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HEALTH SERVICES 401(K) RETIREMENT PLAN 401k Plan overview

Plan NameHEALTH SERVICES 401(K) RETIREMENT PLAN
Plan identification number 001

HEALTH SERVICES 401(K) RETIREMENT 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.
  • 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

COMPASS HEALTHCARE SOLUTIONS, LLC has sponsored the creation of one or more 401k plans.

Company Name:COMPASS HEALTHCARE SOLUTIONS, LLC
Employer identification number (EIN):471743028
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Additional information about COMPASS HEALTHCARE SOLUTIONS, LLC

Jurisdiction of Incorporation: Florida Department of State Division of Corporations
Incorporation Date: 2014-08-25
Company Identification Number: L14000132960
Legal Registered Office Address: 220 MCKENZIE AVENUE

PANAMA CITY

32401

More information about COMPASS HEALTHCARE SOLUTIONS, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HEALTH SERVICES 401(K) RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01DUANE GALLAGHER2023-09-22
0012021-01-01DUANE GALLAGHER2022-10-11
0012020-01-01DUANE GALLAGHER2021-10-06 DUANE GALLAGHER2021-10-06
0012019-01-01DUANE GALLAGHER2020-08-20
0012018-01-01DUANE GALLAGHER2019-10-14
0012017-01-01
0012016-01-01
0012015-01-01
0012014-01-01DUANE GALLAGHER2015-09-28

Plan Statistics for HEALTH SERVICES 401(K) RETIREMENT PLAN

401k plan membership statisitcs for HEALTH SERVICES 401(K) RETIREMENT PLAN

Measure Date Value
2022: HEALTH SERVICES 401(K) RETIREMENT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01134
Total number of active participants reported on line 7a of the Form 55002022-01-01141
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-018
Total of all active and inactive participants2022-01-01149
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-011
Total participants2022-01-01150
Number of participants with account balances2022-01-0134
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: HEALTH SERVICES 401(K) RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01158
Total number of active participants reported on line 7a of the Form 55002021-01-01125
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-018
Total of all active and inactive participants2021-01-01133
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-011
Total participants2021-01-01134
Number of participants with account balances2021-01-0140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: HEALTH SERVICES 401(K) RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01166
Total number of active participants reported on line 7a of the Form 55002020-01-01150
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-017
Total of all active and inactive participants2020-01-01157
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-011
Total participants2020-01-01158
Number of participants with account balances2020-01-0140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: HEALTH SERVICES 401(K) RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01162
Total number of active participants reported on line 7a of the Form 55002019-01-01159
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-017
Total of all active and inactive participants2019-01-01166
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01166
Number of participants with account balances2019-01-0142
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: HEALTH SERVICES 401(K) RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01514
Total number of active participants reported on line 7a of the Form 55002018-01-01153
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-019
Total of all active and inactive participants2018-01-01162
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01162
Number of participants with account balances2018-01-0144
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: HEALTH SERVICES 401(K) RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01487
Total number of active participants reported on line 7a of the Form 55002017-01-01499
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-0115
Total of all active and inactive participants2017-01-01514
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-01514
Number of participants with account balances2017-01-01104
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: HEALTH SERVICES 401(K) RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01493
Total number of active participants reported on line 7a of the Form 55002016-01-01471
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-0116
Total of all active and inactive participants2016-01-01487
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-01487
Number of participants with account balances2016-01-0194
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: HEALTH SERVICES 401(K) RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01493
Total number of active participants reported on line 7a of the Form 55002015-01-01478
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0115
Total of all active and inactive participants2015-01-01493
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-01493
Number of participants with account balances2015-01-01101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010

