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HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 401k Plan overview

Plan NameHENRY COUNTY HOSPITAL, INC. 401(K) PLAN
Plan identification number 002

HENRY COUNTY HOSPITAL, INC. 401(K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • 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.
  • Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
  • 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

HENRY COUNTY HOSPITAL, INC. has sponsored the creation of one or more 401k plans.

Company Name:HENRY COUNTY HOSPITAL, INC.
Employer identification number (EIN):344477047
NAIC Classification:622000
NAIC Description: Hospitals

Additional information about HENRY COUNTY HOSPITAL, INC.

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division
Incorporation Date: 1958-04-19
Company Identification Number: 270733
Legal Registered Office Address: 1600 E. RIVERVIEW AVE
-
NAPOLEON
United States of America (USA)
43545

More information about HENRY COUNTY HOSPITAL, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HENRY COUNTY HOSPITAL, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022022-01-01KRISTI BARND2023-10-03 KRISTI BARND2023-10-03
0022021-01-01KRISTI BARND2022-10-04 KRISTI BARND2022-10-04
0022020-01-01KRISTI BARND2021-10-07 KRISTI BARND2021-10-07
0022019-01-01KRISTI BARND2020-10-09 KRISTI BARND2020-10-09
0022018-01-01KIM BORDENKIRCHER2019-09-23 KIM BORDENKIRCHER2019-09-23
0022017-01-01
0022016-01-01
0022015-01-01
0022014-01-01
0022013-01-01
0022012-01-01KIM BORDENKIRCHER KIM BORDENKIRCHER2013-10-02
0022011-01-01KIM BORDENKIRCHER KIM BORDENKIRCHER2012-10-09
0022010-01-01KIM BORDENKIRCHER KIM BORDENKIRCHER2011-09-30
0022009-01-01KIM BORDENKIRCHER KIM BORDENKIRCHER2010-08-31
0022009-01-01KIM BORDENKIRCHER KIM BORDENKIRCHER2010-09-01

Plan Statistics for HENRY COUNTY HOSPITAL, INC. 401(K) PLAN

401k plan membership statisitcs for HENRY COUNTY HOSPITAL, INC. 401(K) PLAN

Measure Date Value
2022: HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01354
Total number of active participants reported on line 7a of the Form 55002022-01-01287
Number of other retired or separated participants entitled to future benefits2022-01-01102
Total of all active and inactive participants2022-01-01389
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01389
Number of participants with account balances2022-01-01373
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-0132
2021: HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01331
Total number of active participants reported on line 7a of the Form 55002021-01-01266
Number of other retired or separated participants entitled to future benefits2021-01-0188
Total of all active and inactive participants2021-01-01354
Total participants2021-01-01354
Number of participants with account balances2021-01-01349
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-0163
2020: HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01335
Total number of active participants reported on line 7a of the Form 55002020-01-01258
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0173
Total of all active and inactive participants2020-01-01331
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01331
Number of participants with account balances2020-01-01331
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-0143
2019: HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01346
Total number of active participants reported on line 7a of the Form 55002019-01-01277
Number of other retired or separated participants entitled to future benefits2019-01-0158
Total of all active and inactive participants2019-01-01335
Total participants2019-01-01335
Number of participants with account balances2019-01-01332
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-0140
2018: HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01341
Total number of active participants reported on line 7a of the Form 55002018-01-01284
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-0162
Total of all active and inactive participants2018-01-01346
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01346
Number of participants with account balances2018-01-01343
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-0141
2017: HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01325
Total number of active participants reported on line 7a of the Form 55002017-01-01285
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-0156
Total of all active and inactive participants2017-01-01341
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-01341
Number of participants with account balances2017-01-01339
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-0136
2016: HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01308
Total number of active participants reported on line 7a of the Form 55002016-01-01275
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-0150
Total of all active and inactive participants2016-01-01325
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-01325
Number of participants with account balances2016-01-01323
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-0124
2015: HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01299
Total number of active participants reported on line 7a of the Form 55002015-01-01260
Number of other retired or separated participants entitled to future benefits2015-01-0148
Total of all active and inactive participants2015-01-01308
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-01308
Number of participants with account balances2015-01-01300
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-0133
2014: HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01282
Total number of active participants reported on line 7a of the Form 55002014-01-01263
Number of other retired or separated participants entitled to future benefits2014-01-0136
Total of all active and inactive participants2014-01-01299
Total participants2014-01-01299
Number of participants with account balances2014-01-01268
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-016
2013: HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01260
Total number of active participants reported on line 7a of the Form 55002013-01-01252
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-0130
Total of all active and inactive participants2013-01-01282
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-01282
Number of participants with account balances2013-01-01247
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-0116
2012: HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01266
Total number of active participants reported on line 7a of the Form 55002012-01-01239
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-0121
Total of all active and inactive participants2012-01-01260
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-01260
Number of participants with account balances2012-01-01234
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-0114
2011: HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01256
Total number of active participants reported on line 7a of the Form 55002011-01-01241
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-0125
Total of all active and inactive participants2011-01-01266
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-01266
Number of participants with account balances2011-01-01238
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-0118
2010: HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01257
Total number of active participants reported on line 7a of the Form 55002010-01-01233
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-0123
Total of all active and inactive participants2010-01-01256
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-01256
Number of participants with account balances2010-01-01232
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-0116
2009: HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01250
Total number of active participants reported on line 7a of the Form 55002009-01-01241
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-0116
Total of all active and inactive participants2009-01-01257
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-01257
Number of participants with account balances2009-01-01243
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-018

