HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 401k Plan overview

Plan Name	HOSPITAL BUEN SAMARITANO RETIREMENT PLAN
Plan identification number	001

HOSPITAL BUEN SAMARITANO RETIREMENT PLAN Benefits

401k Plan Type

Defined 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. Plan not intended to be qualified - A plan not intended to be qualified under Code sections 401, 403, or 408.

401k Sponsoring company profile

HOSPITAL COMUNITARIO BUEN SAMARITANO has sponsored the creation of one or more 401k plans.

Company Name:	HOSPITAL COMUNITARIO BUEN SAMARITANO
Employer identification number (EIN):	660571457
NAIC Classification:	622000
NAIC Description:	Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HOSPITAL BUEN SAMARITANO RETIREMENT PLAN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2017-01-01	MARILYN MORALES ALCALA		MARILYN MORALES ALCALA	2018-10-14
001	2016-01-01	MARILYN MORALES ALCALA		MARILYN MORALES ALCALA	2018-01-21
001	2016-01-01			JOSE A. GARCIA	2018-01-17
001	2015-01-01	JOSE A. GARCIA		JOSE A. GARCIA	2016-10-07
001	2014-01-01	JOSE A. GARCIA		JOSE A. GARCIA	2015-09-25
001	2013-01-01	JOSE A. GARCIA		JOSE A. GARCIA	2014-10-14
001	2012-01-01	JOSE A. GARCIA		JOSE A. GARCIA	2013-10-15
001	2011-01-01	JOSE A. GARCIA		JOSE A. GARCIA	2013-02-05
001	2009-01-01	JOSE A. GARCIA		JOSE A. GARCIA	2012-03-20
001	2009-01-01	JOSE A. GARCIA		JOSE A. GARCIA	2010-09-20
001	2007-01-01	JOSE A. GARCIA		JOSE A. GARCIA	2012-03-20
001	2006-01-01	JOSE A. GARCIA		JOSE A. GARCIA	2012-03-20
001	2005-01-01	JOSE A. GARCIA		JOSE A. GARCIA	2012-03-20

Plan Statistics for HOSPITAL BUEN SAMARITANO RETIREMENT PLAN

401k plan membership statisitcs for HOSPITAL BUEN SAMARITANO RETIREMENT PLAN

Measure	Date	Value
2021: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	339
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	351
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	351
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	351
Number of participants with account balances	2021-01-01	227
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	372
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	339
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	339
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	339
Number of participants with account balances	2020-01-01	227
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	427
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	372
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	372
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	372
Number of participants with account balances	2019-01-01	372
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	434
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	427
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	427
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	427
Number of participants with account balances	2018-01-01	427
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	465
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	434
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	434
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	434
Number of participants with account balances	2017-01-01	202
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	1
2016: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	465
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	440
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	440
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	440
Number of participants with account balances	2016-01-01	218
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	541
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	465
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	465
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	465
Number of participants with account balances	2015-01-01	218
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	2
2014: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	530
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	541
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	541
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	541
Number of participants with account balances	2014-01-01	203
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	497
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	530
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	530
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	530
Number of participants with account balances	2013-01-01	180
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	2
2012: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	550
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	497
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	497
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	497
Number of participants with account balances	2012-01-01	150
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	128
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	550
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	550
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	550
Number of participants with account balances	2011-01-01	126
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	454
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	478
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	478
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	478
Number of participants with account balances	2009-01-01	478
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0
2007: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2007 401k membership
Total participants, beginning-of-year	2007-01-01	417
Total number of active participants reported on line 7a of the Form 5500	2007-01-01	448
Number of retired or separated participants receiving benefits	2007-01-01	0
Number of other retired or separated participants entitled to future benefits	2007-01-01	0
Total of all active and inactive participants	2007-01-01	448
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2007-01-01	0
Total participants	2007-01-01	448
Number of participants with account balances	2007-01-01	448
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2007-01-01	0
2006: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2006 401k membership
Total participants, beginning-of-year	2006-01-01	412
Total number of active participants reported on line 7a of the Form 5500	2006-01-01	417
Number of retired or separated participants receiving benefits	2006-01-01	0
Number of other retired or separated participants entitled to future benefits	2006-01-01	0
Total of all active and inactive participants	2006-01-01	417
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2006-01-01	0
Total participants	2006-01-01	417
Number of participants with account balances	2006-01-01	417
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2006-01-01	0
2005: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2005 401k membership
Total participants, beginning-of-year	2005-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2005-01-01	412
Number of retired or separated participants receiving benefits	2005-01-01	0
Number of other retired or separated participants entitled to future benefits	2005-01-01	0
Total of all active and inactive participants	2005-01-01	412
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2005-01-01	0
Total participants	2005-01-01	412
Number of participants with account balances	2005-01-01	412
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2005-01-01	0