Financial Data on HEALTH SERVICES 401(K) RETIREMENT PLAN

Measure Date Value
2022 : HEALTH SERVICES 401(K) RETIREMENT PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$-183,850
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$176,218
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$170,987
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$100,427
Value of total assets at end of year2022-12-31$1,391,402
Value of total assets at beginning of year2022-12-31$1,751,470
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$5,231
Total interest from all sources2022-12-31$2,571
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$616
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$616
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$250,000
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$65,617
Participant contributions at end of year2022-12-31$56,960
Participant contributions at beginning of year2022-12-31$50,943
Participant contributions at end of year2022-12-31$250
Participant contributions at beginning of year2022-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$16,900
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-360,068
Value of net assets at end of year (total assets less liabilities)2022-12-31$1,391,402
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$1,751,470
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
Investment advisory and management fees2022-12-31$3,661
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$108,711
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$180,435
Value of interest in pooled separate accounts at end of year2022-12-31$1,036,757
Value of interest in pooled separate accounts at beginning of year2022-12-31$1,437,286
Interest on participant loans2022-12-31$2,571
Value of interest in common/collective trusts at end of year2022-12-31$188,724
Value of interest in common/collective trusts at beginning of year2022-12-31$82,806
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-40,412
Net investment gain/loss from pooled separate accounts2022-12-31$-249,331
Net investment gain or loss from common/collective trusts2022-12-31$2,279
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$17,910
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$170,987
Contract administrator fees2022-12-31$1,570
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31PURYEAR & NOONAN, P.C.
Accountancy firm EIN2022-12-31620788068
2021 : HEALTH SERVICES 401(K) RETIREMENT PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$342,781
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$195,366
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$190,097
Expenses. Certain deemed distributions of participant loans2021-12-31$62
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$89,003
Value of total assets at end of year2021-12-31$1,751,470
Value of total assets at beginning of year2021-12-31$1,604,055
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$5,207
Total interest from all sources2021-12-31$3,770
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$1,040
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$1,040
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$250,000
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$70,213
Participant contributions at end of year2021-12-31$50,943
Participant contributions at beginning of year2021-12-31$69,563
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$147,415
Value of net assets at end of year (total assets less liabilities)2021-12-31$1,751,470
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$1,604,055
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
Investment advisory and management fees2021-12-31$3,968
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$180,435
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$181,127
Value of interest in pooled separate accounts at end of year2021-12-31$1,437,286
Value of interest in pooled separate accounts at beginning of year2021-12-31$1,245,117
Interest on participant loans2021-12-31$3,770
Value of interest in common/collective trusts at end of year2021-12-31$82,806
Value of interest in common/collective trusts at beginning of year2021-12-31$108,248
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$10,758
Net investment gain/loss from pooled separate accounts2021-12-31$237,107
Net investment gain or loss from common/collective trusts2021-12-31$1,103
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$18,790
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$190,097
Contract administrator fees2021-12-31$1,239
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31PURYEAR & NOONAN, P.C.
Accountancy firm EIN2021-12-31620788068
2020 : HEALTH SERVICES 401(K) RETIREMENT PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$329,741
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$272,308
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$267,473
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$92,603
Value of total assets at end of year2020-12-31$1,604,055
Value of total assets at beginning of year2020-12-31$1,546,622
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$4,835
Total interest from all sources2020-12-31$4,852
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$154,663
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$71,981
Participant contributions at end of year2020-12-31$69,563
Participant contributions at beginning of year2020-12-31$57,538
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$57,433
Value of net assets at end of year (total assets less liabilities)2020-12-31$1,604,055
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$1,546,622
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
Investment advisory and management fees2020-12-31$3,571
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$181,127
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$163,775
Value of interest in pooled separate accounts at end of year2020-12-31$1,245,117
Value of interest in pooled separate accounts at beginning of year2020-12-31$1,180,150
Interest on participant loans2020-12-31$4,852
Value of interest in common/collective trusts at end of year2020-12-31$108,248
Value of interest in common/collective trusts at beginning of year2020-12-31$145,159
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$46,187
Net investment gain/loss from pooled separate accounts2020-12-31$186,086
Net investment gain or loss from common/collective trusts2020-12-31$13
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 contributions2020-12-31Yes
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$20,622
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$267,473
Contract administrator fees2020-12-31$1,264
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31PURYEAR & NOONAN, P.C.
Accountancy firm EIN2020-12-31620788068
2019 : HEALTH SERVICES 401(K) RETIREMENT PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$3,593
Total income from all sources (including contributions)2019-12-31$384,237
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$208,237
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$203,270
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$103,275
Value of total assets at end of year2019-12-31$1,546,622
Value of total assets at beginning of year2019-12-31$1,374,215
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$4,967
Total interest from all sources2019-12-31$2,388
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$676
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2019-12-31$676
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$137,063
If this is an individual account plan, was there a blackout period2019-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$82,381
Participant contributions at end of year2019-12-31$57,538
Participant contributions at beginning of year2019-12-31$30,330
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$3,593
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$176,000
Value of net assets at end of year (total assets less liabilities)2019-12-31$1,546,622
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$1,370,622
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
Investment advisory and management fees2019-12-31$3,482
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$163,775
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$123,701
Value of interest in pooled separate accounts at end of year2019-12-31$1,180,150
Value of interest in pooled separate accounts at beginning of year2019-12-31$988,356
Interest on participant loans2019-12-31$2,388
Value of interest in common/collective trusts at end of year2019-12-31$145,159
Value of interest in common/collective trusts at beginning of year2019-12-31$231,828
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$37,387
Net investment gain/loss from pooled separate accounts2019-12-31$232,309
Net investment gain or loss from common/collective trusts2019-12-31$8,202
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$20,894
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$203,270
Contract administrator fees2019-12-31$1,485
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 name2019-12-31PURYEAR & NOONAN, P.C.
Accountancy firm EIN2019-12-31620788068
2018 : HEALTH SERVICES 401(K) RETIREMENT PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total transfer of assets from this plan2018-12-31$1,720,356
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$3,593
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$18,297
Total income from all sources (including contributions)2018-12-31$208,617
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$28,247
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$14,349
Value of total corrective distributions2018-12-31$5,656
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$218,585
Value of total assets at end of year2018-12-31$1,374,215
Value of total assets at beginning of year2018-12-31$2,928,905
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$8,242