Financial Data on HENRY COUNTY HOSPITAL, INC. 401(K) PLAN

Measure Date Value
2022 : HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2022 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$180
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$77
Total income from all sources (including contributions)2022-12-31$-1,372,358
Total of all expenses incurred2022-12-31$882,983
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$877,448
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$1,338,722
Value of total assets at end of year2022-12-31$13,742,943
Value of total assets at beginning of year2022-12-31$15,998,181
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$5,535
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Administrative expenses professional fees incurred2022-12-31$5,535
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 period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$983,706
Total non interest bearing cash at end of year2022-12-31$12,938
Total non interest bearing cash at beginning of year2022-12-31$20,973
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-2,255,341
Value of net assets at end of year (total assets less liabilities)2022-12-31$13,742,763
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$15,998,104
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 pooled separate accounts at end of year2022-12-31$13,491,820
Value of interest in pooled separate accounts at beginning of year2022-12-31$15,749,647
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-2,711,080
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$355,016
Employer contributions (assets) at end of year2022-12-31$238,185
Employer contributions (assets) at beginning of year2022-12-31$227,561
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$877,448
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
Liabilities. Value of acquisition indebtedness at end of year2022-12-31$180
Liabilities. Value of acquisition indebtedness at beginning of year2022-12-31$77
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31BLUE & CO.
Accountancy firm EIN2022-12-31351178662
2021 : HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2021 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$77
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$744
Total income from all sources (including contributions)2021-12-31$3,067,176
Total of all expenses incurred2021-12-31$745,080
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$738,780
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$1,288,094
Value of total assets at end of year2021-12-31$15,998,181
Value of total assets at beginning of year2021-12-31$13,676,752
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$6,300
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Administrative expenses professional fees incurred2021-12-31$6,300
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
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$920,985
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$20,710
Total non interest bearing cash at end of year2021-12-31$20,973
Total non interest bearing cash at beginning of year2021-12-31$15,983
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$2,322,096
Value of net assets at end of year (total assets less liabilities)2021-12-31$15,998,104
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$13,676,008
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 pooled separate accounts at end of year2021-12-31$15,749,647
Value of interest in pooled separate accounts at beginning of year2021-12-31$13,427,675
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$1,779,082
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$346,399
Employer contributions (assets) at end of year2021-12-31$227,561
Employer contributions (assets) at beginning of year2021-12-31$233,094
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$738,780
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
Liabilities. Value of acquisition indebtedness at end of year2021-12-31$77
Liabilities. Value of acquisition indebtedness at beginning of year2021-12-31$744
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31BLUE & CO.
Accountancy firm EIN2021-12-31351178662
2020 : HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2020 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$744
Total income from all sources (including contributions)2020-12-31$3,264,835
Total of all expenses incurred2020-12-31$1,147,944
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$1,142,814
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$1,317,905
Value of total assets at end of year2020-12-31$13,676,752
Value of total assets at beginning of year2020-12-31$11,559,117
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$5,130
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Administrative expenses professional fees incurred2020-12-31$5,130
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
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$915,382
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$45,091
Total non interest bearing cash at end of year2020-12-31$15,983
Total non interest bearing cash at beginning of year2020-12-31$17,052
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$2,116,891
Value of net assets at end of year (total assets less liabilities)2020-12-31$13,676,008
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$11,559,117
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 pooled separate accounts at end of year2020-12-31$13,427,675
Value of interest in pooled separate accounts at beginning of year2020-12-31$11,319,351
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$1,946,930
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$357,432
Employer contributions (assets) at end of year2020-12-31$233,094
Employer contributions (assets) at beginning of year2020-12-31$222,714