Financial Data on HOSPITAL BUEN SAMARITANO RETIREMENT PLAN

Measure	Date	Value
2021 : HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$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	$391,182
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$65,946
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$63,316
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$134,103
Value of total assets at end of year	2021-12-31	$2,011,003
Value of total assets at beginning of year	2021-12-31	$1,685,767
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$2,630
Total interest from all sources	2021-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$300,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$114,298
Participant contributions at end of year	2021-12-31	$4,216
Administrative expenses (other) incurred	2021-12-31	$2,630
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$325,236
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$2,011,003
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$1,685,767
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$1,940,477
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$1,624,161
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$65,571
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$61,606
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$257,079
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$19,805
Employer contributions (assets) at end of year	2021-12-31	$739
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$63,316
Did the plan have assets held for investment	2021-12-31	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	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	J & J CPA, LLC
Accountancy firm EIN	2021-12-31	660826734
2020 : HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$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	$336,361
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$267,743
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$264,516
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$139,702
Value of total assets at end of year	2020-12-31	$1,685,767
Value of total assets at beginning of year	2020-12-31	$1,617,149
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$3,227
Total interest from all sources	2020-12-31	$1,678
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 year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$300,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$120,114
Administrative expenses (other) incurred	2020-12-31	$3,227
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$68,618
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$1,685,767
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$1,617,149
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$1,624,161
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$1,558,256
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-12-31	$1,678
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$61,606
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$58,893
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$194,981
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$19,588
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$264,516
Did the plan have assets held for investment	2020-12-31	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	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	J & J CPA, LLC
Accountancy firm EIN	2020-12-31	660826734
2019 : HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$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	$0
Total income from all sources (including contributions)	2019-12-31	$468,258
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$72,773
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$69,743
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$179,980
Value of total assets at end of year	2019-12-31	$1,617,149
Value of total assets at beginning of year	2019-12-31	$1,221,664
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$3,030
Total interest from all sources	2019-12-31	$1,482
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$300,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$154,876
Administrative expenses (other) incurred	2019-12-31	$3,030
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$395,485
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$1,617,149
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$1,221,664
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$1,558,256
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$1,176,440
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$1,482
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$58,893
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$45,224
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$286,796
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$25,104
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$69,743
Did the plan have assets held for investment	2019-12-31	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	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	LUIS SANCHEZ CPA
Accountancy firm EIN	2019-12-31	660471951
2018 : HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$54,005
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$559,448
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$554,848
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$183,976
Value of total assets at end of year	2018-12-31	$1,221,664
Value of total assets at beginning of year	2018-12-31	$1,727,107
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$4,600
Total interest from all sources	2018-12-31	$1,349
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$300,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$159,474
Administrative expenses (other) incurred	2018-12-31	$4,600
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$-505,443
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$1,221,664
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$1,727,107
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$1,176,440
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$1,672,556
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-31	$1,349
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$45,224
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$54,551
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-131,320
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$24,502
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$554,848
Did the plan have assets held for investment	2018-12-31	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	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	LUIS SANCHEZ CPA
Accountancy firm EIN	2018-12-31	660471951
2017 : HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$363,231
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$19,588
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$17,283
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$146,609
Value of total assets at end of year	2017-12-31	$1,727,107
Value of total assets at beginning of year	2017-12-31	$1,383,464
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$2,305
Total interest from all sources	2017-12-31	$1,525
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$300,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$126,581
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$148
Administrative expenses (other) incurred	2017-12-31	$2,305
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$343,643
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$1,727,107
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$1,383,464
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$1,672,556
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$1,334,288
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-12-31	$1,525
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$54,551
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$49,176
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$215,097
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$19,880
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$17,283
Did the plan have assets held for investment	2017-12-31	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	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	LUIS SANCHEZ CPA
Accountancy firm EIN	2017-12-31	660471951
2016 : HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
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	$347,142
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$135,181
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$132,931
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$260,610
Value of total assets at end of year	2016-12-31	$1,383,464
Value of total assets at beginning of year	2016-12-31	$1,171,503
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$2,250
Total interest from all sources	2016-12-31	$1,167
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$300,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$123,783
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$117,684
Administrative expenses (other) incurred	2016-12-31	$2,250
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$211,961
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$1,383,464
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$1,171,503
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$1,334,288
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$1,117,733
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-12-31	$1,167
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$49,176
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$53,770
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$85,365
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$19,143
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$132,931
Did the plan have assets held for investment	2016-12-31	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	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	LUIS SANCHEZ CPA
Accountancy firm EIN	2016-12-31	660471951
2015 : HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
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	$171,554
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$70,470
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$68,324
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$194,114
Value of total assets at end of year	2015-12-31	$1,171,503
Value of total assets at beginning of year	2015-12-31	$1,070,419
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$2,146
Total interest from all sources	2015-12-31	$1,499
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$300,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$143,459
Participant contributions at beginning of year	2015-12-31	$534
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$28,770
Administrative expenses (other) incurred	2015-12-31	$2,146
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$101,084
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$1,171,503
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$1,070,419
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$1,117,733
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$1,022,107
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$1,499
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$53,770
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$47,719
