401k Plan data: MERCY MEDICAL CENTER, INC. 403(B) PLAN plan

MERCY MEDICAL CENTER, INC. 403(B) PLAN 401k Plan overview

Plan Name	MERCY MEDICAL CENTER, INC. 403(B) PLAN
Plan identification number	002

MERCY MEDICAL CENTER, INC. 403(B) PLAN Benefits

401k Plan Type

Defined 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(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.
Participant-directed brokerage accounts provided as an investment option under the plan.
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

CLEVELAND CLINIC MERCY HOSPITAL FKA MERCY MEDICAL CENTER INC. has sponsored the creation of one or more 401k plans.

Company Name: CLEVELAND CLINIC MERCY HOSPITAL FKA MERCY MEDICAL CENTER INC.

Employer identification number (EIN): 341893439

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about CLEVELAND CLINIC MERCY HOSPITAL FKA MERCY MEDICAL CENTER INC.

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 1913-03-17

Company Identification Number: 11966

Legal Registered Office Address: 1000 NORTH VILLAGE AVENUE
Nassau
ROCKVILLE CENTRE
United States of America (USA)
11570

More information about CLEVELAND CLINIC MERCY HOSPITAL FKA MERCY MEDICAL CENTER INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MERCY MEDICAL CENTER, INC. 403(B) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2017-01-01 DAVID K STEWART
002 2016-01-01 THOMAS E. CECCONI
002 2015-01-01 THOMAS CECCONI
002 2015-01-01 THOMAS E CECCONI
002 2014-01-01 THOMAS CECCONI 2015-08-11
002 2013-01-01 THOMAS CECCONI 2014-08-18
002 2012-01-01 THOMAS CECCONI 2013-09-11
002 2011-01-01 THOMAS CECCONI 2012-07-27 MICHAEL RIEGER 2012-07-27
002 2010-01-01 THOMAS CECCONI 2011-08-05 MICHAEL RIEGER 2011-08-04

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2017-01-01	DAVID K STEWART
002	2016-01-01	THOMAS E. CECCONI
002	2015-01-01	THOMAS CECCONI
002	2015-01-01	THOMAS E CECCONI
002	2014-01-01	THOMAS CECCONI	2015-08-11
002	2013-01-01	THOMAS CECCONI	2014-08-18
002	2012-01-01	THOMAS CECCONI	2013-09-11
002	2011-01-01	THOMAS CECCONI	2012-07-27	MICHAEL RIEGER	2012-07-27
002	2010-01-01	THOMAS CECCONI	2011-08-05	MICHAEL RIEGER	2011-08-04

Plan Statistics for MERCY MEDICAL CENTER, INC. 403(B) PLAN

401k plan membership statisitcs for MERCY MEDICAL CENTER, INC. 403(B) PLAN

Measure Date Value
2017: MERCY MEDICAL CENTER, INC. 403(B) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 49
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 0
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 0
Number of participants with account balances 2017-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: MERCY MEDICAL CENTER, INC. 403(B) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 58
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 43
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 6
Total of all active and inactive participants 2016-01-01 49
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 49
Number of participants with account balances 2016-01-01 20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: MERCY MEDICAL CENTER, INC. 403(B) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 61
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 53
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 5
Total of all active and inactive participants 2015-01-01 58
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 58
Number of participants with account balances 2015-01-01 27

Measure	Date	Value
2017: MERCY MEDICAL CENTER, INC. 403(B) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	49
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	0
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	0
Number of participants with account balances	2017-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: MERCY MEDICAL CENTER, INC. 403(B) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	58
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	43
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	6
Total of all active and inactive participants	2016-01-01	49
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	49
Number of participants with account balances	2016-01-01	20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: MERCY MEDICAL CENTER, INC. 403(B) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	61
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	53
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	5
Total of all active and inactive participants	2015-01-01	58
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	58
Number of participants with account balances	2015-01-01	27