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$1,142,814
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
Liabilities. Value of acquisition indebtedness at end of year2020-12-31$744
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31BLUE & CO.
Accountancy firm EIN2020-12-31351178662
2019 : HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2019 401k financial data
Total income from all sources (including contributions)2019-12-31$3,114,243
Total of all expenses incurred2019-12-31$947,134
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$939,844
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$1,193,236
Value of total assets at end of year2019-12-31$11,559,117
Value of total assets at beginning of year2019-12-31$9,392,008
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$7,290
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Administrative expenses professional fees incurred2019-12-31$7,290
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
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
Contributions received from participants2019-12-31$852,193
Total non interest bearing cash at end of year2019-12-31$17,052
Total non interest bearing cash at beginning of year2019-12-31$10,615
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$2,167,109
Value of net assets at end of year (total assets less liabilities)2019-12-31$11,559,117
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$9,392,008
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 leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in pooled separate accounts at end of year2019-12-31$11,319,351
Value of interest in pooled separate accounts at beginning of year2019-12-31$9,171,194
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$1,921,007
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
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$341,043
Employer contributions (assets) at end of year2019-12-31$222,714
Employer contributions (assets) at beginning of year2019-12-31$210,199
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$939,844
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
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
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31BLUE & CO.
Accountancy firm EIN2019-12-31351178662
2018 : HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2018 401k financial data
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$243
Total income from all sources (including contributions)2018-12-31$342,951
Total of all expenses incurred2018-12-31$1,335,613
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$1,330,708
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$1,112,097
Value of total assets at end of year2018-12-31$9,392,008
Value of total assets at beginning of year2018-12-31$10,384,913
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$4,905
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Administrative expenses professional fees incurred2018-12-31$4,905
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$500,000
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$797,688
Total non interest bearing cash at end of year2018-12-31$10,615
Total non interest bearing cash at beginning of year2018-12-31$9,600
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-992,662
Value of net assets at end of year (total assets less liabilities)2018-12-31$9,392,008
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$10,384,670
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 in pooled separate accounts at end of year2018-12-31$9,171,194
Value of interest in pooled separate accounts at beginning of year2018-12-31$10,172,330
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-769,146
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$314,409
Employer contributions (assets) at end of year2018-12-31$210,199
Employer contributions (assets) at beginning of year2018-12-31$202,983
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$1,330,708
Liabilities. Value of benefit claims payable at beginning of year2018-12-31$243
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party 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)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31BLUE & CO.
Accountancy firm EIN2018-12-31351178662
2017 : HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2017 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$243
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$796
Total income from all sources (including contributions)2017-12-31$2,488,958
Total of all expenses incurred2017-12-31$862,994
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$858,404
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$1,021,632
Value of total assets at end of year2017-12-31$10,384,913
Value of total assets at beginning of year2017-12-31$8,759,502
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$4,590
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Administrative expenses professional fees incurred2017-12-31$4,590
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$500,000
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$716,631
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$1,631
Total non interest bearing cash at end of year2017-12-31$9,600
Total non interest bearing cash at beginning of year2017-12-31$10,192
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$1,625,964
Value of net assets at end of year (total assets less liabilities)2017-12-31$10,384,670
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$8,758,706
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 in pooled separate accounts at end of year2017-12-31$10,172,330
Value of interest in pooled separate accounts at beginning of year2017-12-31$8,552,935
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$1,467,326
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$303,370