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-24,059
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$21,885
Employer contributions (assets) at beginning of year	2015-12-31	$59
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$68,324
Did the plan have assets held for investment	2015-12-31	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	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	LUIS SANCHEZ CPA
Accountancy firm EIN	2015-12-31	660471951
2014 : HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$211,092
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$42,671
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$40,873
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$160,879
Value of total assets at end of year	2014-12-31	$1,070,419
Value of total assets at beginning of year	2014-12-31	$901,998
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$1,798
Total interest from all sources	2014-12-31	$1,317
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$300,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$139,074
Participant contributions at end of year	2014-12-31	$534
Participant contributions at beginning of year	2014-12-31	$5,540
Administrative expenses (other) incurred	2014-12-31	$1,798
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$168,421
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$1,070,419
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$901,998
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$1,022,107
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$854,161
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$1,317
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$47,719
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$41,447
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$48,896
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$21,805
Employer contributions (assets) at end of year	2014-12-31	$59
Employer contributions (assets) at beginning of year	2014-12-31	$850
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$40,873
Did the plan have assets held for investment	2014-12-31	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	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	LUIS SANCHEZ CPA
Accountancy firm EIN	2014-12-31	660471951
2013 : HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$286,538
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$78,007
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$78,007
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$135,244
Value of total assets at end of year	2013-12-31	$901,998
Value of total assets at beginning of year	2013-12-31	$693,467
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$0
Total interest from all sources	2013-12-31	$1,226
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	No
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	$116,961
Participant contributions at end of year	2013-12-31	$5,540
Other income not declared elsewhere	2013-12-31	$1,071
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	$208,531
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$901,998
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$693,467
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 in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$854,161
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$643,474
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$1,226
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$41,447
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$40,596
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$148,997
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	Yes
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	$18,283
Employer contributions (assets) at end of year	2013-12-31	$850
Employer contributions (assets) at beginning of year	2013-12-31	$9,397
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$78,007
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
Did the plan have assets held for investment	2013-12-31	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	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	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	LUIS SANCHEZ CPA
Accountancy firm EIN	2013-12-31	660471951
2012 : HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$192,666
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$26,796
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$25,176
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$122,306
Value of total assets at end of year	2012-12-31	$693,467
Value of total assets at beginning of year	2012-12-31	$527,597
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$1,620
Total interest from all sources	2012-12-31	$1,144
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	No
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	$105,374
Participant contributions at beginning of year	2012-12-31	$638
Administrative expenses (other) incurred	2012-12-31	$1,620
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	$165,870
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$693,467
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$527,597
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 in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$643,474
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$486,776
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$1,144
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$40,596
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$35,983
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$69,216
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	$16,932
Employer contributions (assets) at end of year	2012-12-31	$9,397
Employer contributions (assets) at beginning of year	2012-12-31	$4,200
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$25,176
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
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	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	LUIS SANCHEZ, CPA
Accountancy firm EIN	2012-12-31	660471951
2011 : HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$103,507
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$23,937
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$22,422
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$118,589
Value of total assets at end of year	2011-12-31	$527,597
Value of total assets at beginning of year	2011-12-31	$448,027
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$1,515
Total interest from all sources	2011-12-31	$1,028
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Assets. Real estate other than employer real property at beginning of year	2011-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2011-12-31	$0
Was this plan covered by a fidelity bond	2011-12-31	No
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	$103,084
Participant contributions at beginning of year	2011-12-31	$0
Participant contributions at end of year	2011-12-31	$638
Participant contributions at beginning of year	2011-12-31	$10,725
Assets. Other investments not covered elsewhere at beginning of year	2011-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2011-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$0
Administrative expenses (other) incurred	2011-12-31	$1,515
Liabilities. Value of operating payables at beginning of year	2011-12-31	$0
Total non interest bearing cash at beginning of year	2011-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$79,570
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$527,597
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$448,027
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
Assets. partnership/joint venture interests at beginning of year	2011-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$486,776
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$0
Value of interest in pooled separate accounts at end of year	2011-12-31	$486,776
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$404,232
Value of interest in master investment trust accounts at beginning of year	2011-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$1,028
Assets. Value of investments in 103.12 investment entities at beginning of year	2011-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$35,983
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$31,498
Asset value of US Government securities at beginning of year	2011-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-16,110
Net investment gain/loss from pooled separate accounts	2011-12-31	$-16,110
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
Assets. Invements in employer securities at beginning of year	2011-12-31	$0
Assets. Value of employer real property at beginning of year	2011-12-31	$0
Contributions received in cash from employer	2011-12-31	$15,505
Employer contributions (assets) at end of year	2011-12-31	$4,200
Employer contributions (assets) at beginning of year	2011-12-31	$1,572
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$22,422
Asset. Corporate debt instrument preferred debt at beginning of year	2011-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2011-12-31	$0
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
Assets. Corporate common stocks other than exployer securities at beginning of year	2011-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2011-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2011-12-31	$0
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
Liabilities. Value of acquisition indebtedness at beginning of year	2011-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	LUIS SANCHEZ, CPA
Accountancy firm EIN	2011-12-31	660471951
2010 : HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2010 401k financial data
Unrealized appreciation/depreciation of real estate assets	2010-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2010-12-31	$0
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total transfer of assets to this plan	2010-12-31	$0
Total transfer of assets from this plan	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Expenses. Interest paid	2010-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$157,362
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$22,183
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$20,878
Expenses. Certain deemed distributions of participant loans	2010-12-31	$0
Value of total corrective distributions	2010-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$100,368
Value of total assets at end of year	2010-12-31	$448,027
Value of total assets at beginning of year	2010-12-31	$312,848
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$1,305
Total income from rents	2010-12-31	$0
Total interest from all sources	2010-12-31	$832
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2010-12-31	$0
Assets. Real estate other than employer real property at end of year	2010-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2010-12-31	$0
Administrative expenses professional fees incurred	2010-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2010-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2010-12-31	$0
Was this plan covered by a fidelity bond	2010-12-31	No
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	$87,479
Participant contributions at end of year	2010-12-31	$0
Participant contributions at beginning of year	2010-12-31	$0