Total interest from all sources2018-12-31$2,915
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$643
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2018-12-31$643
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$291,061
If this is an individual account plan, was there a blackout period2018-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$157,274
Participant contributions at end of year2018-12-31$30,330
Participant contributions at beginning of year2018-12-31$75,901
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-12-31$3,593
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-12-31$18,297
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$180,370
Value of net assets at end of year (total assets less liabilities)2018-12-31$1,370,622
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$2,910,608
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
Investment advisory and management fees2018-12-31$6,448
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$123,701
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$254,835
Value of interest in pooled separate accounts at end of year2018-12-31$988,356
Value of interest in pooled separate accounts at beginning of year2018-12-31$2,208,638
Interest on participant loans2018-12-31$2,915
Value of interest in common/collective trusts at end of year2018-12-31$231,828
Value of interest in common/collective trusts at beginning of year2018-12-31$389,531
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-10,439
Net investment gain/loss from pooled separate accounts2018-12-31$-5,704
Net investment gain or loss from common/collective trusts2018-12-31$2,617
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$61,311
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$14,349
Contract administrator fees2018-12-31$1,794
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-12-31No
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 name2018-12-31PURYEAR & NOONAN, P.C.
Accountancy firm EIN2018-12-31620788068
2017 : HEALTH SERVICES 401(K) RETIREMENT PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$18,297
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$1,009
Total income from all sources (including contributions)2017-12-31$621,775
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$237,273
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$209,899
Value of total corrective distributions2017-12-31$18,297
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$258,581
Value of total assets at end of year2017-12-31$2,928,905
Value of total assets at beginning of year2017-12-31$2,527,115
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$9,077
Total interest from all sources2017-12-31$4,761
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$766
Total dividends received from registered investment company shares (eg mutual funds)2017-12-31$766
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$291,061
If this is an individual account plan, was there a blackout period2017-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$214,780
Participant contributions at end of year2017-12-31$75,901
Participant contributions at beginning of year2017-12-31$96,045
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-12-31$18,297
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-12-31$1,009
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$384,502
Value of net assets at end of year (total assets less liabilities)2017-12-31$2,910,608
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$2,526,106
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
Investment advisory and management fees2017-12-31$6,351
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$254,835
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$179,661
Value of interest in pooled separate accounts at end of year2017-12-31$2,208,638
Value of interest in pooled separate accounts at beginning of year2017-12-31$1,884,642
Interest on participant loans2017-12-31$4,761
Value of interest in common/collective trusts at end of year2017-12-31$389,531
Value of interest in common/collective trusts at beginning of year2017-12-31$366,767
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$55,473
Net investment gain/loss from pooled separate accounts2017-12-31$298,439
Net investment gain or loss from common/collective trusts2017-12-31$3,755
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$43,801
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$209,899
Contract administrator fees2017-12-31$2,726
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-12-31No
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
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 name2017-12-31MCKERLEY & NOONAN, P.C.
Accountancy firm EIN2017-12-31621797916
2016 : HEALTH SERVICES 401(K) RETIREMENT PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$1,009
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total income from all sources (including contributions)2016-12-31$416,409
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$366,578
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$356,799
Value of total corrective distributions2016-12-31$1,009
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$259,099
Value of total assets at end of year2016-12-31$2,527,115
Value of total assets at beginning of year2016-12-31$2,476,275
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$8,770
Total interest from all sources2016-12-31$5,674
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$948
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$948
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$252,712
If this is an individual account plan, was there a blackout period2016-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$213,014
Participant contributions at end of year2016-12-31$96,045
Participant contributions at beginning of year2016-12-31$110,181
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-12-31$1,009
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$49,831
Value of net assets at end of year (total assets less liabilities)2016-12-31$2,526,106
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$2,476,275
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
Investment advisory and management fees2016-12-31$5,820
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$179,661
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$162,649
Value of interest in pooled separate accounts at end of year2016-12-31$1,884,642
Value of interest in pooled separate accounts at beginning of year2016-12-31$1,706,786
Interest on participant loans2016-12-31$5,674
Value of interest in common/collective trusts at end of year2016-12-31$366,767
Value of interest in common/collective trusts at beginning of year2016-12-31$496,659
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$4,270
Net investment gain/loss from pooled separate accounts2016-12-31$143,026
Net investment gain or loss from common/collective trusts2016-12-31$3,392
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$46,085
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$356,799
Contract administrator fees2016-12-31$2,950
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-12-31No
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
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 name2016-12-31MCKERLEY & NOONAN, P.C.
Accountancy firm EIN2016-12-31621797916
2015 : HEALTH SERVICES 401(K) RETIREMENT PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total transfer of assets to this plan2015-12-31$1,901,790
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total income from all sources (including contributions)2015-12-31$327,768
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$578,165
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$569,964
Value of total corrective distributions2015-12-31$56
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$308,331
Value of total assets at end of year2015-12-31$2,476,275
Value of total assets at beginning of year2015-12-31$824,882
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$8,145
Total interest from all sources2015-12-31$4,557
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$1,266
Total dividends received from registered investment company shares (eg mutual funds)2015-12-31$1,266
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$250,000
If this is an individual account plan, was there a blackout period2015-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$240,546
Participant contributions at end of year2015-12-31$110,181
Participant contributions at beginning of year2015-12-31$47,026
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$21,076
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$-250,397
Value of net assets at end of year (total assets less liabilities)2015-12-31$2,476,275
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$824,882
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$5,381
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$162,649
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$65,534
Value of interest in pooled separate accounts at end of year2015-12-31$1,706,786
Value of interest in pooled separate accounts at beginning of year2015-12-31$563,937
Income. Interest from loans (other than to participants)2015-12-31$4,557
Value of interest in common/collective trusts at end of year2015-12-31$496,659
Value of interest in common/collective trusts at beginning of year2015-12-31$148,385
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-721
Net investment gain/loss from pooled separate accounts2015-12-31$9,619
Net investment gain or loss from common/collective trusts2015-12-31$4,716
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$46,709
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$569,964
Contract administrator fees2015-12-31$2,764
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32015-12-31No
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 name2015-12-31MCKERLEY & NOONAN, P.C.
Accountancy firm EIN2015-12-31621797916