Employer contributions (assets) at end of year2017-12-31$202,983
Employer contributions (assets) at beginning of year2017-12-31$196,375
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$858,404
Liabilities. Value of benefit claims payable at end of year2017-12-31$243
Liabilities. Value of benefit claims payable at beginning of year2017-12-31$796
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party 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
Liabilities. Value of acquisition indebtedness at beginning of year2017-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31Yes
Opinion of an independent qualified public accountant for this plan2017-12-31Disclaimer
Accountancy firm name2017-12-31BLUE & CO.
Accountancy firm EIN2017-12-31351178662
2016 : HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2016 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$796
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$915
Total income from all sources (including contributions)2016-12-31$1,532,921
Total of all expenses incurred2016-12-31$918,938
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$914,615
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$986,900
Value of total assets at end of year2016-12-31$8,759,502
Value of total assets at beginning of year2016-12-31$8,145,638
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$4,323
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Administrative expenses professional fees incurred2016-12-31$4,323
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$500,000
If this is an individual account plan, was there a blackout period2016-12-31No
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$667,701
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$5,399
Other income not declared elsewhere2016-12-31$5,758
Total non interest bearing cash at end of year2016-12-31$10,192
Total non interest bearing cash at beginning of year2016-12-31$7,788
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$613,983
Value of net assets at end of year (total assets less liabilities)2016-12-31$8,758,706
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$8,144,723
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
Value of interest in pooled separate accounts at end of year2016-12-31$8,552,935
Value of interest in pooled separate accounts at beginning of year2016-12-31$7,949,214
Net investment gain/loss from pooled separate accounts2016-12-31$540,263
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$313,800
Employer contributions (assets) at end of year2016-12-31$196,375
Employer contributions (assets) at beginning of year2016-12-31$188,636
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$914,615
Liabilities. Value of benefit claims payable at end of year2016-12-31$796
Liabilities. Value of benefit claims payable at beginning of year2016-12-31$915
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party 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
Liabilities. Value of acquisition indebtedness at end of year2016-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31BLUE & CO.
Accountancy firm EIN2016-12-31351178662
2015 : HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2015 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$915
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$788
Total income from all sources (including contributions)2015-12-31$873,235
Total of all expenses incurred2015-12-31$712,397
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$708,250
Value of total corrective distributions2015-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$997,517
Value of total assets at end of year2015-12-31$8,145,638
Value of total assets at beginning of year2015-12-31$7,984,673
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$4,147
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$500,000
If this is an individual account plan, was there a blackout period2015-12-31No
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$698,161
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$21,233
Other income not declared elsewhere2015-12-31$5,749
Total non interest bearing cash at end of year2015-12-31$7,788
Total non interest bearing cash at beginning of year2015-12-31$9,022
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$160,838
Value of net assets at end of year (total assets less liabilities)2015-12-31$8,144,723
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$7,983,885
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
Investment advisory and management fees2015-12-31$4,147
Value of interest in pooled separate accounts at end of year2015-12-31$7,949,214
Value of interest in pooled separate accounts at beginning of year2015-12-31$7,789,577
Net investment gain/loss from pooled separate accounts2015-12-31$-130,031
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$278,123
Employer contributions (assets) at end of year2015-12-31$188,636
Employer contributions (assets) at beginning of year2015-12-31$186,074
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$708,250
Liabilities. Value of benefit claims payable at end of year2015-12-31$915
Liabilities. Value of benefit claims payable at beginning of year2015-12-31$788
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)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31BLUE & CO.
Accountancy firm EIN2015-12-31351178662
2014 : HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$788
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$597
Total income from all sources (including contributions)2014-12-31$1,230,953
Total of all expenses incurred2014-12-31$1,032,685
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$1,030,119
Value of total corrective distributions2014-12-31$406
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$901,974
Value of total assets at end of year2014-12-31$7,984,673