Participant contributions at end of year	2010-12-31	$10,725
Participant contributions at beginning of year	2010-12-31	$9,010
Assets. Other investments not covered elsewhere at end of year	2010-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2010-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2010-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$0
Assets. Loans (other than to participants) at end of year	2010-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2010-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$0
Other income not declared elsewhere	2010-12-31	$0
Administrative expenses (other) incurred	2010-12-31	$1,305
Liabilities. Value of operating payables at end of year	2010-12-31	$0
Liabilities. Value of operating payables at beginning of year	2010-12-31	$0
Total non interest bearing cash at end of year	2010-12-31	$0
Total non interest bearing cash at beginning of year	2010-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Income. Non cash contributions	2010-12-31	$0
Value of net income/loss	2010-12-31	$135,179
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$448,027
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$312,848
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
Assets. partnership/joint venture interests at end of year	2010-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2010-12-31	$0
Investment advisory and management fees	2010-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$0
Value of interest in pooled separate accounts at end of year	2010-12-31	$404,232
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$277,367
Interest on participant loans	2010-12-31	$0
Income. Interest from loans (other than to participants)	2010-12-31	$0
Interest earned on other investments	2010-12-31	$0
Income. Interest from US Government securities	2010-12-31	$0
Income. Interest from corporate debt instruments	2010-12-31	$0
Value of interest in master investment trust accounts at end of year	2010-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2010-12-31	$0
Value of interest in common/collective trusts at end of year	2010-12-31	$0
Value of interest in common/collective trusts at beginning of year	2010-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$832
Assets. Value of investments in 103.12 investment entities at end of year	2010-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2010-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$31,498
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$25,204
Expenses. Payments to insurance carriers foe the provision of benefits	2010-12-31	$0
Asset value of US Government securities at end of year	2010-12-31	$0
Asset value of US Government securities at beginning of year	2010-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$0
Net investment gain/loss from pooled separate accounts	2010-12-31	$56,162
Net investment gain or loss from common/collective trusts	2010-12-31	$0
Net gain/loss from 103.12 investment entities	2010-12-31	$0
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	Yes
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Assets. Invements in employer securities at end of year	2010-12-31	$0
Assets. Invements in employer securities at beginning of year	2010-12-31	$0
Assets. Value of employer real property at end of year	2010-12-31	$0
Assets. Value of employer real property at beginning of year	2010-12-31	$0
Contributions received in cash from employer	2010-12-31	$12,889
Employer contributions (assets) at end of year	2010-12-31	$1,572
Employer contributions (assets) at beginning of year	2010-12-31	$1,267
Income. Dividends from preferred stock	2010-12-31	$0
Income. Dividends from common stock	2010-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$20,878
Asset. Corporate debt instrument preferred debt at end of year	2010-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2010-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2010-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2010-12-31	$0
Contract administrator fees	2010-12-31	$0
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
Assets. Corporate common stocks other than exployer securities at end of year	2010-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2010-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2010-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2010-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2010-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2010-12-31	$0
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
Aggregate proceeds on sale of assets	2010-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2010-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2010-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2010-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	LUIS E. SANCHEZ, CPA
Accountancy firm EIN	2010-12-31	660471951
2009 : HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2009 401k financial data
Unrealized appreciation/depreciation of real estate assets	2009-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2009-12-31	$0
Total unrealized appreciation/depreciation of assets	2009-12-31	$0
Total transfer of assets to this plan	2009-12-31	$0
Total transfer of assets from this plan	2009-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2009-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2009-12-31	$0
Expenses. Interest paid	2009-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2009-12-31	$0
Total income from all sources (including contributions)	2009-12-31	$144,813
Total loss/gain on sale of assets	2009-12-31	$0
Total of all expenses incurred	2009-12-31	$9,302
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2009-12-31	$8,267
Expenses. Certain deemed distributions of participant loans	2009-12-31	$0
Value of total corrective distributions	2009-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2009-12-31	$87,450
Value of total assets at end of year	2009-12-31	$312,848
Value of total assets at beginning of year	2009-12-31	$177,337
Total of administrative expenses incurred including professional, contract, advisory and management fees	2009-12-31	$1,035
Total income from rents	2009-12-31	$0
Total interest from all sources	2009-12-31	$651
Total dividends received (eg from common stock, registered investment company shares)	2009-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2009-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2009-12-31	$0
Assets. Real estate other than employer real property at end of year	2009-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2009-12-31	$0
Administrative expenses professional fees incurred	2009-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2009-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2009-12-31	$0
Was this plan covered by a fidelity bond	2009-12-31	No
If this is an individual account plan, was there a blackout period	2009-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2009-12-31	No
Contributions received from participants	2009-12-31	$77,100
Participant contributions at end of year	2009-12-31	$0
Participant contributions at beginning of year	2009-12-31	$0
Participant contributions at end of year	2009-12-31	$9,010
Participant contributions at beginning of year	2009-12-31	$12,467
Assets. Other investments not covered elsewhere at end of year	2009-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2009-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2009-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2009-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2009-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2009-12-31	$0
Assets. Loans (other than to participants) at end of year	2009-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2009-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2009-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2009-12-31	$0
Other income not declared elsewhere	2009-12-31	$0
Administrative expenses (other) incurred	2009-12-31	$1,035
Liabilities. Value of operating payables at end of year	2009-12-31	$0
Liabilities. Value of operating payables at beginning of year	2009-12-31	$0
Total non interest bearing cash at end of year	2009-12-31	$0
Total non interest bearing cash at beginning of year	2009-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2009-12-31	No
Income. Non cash contributions	2009-12-31	$0
Value of net income/loss	2009-12-31	$135,511
Value of net assets at end of year (total assets less liabilities)	2009-12-31	$312,848
Value of net assets at beginning of year (total assets less liabilities)	2009-12-31	$177,337
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2009-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2009-12-31	No
Were any leases to which the plan was party in default or uncollectible	2009-12-31	No
Assets. partnership/joint venture interests at end of year	2009-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2009-12-31	$0
Investment advisory and management fees	2009-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2009-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2009-12-31	$0
Value of interest in pooled separate accounts at end of year	2009-12-31	$277,367
Value of interest in pooled separate accounts at beginning of year	2009-12-31	$144,900
Interest on participant loans	2009-12-31	$0
Income. Interest from loans (other than to participants)	2009-12-31	$0
Interest earned on other investments	2009-12-31	$0
Income. Interest from US Government securities	2009-12-31	$0
Income. Interest from corporate debt instruments	2009-12-31	$0
Value of interest in master investment trust accounts at end of year	2009-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2009-12-31	$0
Value of interest in common/collective trusts at end of year	2009-12-31	$0
Value of interest in common/collective trusts at beginning of year	2009-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2009-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2009-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2009-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2009-12-31	$651
Assets. Value of investments in 103.12 investment entities at end of year	2009-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2009-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2009-12-31	$25,204
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2009-12-31	$18,315
Expenses. Payments to insurance carriers foe the provision of benefits	2009-12-31	$0
Asset value of US Government securities at end of year	2009-12-31	$0
Asset value of US Government securities at beginning of year	2009-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2009-12-31	$0
Net investment gain/loss from pooled separate accounts	2009-12-31	$56,712
Net investment gain or loss from common/collective trusts	2009-12-31	$0
Net gain/loss from 103.12 investment entities	2009-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2009-12-31	No
Was there a failure to transmit to the plan any participant contributions	2009-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2009-12-31	No
Assets. Invements in employer securities at end of year	2009-12-31	$0
Assets. Invements in employer securities at beginning of year	2009-12-31	$0
Assets. Value of employer real property at end of year	2009-12-31	$0
Assets. Value of employer real property at beginning of year	2009-12-31	$0
Contributions received in cash from employer	2009-12-31	$10,350
