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| Plan Name | NORTH DAKOTA HOSPITAL ASSOCIATION SAFE HARBOR 401(K) PLAN |
| Plan identification number | 003 |
| 401k Plan Type | Defined Contribution Pension |
| Plan Features/Benefits |
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| Company Name: | NORTH DAKOTA HOSPITAL ASSOCIATION |
| Employer identification number (EIN): | 450274165 |
| NAIC Classification: | 561110 |
| NAIC Description: | Office Administrative Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 003 | 2022-01-01 | KELLY CERMAK | 2023-07-24 | KELLY CERMAK | 2023-07-24 |
| 003 | 2021-01-01 | KELLY CERMAK | 2022-07-14 | KELLY CERMAK | 2022-07-14 |
| 003 | 2020-01-01 | KELLY CERMAK | 2021-07-23 | KELLY CERMAK | 2021-07-23 |
| 003 | 2019-01-01 | CALLEN CERMAK | 2020-07-16 | CALLEN CERMAK | 2020-07-16 |
| 003 | 2018-01-01 | CALLEN CERMAK | 2019-07-26 | CALLEN CERMAK | 2019-07-26 |
| 003 | 2017-01-01 | CALLEN CERMAK | 2018-07-30 | CALLEN CERMAK | 2018-07-30 |
| 003 | 2016-01-01 | CALLEN CERMAK | 2017-07-27 | CALLEN CERMAK | 2017-07-27 |
| 003 | 2015-01-01 | CALLEN CERMAK | 2016-10-12 | CALLEN CERMAK | 2016-10-12 |
| 003 | 2014-01-01 | CALLEN CERMAK | 2015-06-26 | CALLEN CERMAK | 2015-06-26 |
| 003 | 2012-01-01 | CALLEN CERMAK | 2013-07-09 | CALLEN CERMAK | 2013-07-09 |
| 003 | 2011-01-01 | DEANN KUNTZ | 2012-05-11 | ||
| 003 | 2009-01-01 | DEANN LAFOND |
| Measure | Date | Value |
|---|---|---|
| 2009: NORTH DAKOTA HOSPITAL ASSOCIATION SAFE HARBOR 401(K) PLAN 2009 401k membership | ||
| Total participants, beginning-of-year | 2009-01-01 | 6 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 5 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 5 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-01-01 | 0 |
| Total participants | 2009-01-01 | 5 |
| Number of participants with account balances | 2009-01-01 | 5 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2009-01-01 | 0 |
| Measure | Date | Value |
|---|---|---|
| 2010 : NORTH DAKOTA HOSPITAL ASSOCIATION SAFE HARBOR 401(K) PLAN 2010 401k financial data | ||
| Total income from all sources | 2010-12-31 | $221,170 |
| Expenses. Total of all expenses incurred | 2010-12-31 | $3,167 |
| Total plan assets at end of year | 2010-12-31 | $399,825 |
| Total plan assets at beginning of year | 2010-12-31 | $181,822 |
| Value of fidelity bond covering the plan | 2010-12-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2010-12-31 | $34,143 |
| Contributions received from other sources (not participants or employers) | 2010-12-31 | $115,823 |
| Other income received | 2010-12-31 | $36,293 |
| Net income (gross income less expenses) | 2010-12-31 | $218,003 |
| Net plan assets at end of year (total assets less liabilities) | 2010-12-31 | $399,825 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-12-31 | $181,822 |
| Total contributions received or receivable from employer(s) | 2010-12-31 | $34,911 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2010-12-31 | $3,167 |
| 2009: NORTH DAKOTA HOSPITAL ASSOCIATION SAFE HARBOR 401(K) PLAN 2009 form 5500 responses | ||
|---|---|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Trust | Yes |
| 2009-01-01 | Plan benefit arrangement - Trust | Yes |
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