Value of total assets at beginning of year2014-12-31$7,786,214
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$2,160
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$500,000
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$555,606
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$66,340
Other income not declared elsewhere2014-12-31$35
Total non interest bearing cash at end of year2014-12-31$9,022
Total non interest bearing cash at beginning of year2014-12-31$5,502
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
Value of net income/loss2014-12-31$198,268
Value of net assets at end of year (total assets less liabilities)2014-12-31$7,983,885
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$7,785,617
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
Investment advisory and management fees2014-12-31$2,160
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$11,276
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$9,369
Value of interest in pooled separate accounts at end of year2014-12-31$7,778,301
Value of interest in pooled separate accounts at beginning of year2014-12-31$7,589,287
Net investment gain/loss from pooled separate accounts2014-12-31$328,944
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$280,028
Employer contributions (assets) at end of year2014-12-31$186,074
Employer contributions (assets) at beginning of year2014-12-31$182,056
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$1,030,119
Liabilities. Value of benefit claims payable at end of year2014-12-31$788
Liabilities. Value of benefit claims payable at beginning of year2014-12-31$597
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)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31BLUE & CO.
Accountancy firm EIN2014-12-31351178662
2013 : HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$597
Total income from all sources (including contributions)2013-12-31$1,918,481
Total of all expenses incurred2013-12-31$584,092
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$578,362
Value of total corrective distributions2013-12-31$597
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$765,047
Value of total assets at end of year2013-12-31$7,786,214
Value of total assets at beginning of year2013-12-31$6,451,228
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$5,133
Total interest from all sources2013-12-31$1,966
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$500,000
If this is an individual account plan, was there a blackout period2013-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$497,887
Income. Received or receivable in cash from other sources (including rollovers)2013-12-31$0
Other income not declared elsewhere2013-12-31$42
Total non interest bearing cash at end of year2013-12-31$5,502
Total non interest bearing cash at beginning of year2013-12-31$8,742
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
Income. Non cash contributions2013-12-31$0
Value of net income/loss2013-12-31$1,334,389
Value of net assets at end of year (total assets less liabilities)2013-12-31$7,785,617
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$6,451,228
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 registered invesment companies (eg mutual funds) at end of year2013-12-31$9,369
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$8,275
Value of interest in pooled separate accounts at end of year2013-12-31$7,589,287
Value of interest in pooled separate accounts at beginning of year2013-12-31$6,263,018
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-12-31$1,966
Net investment gain/loss from pooled separate accounts2013-12-31$1,151,426
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$267,160
Employer contributions (assets) at end of year2013-12-31$182,056
Employer contributions (assets) at beginning of year2013-12-31$171,193
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$578,362
Contract administrator fees2013-12-31$5,133
Liabilities. Value of benefit claims payable at end of year2013-12-31$597
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)2013-12-31Yes
Opinion of an independent qualified public accountant for this plan2013-12-31Disclaimer
Accountancy firm name2013-12-31BLUE & CO.
Accountancy firm EIN2013-12-31351178662
2012 : HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$1,877
Total income from all sources (including contributions)2012-12-31$1,521,068
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$978,946
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$970,416
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$729,124
Value of total assets at end of year2012-12-31$6,451,228
Value of total assets at beginning of year2012-12-31$5,910,983
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$8,530
Total interest from all sources2012-12-31$1,815
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$0
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$500,000
If this is an individual account plan, was there a blackout period2012-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$476,641
Participant contributions at beginning of year2012-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$7,727
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-12-31$1,877
Other income not declared elsewhere2012-12-31$211
Total non interest bearing cash at end of year2012-12-31$8,742
Total non interest bearing cash at beginning of year2012-12-31$9,614
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
Income. Non cash contributions2012-12-31$0
Value of net income/loss2012-12-31$542,122
Value of net assets at end of year (total assets less liabilities)2012-12-31$6,451,228
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$5,909,106
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 pooled separate accounts at end of year2012-12-31$6,263,018
Value of interest in pooled separate accounts at beginning of year2012-12-31$5,727,436