Employer contributions (assets) at end of year	2009-12-31	$1,267
Employer contributions (assets) at beginning of year	2009-12-31	$1,655
Income. Dividends from preferred stock	2009-12-31	$0
Income. Dividends from common stock	2009-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2009-12-31	$8,267
Asset. Corporate debt instrument preferred debt at end of year	2009-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2009-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2009-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2009-12-31	$0
Contract administrator fees	2009-12-31	$0
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	2009-12-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2009-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2009-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2009-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2009-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2009-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2009-12-31	$0
Did the plan have assets held for investment	2009-12-31	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	2009-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2009-12-31	No
Aggregate proceeds on sale of assets	2009-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2009-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2009-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2009-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2009-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2009-12-31	Disclaimer
Accountancy firm name	2009-12-31	LUIS E. SANCHEZ, CPA
Accountancy firm EIN	2009-12-31	660471951
2008 : HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2008 401k financial data
Unrealized appreciation/depreciation of real estate assets	2008-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2008-12-31	$0
Total unrealized appreciation/depreciation of assets	2008-12-31	$0
Total transfer of assets to this plan	2008-12-31	$0
Total transfer of assets from this plan	2008-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2008-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2008-12-31	$0
Expenses. Interest paid	2008-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2008-12-31	$0
Total income from all sources (including contributions)	2008-12-31	$19,660
Total loss/gain on sale of assets	2008-12-31	$0
Total of all expenses incurred	2008-12-31	$5,420
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2008-12-31	$3,820
Expenses. Certain deemed distributions of participant loans	2008-12-31	$0
Value of total corrective distributions	2008-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2008-12-31	$95,881
Value of total assets at end of year	2008-12-31	$177,337
Value of total assets at beginning of year	2008-12-31	$163,097
Total of administrative expenses incurred including professional, contract, advisory and management fees	2008-12-31	$1,600
Total income from rents	2008-12-31	$0
Total interest from all sources	2008-12-31	$484
Total dividends received (eg from common stock, registered investment company shares)	2008-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2008-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2008-12-31	$0
Assets. Real estate other than employer real property at end of year	2008-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2008-12-31	$0
Administrative expenses professional fees incurred	2008-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2008-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2008-12-31	$0
Was this plan covered by a fidelity bond	2008-12-31	No
If this is an individual account plan, was there a blackout period	2008-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2008-12-31	No
Contributions received from participants	2008-12-31	$84,601
Participant contributions at end of year	2008-12-31	$0
Participant contributions at beginning of year	2008-12-31	$0
Participant contributions at end of year	2008-12-31	$12,467
Participant contributions at beginning of year	2008-12-31	$6,620
Assets. Other investments not covered elsewhere at end of year	2008-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2008-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2008-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2008-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2008-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2008-12-31	$0
Assets. Loans (other than to participants) at end of year	2008-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2008-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2008-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2008-12-31	$0
Other income not declared elsewhere	2008-12-31	$0
Administrative expenses (other) incurred	2008-12-31	$1,600
Liabilities. Value of operating payables at end of year	2008-12-31	$0
Liabilities. Value of operating payables at beginning of year	2008-12-31	$0
Total non interest bearing cash at end of year	2008-12-31	$0
Total non interest bearing cash at beginning of year	2008-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2008-12-31	No
Income. Non cash contributions	2008-12-31	$0
Value of net income/loss	2008-12-31	$14,240
Value of net assets at end of year (total assets less liabilities)	2008-12-31	$177,337
Value of net assets at beginning of year (total assets less liabilities)	2008-12-31	$163,097
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2008-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2008-12-31	No
Were any leases to which the plan was party in default or uncollectible	2008-12-31	No
Assets. partnership/joint venture interests at end of year	2008-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2008-12-31	$0
Investment advisory and management fees	2008-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2008-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2008-12-31	$0
Value of interest in pooled separate accounts at end of year	2008-12-31	$144,900
Value of interest in pooled separate accounts at beginning of year	2008-12-31	$148,261
Interest on participant loans	2008-12-31	$0
Income. Interest from loans (other than to participants)	2008-12-31	$0
Interest earned on other investments	2008-12-31	$0
Income. Interest from US Government securities	2008-12-31	$0
Income. Interest from corporate debt instruments	2008-12-31	$0
Value of interest in master investment trust accounts at end of year	2008-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2008-12-31	$0
Value of interest in common/collective trusts at end of year	2008-12-31	$0
Value of interest in common/collective trusts at beginning of year	2008-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2008-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2008-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2008-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2008-12-31	$484
Assets. Value of investments in 103.12 investment entities at end of year	2008-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2008-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2008-12-31	$18,315
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2008-12-31	$7,330
Expenses. Payments to insurance carriers foe the provision of benefits	2008-12-31	$0
Asset value of US Government securities at end of year	2008-12-31	$0
Asset value of US Government securities at beginning of year	2008-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2008-12-31	$0
Net investment gain/loss from pooled separate accounts	2008-12-31	$-76,705
Net investment gain or loss from common/collective trusts	2008-12-31	$0
Net gain/loss from 103.12 investment entities	2008-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2008-12-31	No
Was there a failure to transmit to the plan any participant contributions	2008-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2008-12-31	No
Assets. Invements in employer securities at end of year	2008-12-31	$0
Assets. Invements in employer securities at beginning of year	2008-12-31	$0
Assets. Value of employer real property at end of year	2008-12-31	$0
Assets. Value of employer real property at beginning of year	2008-12-31	$0
Contributions received in cash from employer	2008-12-31	$11,280
Employer contributions (assets) at end of year	2008-12-31	$1,655
Employer contributions (assets) at beginning of year	2008-12-31	$886
Income. Dividends from preferred stock	2008-12-31	$0
Income. Dividends from common stock	2008-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2008-12-31	$3,820
Asset. Corporate debt instrument preferred debt at end of year	2008-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2008-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2008-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2008-12-31	$0
Contract administrator fees	2008-12-31	$0
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	2008-12-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2008-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2008-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2008-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2008-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2008-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2008-12-31	$0
Did the plan have assets held for investment	2008-12-31	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	2008-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2008-12-31	No
Aggregate proceeds on sale of assets	2008-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2008-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2008-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2008-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2008-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2008-12-31	Disclaimer
Accountancy firm name	2008-12-31	LUIS E. SANCHEZ, CPA
Accountancy firm EIN	2008-12-31	660471951
2007 : HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2007 401k financial data
Unrealized appreciation/depreciation of real estate assets	2007-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2007-12-31	$0
Total unrealized appreciation/depreciation of assets	2007-12-31	$0
Total transfer of assets to this plan	2007-12-31	$0
Total transfer of assets from this plan	2007-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2007-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2007-12-31	$0
Expenses. Interest paid	2007-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2007-12-31	$0
Total income from all sources (including contributions)	2007-12-31	$90,414
Total loss/gain on sale of assets	2007-12-31	$0
Total of all expenses incurred	2007-12-31	$7,919
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2007-12-31	$6,369
Expenses. Certain deemed distributions of participant loans	2007-12-31	$0
Value of total corrective distributions	2007-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2007-12-31	$90,999
Value of total assets at end of year	2007-12-31	$163,097
Value of total assets at beginning of year	2007-12-31	$80,602
Total of administrative expenses incurred including professional, contract, advisory and management fees	2007-12-31	$1,550
Total income from rents	2007-12-31	$0
Total interest from all sources	2007-12-31	$165
Total dividends received (eg from common stock, registered investment company shares)	2007-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2007-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2007-12-31	$0
