401k Plan data: BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN plan

BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 401k Plan overview

Plan Name	BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN
Plan identification number	504

BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision

401k Sponsoring company profile

BURGESS HEALTH CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: BURGESS HEALTH CORPORATION

Employer identification number (EIN): 421320408

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2016-01-01
504 2015-01-01
504 2014-01-01
504 2013-01-01
504 2012-01-01 FRANCIS TRAMP
504 2011-01-01 FRANCIS TRAMP
504 2010-01-01 FRANCIS TRAMP
504 2009-01-01 SHAWN GOSCH

Plan Statistics for BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN

401k plan membership statisitcs for BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN

Measure Date Value
2016: BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 173
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 181
Total of all active and inactive participants 2016-01-01 181
2015: BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 138
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 173
Total of all active and inactive participants 2015-01-01 173
2014: BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 132
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 138
Total of all active and inactive participants 2014-01-01 138
2013: BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 133
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 132
Total of all active and inactive participants 2013-01-01 132
2012: BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 128
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 133
Total of all active and inactive participants 2012-01-01 133
2011: BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 131
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 128
Total of all active and inactive participants 2011-01-01 128
2010: BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 126
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 131
Total of all active and inactive participants 2010-01-01 131
2009: BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 135
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 126
Total of all active and inactive participants 2009-01-01 126

Measure	Date	Value
2016: BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	173
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	181
Total of all active and inactive participants	2016-01-01	181
2015: BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	138
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	173
Total of all active and inactive participants	2015-01-01	173
2014: BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	132
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	138
Total of all active and inactive participants	2014-01-01	138
2013: BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	133
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	132
Total of all active and inactive participants	2013-01-01	132
2012: BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	128
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	133
Total of all active and inactive participants	2012-01-01	133
2011: BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	131
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	128
Total of all active and inactive participants	2011-01-01	128
2010: BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	126
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	131
Total of all active and inactive participants	2010-01-01	131
2009: BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	135
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	126
Total of all active and inactive participants	2009-01-01	126