Financial Data on MERCY MEDICAL CENTER, INC. 403(B) PLAN

Measure	Date	Value
2017 : MERCY MEDICAL CENTER, INC. 403(B) PLAN 2017 401k financial data
Transfers to/from the plan	2017-08-31	$0
Total plan liabilities at end of year	2017-08-31	$0
Total plan liabilities at beginning of year	2017-08-31	$0
Total income from all sources	2017-08-31	$254,426
Expenses. Total of all expenses incurred	2017-08-31	$2,268,578
Benefits paid (including direct rollovers)	2017-08-31	$2,268,565
Total plan assets at end of year	2017-08-31	$0
Total plan assets at beginning of year	2017-08-31	$2,014,152
Value of fidelity bond covering the plan	2017-08-31	$15,000,000
Total contributions received or receivable from participants	2017-08-31	$0
Expenses. Other expenses not covered elsewhere	2017-08-31	$0
Contributions received from other sources (not participants or employers)	2017-08-31	$0
Other income received	2017-08-31	$254,426
Noncash contributions received	2017-08-31	$0
Net income (gross income less expenses)	2017-08-31	$-2,014,152
Net plan assets at end of year (total assets less liabilities)	2017-08-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2017-08-31	$2,014,152
Total contributions received or receivable from employer(s)	2017-08-31	$0
Value of certain deemed distributions of participant loans	2017-08-31	$0
Value of corrective distributions	2017-08-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2017-08-31	$13
2016 : MERCY MEDICAL CENTER, INC. 403(B) PLAN 2016 401k financial data
Transfers to/from the plan	2016-12-31	$0
Total plan liabilities at end of year	2016-12-31	$0
Total plan liabilities at beginning of year	2016-12-31	$0
Total income from all sources	2016-12-31	$132,203
Expenses. Total of all expenses incurred	2016-12-31	$393,735
Benefits paid (including direct rollovers)	2016-12-31	$393,647
Total plan assets at end of year	2016-12-31	$2,014,152
Total plan assets at beginning of year	2016-12-31	$2,275,684
Value of fidelity bond covering the plan	2016-12-31	$15,000,000
Total contributions received or receivable from participants	2016-12-31	$0
Expenses. Other expenses not covered elsewhere	2016-12-31	$0
Contributions received from other sources (not participants or employers)	2016-12-31	$0
Other income received	2016-12-31	$132,203
Noncash contributions received	2016-12-31	$0
Net income (gross income less expenses)	2016-12-31	$-261,532
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$2,014,152
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$2,275,684
Assets. Value of participant loans	2016-12-31	$0
Total contributions received or receivable from employer(s)	2016-12-31	$0
Value of certain deemed distributions of participant loans	2016-12-31	$0
Value of corrective distributions	2016-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$88
2015 : MERCY MEDICAL CENTER, INC. 403(B) PLAN 2015 401k financial data
Transfers to/from the plan	2015-12-31	$0
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$33,932
Expenses. Total of all expenses incurred	2015-12-31	$92,950
Benefits paid (including direct rollovers)	2015-12-31	$92,850
Total plan assets at end of year	2015-12-31	$2,275,684
Total plan assets at beginning of year	2015-12-31	$2,334,702
Value of fidelity bond covering the plan	2015-12-31	$15,000,000
Total contributions received or receivable from participants	2015-12-31	$0
Expenses. Other expenses not covered elsewhere	2015-12-31	$0
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$33,932
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$-59,018
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$2,275,684
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$2,334,702
Assets. Value of participant loans	2015-12-31	$3,342
Total contributions received or receivable from employer(s)	2015-12-31	$0
Value of certain deemed distributions of participant loans	2015-12-31	$0
Value of corrective distributions	2015-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$100

Form 5500 Responses for MERCY MEDICAL CENTER, INC. 403(B) PLAN

2017: MERCY MEDICAL CENTER, INC. 403(B) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	Yes
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: MERCY MEDICAL CENTER, INC. 403(B) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: MERCY MEDICAL CENTER, INC. 403(B) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )

Policy contract number

GA80042

Policy instance

Insurance contract or identification number	GA80042
Number of Individuals Covered	0
Insurance policy start date	2017-01-01
Insurance policy end date	2017-08-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )

Policy contract number

GA80042

Policy instance

Insurance contract or identification number	GA80042
Number of Individuals Covered	4
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	CLEVELAND CLINIC MERCY HOSPITAL FKA MERCY MEDICAL CENTER INC.
Employer identification number (EIN):	341893439
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	1913-03-17
Company Identification Number:	11966
Legal Registered Office Address:	1000 NORTH VILLAGE AVENUE Nassau ROCKVILLE CENTRE United States of America (USA) 11570