Assets. Real estate other than employer real property at end of year	2007-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2007-12-31	$0
Administrative expenses professional fees incurred	2007-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2007-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2007-12-31	$0
Was this plan covered by a fidelity bond	2007-12-31	No
If this is an individual account plan, was there a blackout period	2007-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2007-12-31	No
Contributions received from participants	2007-12-31	$80,104
Participant contributions at end of year	2007-12-31	$0
Participant contributions at beginning of year	2007-12-31	$0
Participant contributions at end of year	2007-12-31	$6,620
Participant contributions at beginning of year	2007-12-31	$7,167
Assets. Other investments not covered elsewhere at end of year	2007-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2007-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2007-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2007-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2007-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2007-12-31	$0
Assets. Loans (other than to participants) at end of year	2007-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2007-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2007-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2007-12-31	$0
Other income not declared elsewhere	2007-12-31	$0
Administrative expenses (other) incurred	2007-12-31	$1,550
Liabilities. Value of operating payables at end of year	2007-12-31	$0
Liabilities. Value of operating payables at beginning of year	2007-12-31	$0
Total non interest bearing cash at end of year	2007-12-31	$0
Total non interest bearing cash at beginning of year	2007-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2007-12-31	No
Income. Non cash contributions	2007-12-31	$0
Value of net income/loss	2007-12-31	$82,495
Value of net assets at end of year (total assets less liabilities)	2007-12-31	$163,097
Value of net assets at beginning of year (total assets less liabilities)	2007-12-31	$80,602
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2007-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2007-12-31	No
Were any leases to which the plan was party in default or uncollectible	2007-12-31	No
Assets. partnership/joint venture interests at end of year	2007-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2007-12-31	$0
Investment advisory and management fees	2007-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2007-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2007-12-31	$0
Value of interest in pooled separate accounts at end of year	2007-12-31	$148,261
Value of interest in pooled separate accounts at beginning of year	2007-12-31	$68,733
Interest on participant loans	2007-12-31	$0
Income. Interest from loans (other than to participants)	2007-12-31	$0
Interest earned on other investments	2007-12-31	$0
Income. Interest from US Government securities	2007-12-31	$0
Income. Interest from corporate debt instruments	2007-12-31	$0
Value of interest in master investment trust accounts at end of year	2007-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2007-12-31	$0
Value of interest in common/collective trusts at end of year	2007-12-31	$0
Value of interest in common/collective trusts at beginning of year	2007-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2007-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2007-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2007-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2007-12-31	$165
Assets. Value of investments in 103.12 investment entities at end of year	2007-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2007-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2007-12-31	$7,330
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2007-12-31	$3,733
Expenses. Payments to insurance carriers foe the provision of benefits	2007-12-31	$0
Asset value of US Government securities at end of year	2007-12-31	$0
Asset value of US Government securities at beginning of year	2007-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2007-12-31	$0
Net investment gain/loss from pooled separate accounts	2007-12-31	$-750
Net investment gain or loss from common/collective trusts	2007-12-31	$0
Net gain/loss from 103.12 investment entities	2007-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2007-12-31	No
Was there a failure to transmit to the plan any participant contributions	2007-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2007-12-31	No
Assets. Invements in employer securities at end of year	2007-12-31	$0
Assets. Invements in employer securities at beginning of year	2007-12-31	$0
Assets. Value of employer real property at end of year	2007-12-31	$0
Assets. Value of employer real property at beginning of year	2007-12-31	$0
Contributions received in cash from employer	2007-12-31	$10,895
Employer contributions (assets) at end of year	2007-12-31	$886
Employer contributions (assets) at beginning of year	2007-12-31	$969
Income. Dividends from preferred stock	2007-12-31	$0
Income. Dividends from common stock	2007-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2007-12-31	$6,369
Asset. Corporate debt instrument preferred debt at end of year	2007-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2007-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2007-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2007-12-31	$0
Contract administrator fees	2007-12-31	$0
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	2007-12-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2007-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2007-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2007-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2007-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2007-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2007-12-31	$0
Did the plan have assets held for investment	2007-12-31	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	2007-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2007-12-31	No
Aggregate proceeds on sale of assets	2007-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2007-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2007-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2007-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2007-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2007-12-31	Disclaimer
Accountancy firm name	2007-12-31	LUIS E. SANCHE, CPA
Accountancy firm EIN	2007-12-31	660471951
2006 : HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2006 401k financial data
Unrealized appreciation/depreciation of real estate assets	2006-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2006-12-31	$0
Total unrealized appreciation/depreciation of assets	2006-12-31	$0
Total transfer of assets to this plan	2006-12-31	$0
Total transfer of assets from this plan	2006-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2006-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2006-12-31	$0
Expenses. Interest paid	2006-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2006-12-31	$0
Total income from all sources (including contributions)	2006-12-31	$75,412
Total loss/gain on sale of assets	2006-12-31	$0
Total of all expenses incurred	2006-12-31	$550
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2006-12-31	$0
Expenses. Certain deemed distributions of participant loans	2006-12-31	$0
Value of total corrective distributions	2006-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2006-12-31	$70,131
Value of total assets at end of year	2006-12-31	$80,602
Value of total assets at beginning of year	2006-12-31	$5,740
Total of administrative expenses incurred including professional, contract, advisory and management fees	2006-12-31	$550
Total income from rents	2006-12-31	$0
Total interest from all sources	2006-12-31	$57
Total dividends received (eg from common stock, registered investment company shares)	2006-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2006-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2006-12-31	$0
Assets. Real estate other than employer real property at end of year	2006-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2006-12-31	$0
Administrative expenses professional fees incurred	2006-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2006-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2006-12-31	$0
Was this plan covered by a fidelity bond	2006-12-31	No
If this is an individual account plan, was there a blackout period	2006-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2006-12-31	No
Contributions received from participants	2006-12-31	$62,132
Participant contributions at end of year	2006-12-31	$0
Participant contributions at beginning of year	2006-12-31	$0
Participant contributions at end of year	2006-12-31	$7,167
Participant contributions at beginning of year	2006-12-31	$1,249
Assets. Other investments not covered elsewhere at end of year	2006-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2006-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2006-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2006-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2006-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2006-12-31	$0
Assets. Loans (other than to participants) at end of year	2006-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2006-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2006-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2006-12-31	$0
Other income not declared elsewhere	2006-12-31	$0
Administrative expenses (other) incurred	2006-12-31	$550
Liabilities. Value of operating payables at end of year	2006-12-31	$0
Liabilities. Value of operating payables at beginning of year	2006-12-31	$0
Total non interest bearing cash at end of year	2006-12-31	$0
Total non interest bearing cash at beginning of year	2006-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2006-12-31	No
Income. Non cash contributions	2006-12-31	$0
Value of net income/loss	2006-12-31	$74,862
Value of net assets at end of year (total assets less liabilities)	2006-12-31	$80,602
Value of net assets at beginning of year (total assets less liabilities)	2006-12-31	$5,740
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2006-12-31	Yes
Were any loans by the plan or fixed income obligations due to the plan in default	2006-12-31	No
Were any leases to which the plan was party in default or uncollectible	2006-12-31	No
Assets. partnership/joint venture interests at end of year	2006-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2006-12-31	$0
Investment advisory and management fees	2006-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2006-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2006-12-31	$0
Value of interest in pooled separate accounts at end of year	2006-12-31	$68,733
Value of interest in pooled separate accounts at beginning of year	2006-12-31	$4,039
Interest on participant loans	2006-12-31	$0
Income. Interest from loans (other than to participants)	2006-12-31	$0
Interest earned on other investments	2006-12-31	$0
Income. Interest from US Government securities	2006-12-31	$0
Income. Interest from corporate debt instruments	2006-12-31	$0