Financial Data on BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN

Measure	Date	Value
2013 : BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$283,955
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$189,949
Total income from all sources (including contributions)	2013-12-31	$1,240,078
Total of all expenses incurred	2013-12-31	$1,774,416
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$1,670,142
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$1,239,945
Value of total assets at end of year	2013-12-31	$283,955
Value of total assets at beginning of year	2013-12-31	$724,287
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$104,274
Total interest from all sources	2013-12-31	$133
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Administrative expenses professional fees incurred	2013-12-31	$12,203
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$500,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$524,704
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$81,791
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$57,893
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-12-31	$28,160
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-12-31	$54,280
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-12-31	$72,559
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$-534,338
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$534,338
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$696,127
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$696,127
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$133
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$174,247
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$633,450
Employer contributions (assets) at end of year	2013-12-31	$226,062
Employer contributions (assets) at beginning of year	2013-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$1,495,895
Contract administrator fees	2013-12-31	$92,071
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2013-12-31	No
Liabilities. Value of benefit claims payable at end of year	2013-12-31	$229,675
Liabilities. Value of benefit claims payable at beginning of year	2013-12-31	$117,390
Did the plan have assets held for investment	2013-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	No
Opinion of an independent qualified public accountant for this plan	2013-12-31	Unqualified
Accountancy firm name	2013-12-31	SEIM JOHNSON, LLP
Accountancy firm EIN	2013-12-31	476097913
2012 : BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$189,949
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$157,849
Total income from all sources (including contributions)	2012-12-31	$1,615,111
Total of all expenses incurred	2012-12-31	$1,492,467
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$1,395,233
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$1,613,484
Value of total assets at end of year	2012-12-31	$724,287
Value of total assets at beginning of year	2012-12-31	$569,543
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$97,234
Total interest from all sources	2012-12-31	$1,627
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Administrative expenses professional fees incurred	2012-12-31	$8,990
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$500,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$466,236
Participant contributions at end of year	2012-12-31	$0
Participant contributions at beginning of year	2012-12-31	$1,121
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$204,944
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-12-31	$28,160
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$2,537
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-12-31	$72,559
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$67,431
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$122,644
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$534,338
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$411,694
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$696,127
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$565,885
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$565,885
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$1,627
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$283,147
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$942,304
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$1,112,086
Contract administrator fees	2012-12-31	$88,244
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2012-12-31	No
Liabilities. Value of benefit claims payable at end of year	2012-12-31	$117,390
Liabilities. Value of benefit claims payable at beginning of year	2012-12-31	$90,418
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	No
Opinion of an independent qualified public accountant for this plan	2012-12-31	Unqualified
Accountancy firm name	2012-12-31	SEIM JOHNSON, LLP
Accountancy firm EIN	2012-12-31	476097913
2011 : BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$157,849
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$185,676
Total income from all sources (including contributions)	2011-12-31	$1,604,515
Total of all expenses incurred	2011-12-31	$1,357,424
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$1,262,465
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$1,601,849
Value of total assets at end of year	2011-12-31	$569,543
Value of total assets at beginning of year	2011-12-31	$350,279
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$94,959
Total interest from all sources	2011-12-31	$2,666
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Administrative expenses professional fees incurred	2011-12-31	$11,760
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$500,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$420,376
Participant contributions at end of year	2011-12-31	$1,121
Participant contributions at beginning of year	2011-12-31	$512
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$91,879
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$2,537
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$59,389
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$67,431
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$60,366
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$247,091
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$411,694
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$164,603
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$565,885
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$290,378
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$290,378
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$2,666
Expenses. Payments to insurance carriers foe the provision of benefits	2011-12-31	$269,823
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$1,089,594
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$992,642
Contract administrator fees	2011-12-31	$83,199
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2011-12-31	No
Liabilities. Value of benefit claims payable at end of year	2011-12-31	$90,418
Liabilities. Value of benefit claims payable at beginning of year	2011-12-31	$125,310
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	No
Opinion of an independent qualified public accountant for this plan	2011-12-31	Unqualified
Accountancy firm name	2011-12-31	SEIM JOHNSON, LLP
Accountancy firm EIN	2011-12-31	476097913
2010 : BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2010 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$185,676
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$258,434
Total income from all sources (including contributions)	2010-12-31	$1,567,327
Total of all expenses incurred	2010-12-31	$1,515,228
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$1,426,636
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$1,565,356
Value of total assets at end of year	2010-12-31	$350,279
Value of total assets at beginning of year	2010-12-31	$370,938
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$88,592
Total interest from all sources	2010-12-31	$1,971
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Administrative expenses professional fees incurred	2010-12-31	$11,820
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$500,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$351,262
Participant contributions at end of year	2010-12-31	$512
Participant contributions at beginning of year	2010-12-31	$895
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$255,893
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$59,389
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$16,683
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-12-31	$60,366
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$31,761
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$52,099
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$164,603
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$112,504
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$290,378
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$353,360
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$353,360
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$1,971
Expenses. Payments to insurance carriers foe the provision of benefits	2010-12-31	$221,360
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$958,201
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$1,205,276
Contract administrator fees	2010-12-31	$76,772
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2010-12-31	No
Liabilities. Value of benefit claims payable at end of year	2010-12-31	$125,310
Liabilities. Value of benefit claims payable at beginning of year	2010-12-31	$226,673
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	No
Opinion of an independent qualified public accountant for this plan	2010-12-31	Unqualified
Accountancy firm name	2010-12-31	SEIM JOHNSON, LLP
Accountancy firm EIN	2010-12-31	476097913

Form 5500 Responses for BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN

2016: BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: BURGESS HEALTH CORP EMPLOYEE HEALTH PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )

Policy contract number

050

Policy instance

Insurance contract or identification number	050
Number of Individuals Covered	132
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )

Policy contract number

050

Policy instance

Insurance contract or identification number	050
Number of Individuals Covered	133
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )

Policy contract number

050

Policy instance

Insurance contract or identification number	050
Number of Individuals Covered	128
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )

Policy contract number

050

Policy instance

Insurance contract or identification number	050
Number of Individuals Covered	131
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

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Company Name:	BURGESS HEALTH CORPORATION
Employer identification number (EIN):	421320408
NAIC Classification:	622000
NAIC Description:	Hospitals