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-12-31$1,815
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-12-31$8,275
Net investment gain/loss from pooled separate accounts2012-12-31$789,918
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$244,756
Employer contributions (assets) at end of year2012-12-31$171,193
Employer contributions (assets) at beginning of year2012-12-31$173,933
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$970,416
Contract administrator fees2012-12-31$8,530
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-12-31No
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)2012-12-31Yes
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31BLUE & CO., LLC
Accountancy firm EIN2012-12-31351178662
2011 : HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$1,877
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$219
Total income from all sources (including contributions)2011-12-31$531,223
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$640,854
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$634,346
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$690,504
Value of total assets at end of year2011-12-31$5,910,983
Value of total assets at beginning of year2011-12-31$6,018,956
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$6,508
Total interest from all sources2011-12-31$55
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$0
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$500,000
If this is an individual account plan, was there a blackout period2011-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$433,464
Participant contributions at end of year2011-12-31$0
Participant contributions at beginning of year2011-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2011-12-31$2,585
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2011-12-31$-91
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-12-31$1,877
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-12-31$219
Other income not declared elsewhere2011-12-31$1,563
Total non interest bearing cash at end of year2011-12-31$9,614
Total non interest bearing cash at beginning of year2011-12-31$1,563
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
Income. Non cash contributions2011-12-31$0
Value of net income/loss2011-12-31$-109,631
Value of net assets at end of year (total assets less liabilities)2011-12-31$5,909,106
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$6,018,737
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
Value of interest in pooled separate accounts at end of year2011-12-31$5,727,436
Value of interest in pooled separate accounts at beginning of year2011-12-31$5,862,049
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$55
Net investment gain/loss from pooled separate accounts2011-12-31$-160,899
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$254,455
Employer contributions (assets) at end of year2011-12-31$173,933
Employer contributions (assets) at beginning of year2011-12-31$155,344
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$634,437
Contract administrator fees2011-12-31$6,508
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-12-31No
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)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31BLUE & CO., LLC
Accountancy firm EIN2011-12-31351178662
2010 : HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets2010-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$219
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total income from all sources (including contributions)2010-12-31$1,285,260
Total loss/gain on sale of assets2010-12-31$0
Total of all expenses incurred2010-12-31$598,421
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$593,386
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$599,894
Value of total assets at end of year2010-12-31$6,018,956
Value of total assets at beginning of year2010-12-31$5,331,898
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$5,035
Total interest from all sources2010-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$0
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$500,000
If this is an individual account plan, was there a blackout period2010-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$378,640
Participant contributions at end of year2010-12-31$0
Participant contributions at beginning of year2010-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2010-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2010-12-31$219
Total non interest bearing cash at end of year2010-12-31$1,563
Total non interest bearing cash at beginning of year2010-12-31$6,166
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
Income. Non cash contributions2010-12-31$0
Value of net income/loss2010-12-31$686,839
Value of net assets at end of year (total assets less liabilities)2010-12-31$6,018,737
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$5,331,898
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
Value of interest in pooled separate accounts at end of year2010-12-31$5,862,049
Value of interest in pooled separate accounts at beginning of year2010-12-31$5,157,243
Net investment gain/loss from pooled separate accounts2010-12-31$685,366
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$221,254
Employer contributions (assets) at end of year2010-12-31$155,344
Employer contributions (assets) at beginning of year2010-12-31$168,489
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$593,386
Contract administrator fees2010-12-31$5,035
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-12-31No
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)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31BLUE & CO., LLC
Accountancy firm EIN2010-12-31351178662
2009 : HENRY COUNTY HOSPITAL, INC. 401(K) 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 HENRY COUNTY HOSPITAL, INC. 401(K) PLAN