Value of interest in master investment trust accounts at end of year	2006-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2006-12-31	$0
Value of interest in common/collective trusts at end of year	2006-12-31	$0
Value of interest in common/collective trusts at beginning of year	2006-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2006-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2006-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2006-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2006-12-31	$57
Assets. Value of investments in 103.12 investment entities at end of year	2006-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2006-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2006-12-31	$3,733
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2006-12-31	$322
Expenses. Payments to insurance carriers foe the provision of benefits	2006-12-31	$0
Asset value of US Government securities at end of year	2006-12-31	$0
Asset value of US Government securities at beginning of year	2006-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2006-12-31	$0
Net investment gain/loss from pooled separate accounts	2006-12-31	$5,224
Net investment gain or loss from common/collective trusts	2006-12-31	$0
Net gain/loss from 103.12 investment entities	2006-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2006-12-31	No
Was there a failure to transmit to the plan any participant contributions	2006-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2006-12-31	No
Assets. Invements in employer securities at end of year	2006-12-31	$0
Assets. Invements in employer securities at beginning of year	2006-12-31	$0
Assets. Value of employer real property at end of year	2006-12-31	$0
Assets. Value of employer real property at beginning of year	2006-12-31	$0
Contributions received in cash from employer	2006-12-31	$7,999
Employer contributions (assets) at end of year	2006-12-31	$969
Employer contributions (assets) at beginning of year	2006-12-31	$130
Income. Dividends from preferred stock	2006-12-31	$0
Income. Dividends from common stock	2006-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2006-12-31	$0
Asset. Corporate debt instrument preferred debt at end of year	2006-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2006-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2006-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2006-12-31	$0
Contract administrator fees	2006-12-31	$0
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	2006-12-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2006-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2006-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2006-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2006-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2006-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2006-12-31	$0
Did the plan have assets held for investment	2006-12-31	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	2006-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2006-12-31	No
Aggregate proceeds on sale of assets	2006-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2006-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2006-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2006-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2006-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2006-12-31	Disclaimer
Accountancy firm name	2006-12-31	LUIS E. SANCHEZ, CPA
Accountancy firm EIN	2006-12-31	660471951
2005 : HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2005 401k financial data
Unrealized appreciation/depreciation of real estate assets	2005-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2005-12-31	$0
Total unrealized appreciation/depreciation of assets	2005-12-31	$0
Total transfer of assets to this plan	2005-12-31	$0
Total transfer of assets from this plan	2005-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2005-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2005-12-31	$0
Expenses. Interest paid	2005-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2005-12-31	$0
Total income from all sources (including contributions)	2005-12-31	$5,740
Total loss/gain on sale of assets	2005-12-31	$0
Total of all expenses incurred	2005-12-31	$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2005-12-31	$0
Expenses. Certain deemed distributions of participant loans	2005-12-31	$0
Value of total corrective distributions	2005-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2005-12-31	$5,751
Value of total assets at end of year	2005-12-31	$5,740
Value of total assets at beginning of year	2005-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2005-12-31	$0
Total income from rents	2005-12-31	$0
Total interest from all sources	2005-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2005-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2005-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2005-12-31	$0
Assets. Real estate other than employer real property at end of year	2005-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2005-12-31	$0
Administrative expenses professional fees incurred	2005-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2005-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2005-12-31	$0
Was this plan covered by a fidelity bond	2005-12-31	Yes
If this is an individual account plan, was there a blackout period	2005-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2005-12-31	No
Contributions received from participants	2005-12-31	$5,184
Participant contributions at end of year	2005-12-31	$0
Participant contributions at beginning of year	2005-12-31	$0
Participant contributions at end of year	2005-12-31	$1,249
Participant contributions at beginning of year	2005-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2005-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2005-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2005-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2005-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2005-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2005-12-31	$0
Assets. Loans (other than to participants) at end of year	2005-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2005-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2005-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2005-12-31	$0
Other income not declared elsewhere	2005-12-31	$0
Administrative expenses (other) incurred	2005-12-31	$0
Liabilities. Value of operating payables at end of year	2005-12-31	$0
Liabilities. Value of operating payables at beginning of year	2005-12-31	$0
Total non interest bearing cash at end of year	2005-12-31	$0
Total non interest bearing cash at beginning of year	2005-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2005-12-31	No
Income. Non cash contributions	2005-12-31	$0
Value of net income/loss	2005-12-31	$5,740
Value of net assets at end of year (total assets less liabilities)	2005-12-31	$5,740
Value of net assets at beginning of year (total assets less liabilities)	2005-12-31	$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2005-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2005-12-31	No
Were any leases to which the plan was party in default or uncollectible	2005-12-31	No
Assets. partnership/joint venture interests at end of year	2005-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2005-12-31	$0
Investment advisory and management fees	2005-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2005-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2005-12-31	$0
Value of interest in pooled separate accounts at end of year	2005-12-31	$4,039
Value of interest in pooled separate accounts at beginning of year	2005-12-31	$0
Interest on participant loans	2005-12-31	$0
Income. Interest from loans (other than to participants)	2005-12-31	$0
Interest earned on other investments	2005-12-31	$0
Income. Interest from US Government securities	2005-12-31	$0
Income. Interest from corporate debt instruments	2005-12-31	$0
Value of interest in master investment trust accounts at end of year	2005-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2005-12-31	$0
Value of interest in common/collective trusts at end of year	2005-12-31	$0
Value of interest in common/collective trusts at beginning of year	2005-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2005-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2005-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2005-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2005-12-31	$0
Assets. Value of investments in 103.12 investment entities at end of year	2005-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2005-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2005-12-31	$322
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2005-12-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2005-12-31	$0
Asset value of US Government securities at end of year	2005-12-31	$0
Asset value of US Government securities at beginning of year	2005-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2005-12-31	$0
Net investment gain/loss from pooled separate accounts	2005-12-31	$-11
Net investment gain or loss from common/collective trusts	2005-12-31	$0
Net gain/loss from 103.12 investment entities	2005-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2005-12-31	No
Was there a failure to transmit to the plan any participant contributions	2005-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2005-12-31	No
Assets. Invements in employer securities at end of year	2005-12-31	$0
Assets. Invements in employer securities at beginning of year	2005-12-31	$0
Assets. Value of employer real property at end of year	2005-12-31	$0
Assets. Value of employer real property at beginning of year	2005-12-31	$0
Contributions received in cash from employer	2005-12-31	$567
Employer contributions (assets) at end of year	2005-12-31	$130
Employer contributions (assets) at beginning of year	2005-12-31	$0
Income. Dividends from preferred stock	2005-12-31	$0
Income. Dividends from common stock	2005-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2005-12-31	$0
Asset. Corporate debt instrument preferred debt at end of year	2005-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2005-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2005-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2005-12-31	$0
Contract administrator fees	2005-12-31	$0
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	2005-12-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2005-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2005-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2005-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2005-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2005-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2005-12-31	$0
Did the plan have assets held for investment	2005-12-31	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	2005-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2005-12-31	No
Aggregate proceeds on sale of assets	2005-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2005-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2005-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2005-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2005-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2005-12-31	Disclaimer
Accountancy firm name	2005-12-31	LUIS E. SANCHEZ, CPA
Accountancy firm EIN	2005-12-31	660471951