Form 5500 Responses for HEALTH SERVICES 401(K) RETIREMENT PLAN

2022: HEALTH SERVICES 401(K) RETIREMENT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: HEALTH SERVICES 401(K) RETIREMENT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: HEALTH SERVICES 401(K) RETIREMENT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: HEALTH SERVICES 401(K) RETIREMENT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: HEALTH SERVICES 401(K) RETIREMENT 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 funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: HEALTH SERVICES 401(K) RETIREMENT 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 funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: HEALTH SERVICES 401(K) RETIREMENT 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 funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: HEALTH SERVICES 401(K) RETIREMENT 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 funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number461630
Policy instance 1
Insurance contract or identification number461630
Number of Individuals Covered34
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $588
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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?No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees588
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?5
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number461630
Policy instance 1
Insurance contract or identification number461630
Number of Individuals Covered40
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $653
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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?No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees653
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?5
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number461630
Policy instance 1
Insurance contract or identification number461630
Number of Individuals Covered40
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $560
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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?No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees560
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number461630
Policy instance 1
Insurance contract or identification number461630
Number of Individuals Covered42
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $529
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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?No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees529
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?5
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number461630
Policy instance 1
Insurance contract or identification number461630
Number of Individuals Covered44
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,000
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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?No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1000
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?5
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number461630
Policy instance 1
Insurance contract or identification number461630
Number of Individuals Covered104
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $981
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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?No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees981
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?5
Insurance broker nameACUFF & ASSOCIATES, INC.
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number461630
Policy instance 1
Insurance contract or identification number461630
Number of Individuals Covered493
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $790
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?No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees790
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?5
Insurance broker nameACUFF & ASSOCIATES, INC.

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