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-01-01$6,317
Total interest from all sources2022-01-01$724
Total dividends received (eg from common stock, registered investment company shares)2022-01-01$1,621
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-01-01No
Total dividends received from registered investment company shares (eg mutual funds)2022-01-01$1,621
Administrative expenses professional fees incurred2022-01-01$2,316
Was this plan covered by a fidelity bond2022-01-01Yes
Value of fidelity bond cover2022-01-01$500,000
If this is an individual account plan, was there a blackout period2022-01-01Yes
Were there any nonexempt tranactions with any party-in-interest2022-01-01No
Contributions received from participants2022-01-01$394,524
Participant contributions at end of year2022-01-01$0
Participant contributions at beginning of year2022-01-01$12,216
Income. Received or receivable in cash from other sources (including rollovers)2022-01-01$514,780
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-01-01$95
Other income not declared elsewhere2022-01-01$0
Administrative expenses (other) incurred2022-01-01$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-01-01No
Value of net income/loss2022-01-01$-110,424
Value of net assets at end of year (total assets less liabilities)2022-01-01$4,637,413
Value of net assets at beginning of year (total assets less liabilities)2022-01-01$4,747,837
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-01-01No
Were any loans by the plan or fixed income obligations due to the plan in default2022-01-01No
Were any leases to which the plan was party in default or uncollectible2022-01-01No
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-01-01$4,607,039
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-01-01$4,699,563
Interest earned on other investments2022-01-01$724
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-01-01$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-01-01$30,469
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-01-01$29,781
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-01-01$-944,068
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-01-01No
Was there a failure to transmit to the plan any participant contributions2022-01-01No
Has the plan failed to provide any benefit when due under the plan2022-01-01No
Contributions received in cash from employer2022-01-01$167,555
Employer contributions (assets) at end of year2022-01-01$0
Employer contributions (assets) at beginning of year2022-01-01$6,277
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-01-01$239,243
Contract administrator fees2022-01-01$4,001
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32022-01-01Yes
Did the plan have assets held for investment2022-01-01Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-01-01No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-01-01No
Opinion of an independent qualified public accountant for this plan2022-01-011
Accountancy firm name2022-01-01CLIFTONLARSONALLEN LLP
Accountancy firm EIN2022-01-01410746749
2021 : LAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$1,274,339
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$799,487
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$790,241
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$666,981
Value of total assets at end of year2021-12-31$4,747,837
Value of total assets at beginning of year2021-12-31$4,272,985
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$9,246
Total interest from all sources2021-12-31$591
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$80,736
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$80,736
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$372,081
Participant contributions at end of year2021-12-31$12,216
Participant contributions at beginning of year2021-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$110,009
Total non interest bearing cash at end of year2021-12-31$0
Total non interest bearing cash at beginning of year2021-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$474,852
Value of net assets at end of year (total assets less liabilities)2021-12-31$4,747,837
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$4,272,985
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 in registered invesment companies (eg mutual funds) at end of year2021-12-31$4,699,563
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$4,260,763
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-12-31$591
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$29,781
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$12,222
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$526,031
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$184,891
Employer contributions (assets) at end of year2021-12-31$6,277
Employer contributions (assets) at beginning of year2021-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$790,241
Contract administrator fees2021-12-31$9,246
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party 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 name2021-12-31WIPFLI LLP
Accountancy firm EIN2021-12-31390758449
2020 : LAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$954,723
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$669,866
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$665,860
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$425,261
Value of total assets at end of year2020-12-31$4,272,985
Value of total assets at beginning of year2020-12-31$3,988,128
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$4,006
Total interest from all sources2020-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$46,666
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$46,666
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$400,000
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$297,204
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$1,228
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$284,857
Value of net assets at end of year (total assets less liabilities)2020-12-31$4,272,985
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$3,988,128
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 in registered invesment companies (eg mutual funds) at end of year2020-12-31$4,260,763
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$3,554,508
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$12,222
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$433,620
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$482,796
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$126,829
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$665,860
Contract administrator fees2020-12-31$4,006
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party 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 plan2020-12-31Disclaimer
Accountancy firm name2020-12-31WIPFLI LLP
Accountancy firm EIN2020-12-31390758449
2019 : LAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$1,154,381
Total income from all sources (including contributions)2019-12-31$1,154,381
Total loss/gain on sale of assets2019-12-31$0
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$357,750
Total of all expenses incurred2019-12-31$357,750
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$354,219
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$354,219
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$472,443
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$472,443
Value of total assets at end of year2019-12-31$3,988,128
Value of total assets at end of year2019-12-31$3,988,128
Value of total assets at beginning of year2019-12-31$3,191,497
Value of total assets at beginning of year2019-12-31$3,191,497
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$3,531
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$3,531
Total interest from all sources2019-12-31$0
Total interest from all sources2019-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$50,431
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$50,431
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
Total dividends received from registered investment company shares (eg mutual funds)2019-12-31$50,431
Total dividends received from registered investment company shares (eg mutual funds)2019-12-31$50,431
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$400,000
Value of fidelity bond cover2019-12-31$400,000
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
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
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$330,581
Contributions received from participants2019-12-31$330,581
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$7,805
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$7,805
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$796,631
Value of net income/loss2019-12-31$796,631
Value of net assets at end of year (total assets less liabilities)2019-12-31$3,988,128
Value of net assets at end of year (total assets less liabilities)2019-12-31$3,988,128
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$3,191,497
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$3,191,497
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 in registered invesment companies (eg mutual funds) at end of year2019-12-31$3,554,508
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$3,554,508
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$3,189,620
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$3,189,620
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$433,620
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$433,620
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$1,877
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$1,877
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$631,507
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$631,507
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
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$134,057
Contributions received in cash from employer2019-12-31$134,057
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$354,219
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$354,219
Contract administrator fees2019-12-31$3,531
Contract administrator fees2019-12-31$3,531
Did the plan have assets held for investment2019-12-31Yes
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party 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)2019-12-31Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31WIPFLI LLP
Accountancy firm name2019-12-31WIPFLI LLP
Accountancy firm EIN2019-12-31390758449
Accountancy firm EIN2019-12-31390758449
2009 : LAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for LAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN

2022: LAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
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: LAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
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: LAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
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: LAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2009: LAKE SUPERIOR COMMUNITY HEALTH CENTER 403(B) RETIREMENT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number664T7S
Policy instance 1
Insurance contract or identification number664T7S
Number of Individuals Covered96
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 2
Insurance contract or identification number613953
Number of Individuals Covered0
Insurance policy start date2022-01-01
Insurance policy end date2022-12-07
Total amount of commissions paid to insurance brokerUSD $31
Total amount of fees paid to insurance companyUSD $6
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract numberCR31568
Policy instance 3
Insurance contract or identification numberCR31568
Number of Individuals Covered5
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $203
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract numberCR31568
Policy instance 2
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract numberCR31568
Policy instance 2
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1

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