Form 5500 Responses for HOSPITAL BUEN SAMARITANO RETIREMENT PLAN

2021: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	Yes
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
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: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
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: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	Yes
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
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
2009: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
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 – 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
2007: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2007 form 5500 responses
2007-01-01	Type of plan entity	Single employer plan
2007-01-01	Submission has been amended	Yes
2007-01-01	This submission is the final filing	No
2007-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2007-01-01	Plan is a collectively bargained plan	No
2007-01-01	Plan funding arrangement – Insurance	Yes
2007-01-01	Plan funding arrangement – Trust	Yes
2007-01-01	Plan benefit arrangement – Insurance	Yes
2007-01-01	Plan benefit arrangement - Trust	Yes
2006: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2006 form 5500 responses
2006-01-01	Type of plan entity	Single employer plan
2006-01-01	Submission has been amended	Yes
2006-01-01	This submission is the final filing	No
2006-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2006-01-01	Plan is a collectively bargained plan	No
2006-01-01	Plan funding arrangement – Insurance	Yes
2006-01-01	Plan funding arrangement – Trust	Yes
2006-01-01	Plan benefit arrangement – Insurance	Yes
2006-01-01	Plan benefit arrangement - Trust	Yes
2005: HOSPITAL BUEN SAMARITANO RETIREMENT PLAN 2005 form 5500 responses
2005-01-01	Type of plan entity	Single employer plan
2005-01-01	Submission has been amended	Yes
2005-01-01	This submission is the final filing	No
2005-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2005-01-01	Plan is a collectively bargained plan	No
2005-01-01	Plan funding arrangement – Insurance	Yes
2005-01-01	Plan funding arrangement – Trust	Yes
2005-01-01	Plan benefit arrangement – Insurance	Yes
2005-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	PHT 295
Policy instance	1
Insurance contract or identification number PHT 295 Number of Individuals Covered 227 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	PHT 295
Policy instance	1
Insurance contract or identification number PHT 295 Number of Individuals Covered 227 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	PHT 295
Policy instance	1
Insurance contract or identification number PHT 295 Number of Individuals Covered 219 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	PHT 295
Policy instance	1
Insurance contract or identification number PHT 295 Number of Individuals Covered 225 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	PHT 295
Policy instance	1
Insurance contract or identification number PHT 295 Number of Individuals Covered 202 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	PHT 295
Policy instance	1
Insurance contract or identification number PHT 295 Number of Individuals Covered 218 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $2,811 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,811 Insurance broker organization code? 3 Insurance broker name FAIRBRIDGE CAPITAL MARKETS, INC
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	PHT 295
Policy instance	1
Insurance contract or identification number PHT 295 Number of Individuals Covered 203 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $2,443 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,443 Insurance broker organization code? 3 Insurance broker name FAIRBRIDGE CAPITAL MARKETS, INC
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	PHT 295
Policy instance	1
Insurance contract or identification number PHT 295 Number of Individuals Covered 180 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $2,997 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,997 Insurance broker organization code? 3 Insurance broker name FAIRBRIDGE CAPITAL MARKETS, INC
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	PHT 295
Policy instance	1
Insurance contract or identification number PHT 295 Number of Individuals Covered 150 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $475 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $475 Insurance broker organization code? 3 Insurance broker name CONSULTIVA SECURITIES, INC.
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	PHT 295
Policy instance	1
Insurance contract or identification number PHT 295 Number of Individuals Covered 130 Insurance policy start date 2011-01-01 Total amount of commissions paid to insurance broker USD $1,226 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	PHT 295
Policy instance	1
Insurance contract or identification number PHT 295 Number of Individuals Covered 132 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $855 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? Yes Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $0 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	PHT 295
Policy instance	1
Insurance contract or identification number PHT 295 Insurance policy start date 2009-01-01 Insurance policy end date 2009-12-31 Total amount of commissions paid to insurance broker USD $545 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $0 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	PHT 295
Policy instance	1
Insurance contract or identification number PHT 295 Insurance policy start date 2008-01-01 Insurance policy end date 2008-12-31 Total amount of commissions paid to insurance broker USD $431 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $0 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	PHT 295
Policy instance	1
Insurance contract or identification number PHT 295 Insurance policy start date 2007-01-01 Insurance policy end date 2007-12-31 Total amount of commissions paid to insurance broker USD $294 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $0 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	PHT 295
Policy instance	1
Insurance contract or identification number PHT 295 Number of Individuals Covered 26 Insurance policy start date 2006-01-01 Insurance policy end date 2006-12-31 Total amount of commissions paid to insurance broker USD $571 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $0 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number	PHT 295
Policy instance	1
Insurance contract or identification number PHT 295 Number of Individuals Covered 26 Insurance policy start date 2005-01-01 Insurance policy end date 2005-12-31 Total amount of commissions paid to insurance broker USD $29 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? No Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Welfare Benefit Premiums Paid to Carrier USD $0 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No

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