2022: HENRY COUNTY HOSPITAL, INC. 401(K) 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 benefit arrangement – InsuranceYes
2021: HENRY COUNTY HOSPITAL, INC. 401(K) 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 benefit arrangement – InsuranceYes
2020: HENRY COUNTY HOSPITAL, INC. 401(K) 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 benefit arrangement – InsuranceYes
2019: HENRY COUNTY HOSPITAL, INC. 401(K) 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 benefit arrangement – InsuranceYes
2018: HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: HENRY COUNTY HOSPITAL, INC. 401(K) PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: HENRY COUNTY HOSPITAL, INC. 401(K) 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 – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number27086
Policy instance 1
Insurance contract or identification number27086
Number of Individuals Covered406
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $41,561
Total amount of fees paid to insurance companyUSD $12,535
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Commission paid to Insurance BrokerUSD $41,561
Insurance broker organization code?3
Amount paid for insurance broker fees5535
Additional information about fees paid to insurance brokerTPA FEES
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number27086
Policy instance 1
Insurance contract or identification number27086
Number of Individuals Covered383
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $42,665
Total amount of fees paid to insurance companyUSD $13,578
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Commission paid to Insurance BrokerUSD $42,665
Insurance broker organization code?3
Amount paid for insurance broker fees6300
Additional information about fees paid to insurance brokerTPA FEES
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number27086
Policy instance 1
Insurance contract or identification number27086
Number of Individuals Covered363
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $34,262
Total amount of fees paid to insurance companyUSD $10,770
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Commission paid to Insurance BrokerUSD $34,262
Insurance broker organization code?3
Amount paid for insurance broker fees5130
Additional information about fees paid to insurance brokerTPA FEES
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number27086
Policy instance 1
Insurance contract or identification number27086
Number of Individuals Covered362
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $31,534
Total amount of fees paid to insurance companyUSD $12,426
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Commission paid to Insurance BrokerUSD $31,534
Insurance broker organization code?3
Amount paid for insurance broker fees7290
Additional information about fees paid to insurance brokerTPA FEES
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number27086
Policy instance 1
Insurance contract or identification number27086
Number of Individuals Covered374
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $30,746
Total amount of fees paid to insurance companyUSD $9,968
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Commission paid to Insurance BrokerUSD $30,746
Insurance broker organization code?3
Amount paid for insurance broker fees4905
Additional information about fees paid to insurance brokerTPA FEES
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number27086
Policy instance 1
Insurance contract or identification number27086
Number of Individuals Covered357
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $37,557
Total amount of fees paid to insurance companyUSD $34
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Commission paid to Insurance BrokerUSD $28,307
Insurance broker organization code?3
Additional information about fees paid to insurance brokerTPA FEES
Amount paid for insurance broker fees34
Insurance broker namePENSION INNOVATIONS & CONSULTING
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number27086
Policy instance 1
Insurance contract or identification number27086
Number of Individuals Covered318
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $29,115
Total amount of fees paid to insurance companyUSD $4,147
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Commission paid to Insurance BrokerUSD $25,029
Insurance broker organization code?3
Amount paid for insurance broker fees4147
Additional information about fees paid to insurance brokerTPA FEES
Insurance broker namePENSION INNOVATIONS & CONSULTING
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number27086
Policy instance 1
Insurance contract or identification number27086
Number of Individuals Covered280
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $22,981
Total amount of fees paid to insurance companyUSD $3,825
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Commission paid to Insurance BrokerUSD $22,981
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker namePENSION INNOVATIONS & CONSULTING
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number27086
Policy instance 1
Insurance contract or identification number27086
Number of Individuals Covered275
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $20,930
Total amount of fees paid to insurance companyUSD $3,457
Commission paid to Insurance BrokerUSD $13,658
Insurance broker organization code?3
Amount paid for insurance broker fees3457
Additional information about fees paid to insurance brokerNOT PART OF PLAN CONTRACT OR PLAN COSTS
Insurance broker namePENSION INNOVATIONS & CONSULTING
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number27086
Policy instance 1
Insurance contract or identification number27086
Number of Individuals Covered251
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $18,776
Total amount of fees paid to insurance companyUSD $3,037
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?Yes
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
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $18,776
Insurance broker organization code?3
Amount paid for insurance broker fees3037
Additional information about fees paid to insurance brokerNOT PART OF PLAN CONTRACT OR PLAN COSTS
Insurance broker namePENSION INNOVATIONS & CONSULTING
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number27086
Policy instance 1
Insurance contract or identification number27086
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $17,813
Total amount of fees paid to insurance companyUSD $4,442
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?Yes
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
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number27086
Policy instance 1
Insurance contract or identification number27086
Number of Individuals Covered247
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $15,880
Total amount of fees paid to insurance companyUSD $2,589
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?Yes
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
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $15,880
Insurance broker organization code?3
Amount paid for insurance broker fees2589
Additional information about fees paid to insurance brokerNOT PART OF PLAN CONTRACT OR PLAN COSTS
Insurance broker namePENSION INNOVATIONS & CONSULTING

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