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CALDWELL MEMORIAL HOSPITAL, INC. 401K PROFIT SHARING PLAN AND TRUST 401k Plan overview

Plan NameCALDWELL MEMORIAL HOSPITAL, INC. 401K PROFIT SHARING PLAN AND TRUST
Plan identification number 001

CALDWELL MEMORIAL HOSPITAL, INC. 401K PROFIT SHARING PLAN AND TRUST Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

CALDWELL MEMORIAL HOSPITAL, INC. has sponsored the creation of one or more 401k plans.

Company Name:CALDWELL MEMORIAL HOSPITAL, INC.
Employer identification number (EIN):720878037
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CALDWELL MEMORIAL HOSPITAL, INC. 401K PROFIT SHARING PLAN AND TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01MATT HALE2023-07-10
0012021-01-01MATT HALE2022-06-28
0012020-01-01JESSICA E. SIETSEMA2021-07-06
0012019-01-01LISA PATRICK2020-07-15
0012018-01-01LISA PATRICK2019-06-26
0012017-01-01LISA PATRICK2018-04-27
0012016-01-01LISA PATRICK2017-07-18
0012016-01-01LISA PATRICK2017-11-10
0012015-01-01HEATHER CLARK2016-07-08
0012014-01-01HEATHER CLARK2015-10-06
0012013-01-01HEATHER CLARK2015-10-06
0012012-01-01HEATHER CLARK2013-05-16 HEATHER CLARK2013-05-16
0012011-01-01HEATHER CLARK2012-04-11 HEATHER CLARK2012-04-11
0012010-01-01HEATHER CLARK2011-04-04

Plan Statistics for CALDWELL MEMORIAL HOSPITAL, INC. 401K PROFIT SHARING PLAN AND TRUST

401k plan membership statisitcs for CALDWELL MEMORIAL HOSPITAL, INC. 401K PROFIT SHARING PLAN AND TRUST

Measure Date Value
2022: CALDWELL MEMORIAL HOSPITAL, INC. 401K PROFIT SHARING PLAN AND TRUST 2022 401k membership
Total participants, beginning-of-year2022-01-01107
Total number of active participants reported on line 7a of the Form 55002022-01-0179
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0121
Total of all active and inactive participants2022-01-01100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01100
Number of participants with account balances2022-01-0174
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: CALDWELL MEMORIAL HOSPITAL, INC. 401K PROFIT SHARING PLAN AND TRUST 2021 401k membership
Total participants, beginning-of-year2021-01-01106
Total number of active participants reported on line 7a of the Form 55002021-01-0185
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0117
Total of all active and inactive participants2021-01-01102
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01102
Number of participants with account balances2021-01-0176
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: CALDWELL MEMORIAL HOSPITAL, INC. 401K PROFIT SHARING PLAN AND TRUST 2020 401k membership
Total participants, beginning-of-year2020-01-0191
Total number of active participants reported on line 7a of the Form 55002020-01-0189
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0122
Total of all active and inactive participants2020-01-01111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01111
Number of participants with account balances2020-01-0178
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010

Financial Data on CALDWELL MEMORIAL HOSPITAL, INC. 401K PROFIT SHARING PLAN AND TRUST

Measure Date Value
2022 : CALDWELL MEMORIAL HOSPITAL, INC. 401K PROFIT SHARING PLAN AND TRUST 2022 401k financial data
Total plan liabilities at end of year2022-12-31$0
Total plan liabilities at beginning of year2022-12-31$0
Total income from all sources2022-12-31$30,335
Expenses. Total of all expenses incurred2022-12-31$809,230
Benefits paid (including direct rollovers)2022-12-31$802,365
Total plan assets at end of year2022-12-31$2,048,030
Total plan assets at beginning of year2022-12-31$2,826,925
Value of fidelity bond covering the plan2022-12-31$500,000
Total contributions received or receivable from participants2022-12-31$206,582
Expenses. Other expenses not covered elsewhere2022-12-31$0
Contributions received from other sources (not participants or employers)2022-12-31$0
Other income received2022-12-31$-292,215
Noncash contributions received2022-12-31$0
Net income (gross income less expenses)2022-12-31$-778,895
Net plan assets at end of year (total assets less liabilities)2022-12-31$2,048,030
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$2,826,925
Assets. Value of assets in partnership/joint-venture interests2022-12-31$0
Total contributions received or receivable from employer(s)2022-12-31$115,968
Value of certain deemed distributions of participant loans2022-12-31$0
Value of corrective distributions2022-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$6,865
2021 : CALDWELL MEMORIAL HOSPITAL, INC. 401K PROFIT SHARING PLAN AND TRUST 2021 401k financial data
Total plan liabilities at end of year2021-12-31$0
Total plan liabilities at beginning of year2021-12-31$0
Total income from all sources2021-12-31$693,861
Expenses. Total of all expenses incurred2021-12-31$688,470
Benefits paid (including direct rollovers)2021-12-31$687,382
Total plan assets at end of year2021-12-31$2,826,925
Total plan assets at beginning of year2021-12-31$2,821,534
Value of fidelity bond covering the plan2021-12-31$500,000
Total contributions received or receivable from participants2021-12-31$235,091
Expenses. Other expenses not covered elsewhere2021-12-31$0
Contributions received from other sources (not participants or employers)2021-12-31$0
Other income received2021-12-31$322,914
Noncash contributions received2021-12-31$0
Net income (gross income less expenses)2021-12-31$5,391
Net plan assets at end of year (total assets less liabilities)2021-12-31$2,826,925
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$2,821,534
Assets. Value of assets in partnership/joint-venture interests2021-12-31$250,000
Total contributions received or receivable from employer(s)2021-12-31$135,856
Value of certain deemed distributions of participant loans2021-12-31$0
Value of corrective distributions2021-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$1,088
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
2020 : CALDWELL MEMORIAL HOSPITAL, INC. 401K PROFIT SHARING PLAN AND TRUST 2020 401k financial data
Total plan liabilities at end of year2020-12-31$0
Total plan liabilities at beginning of year2020-12-31$0
Total income from all sources2020-12-31$603,209
Expenses. Total of all expenses incurred2020-12-31$127,609
Benefits paid (including direct rollovers)2020-12-31$121,779
Total plan assets at end of year2020-12-31$2,821,534
Total plan assets at beginning of year2020-12-31$2,345,934
Value of fidelity bond covering the plan2020-12-31$500,000
Total contributions received or receivable from participants2020-12-31$269,645
Expenses. Other expenses not covered elsewhere2020-12-31$0
Contributions received from other sources (not participants or employers)2020-12-31$0
Other income received2020-12-31$333,564
Noncash contributions received2020-12-31$0
Net income (gross income less expenses)2020-12-31$475,600
Net plan assets at end of year (total assets less liabilities)2020-12-31$2,821,534
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$2,345,934
Assets. Value of assets in partnership/joint-venture interests2020-12-31$250,000
Total contributions received or receivable from employer(s)2020-12-31$0
Value of certain deemed distributions of participant loans2020-12-31$0
Value of corrective distributions2020-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$5,830
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0

Form 5500 Responses for CALDWELL MEMORIAL HOSPITAL, INC. 401K PROFIT SHARING PLAN AND TRUST

2022: CALDWELL MEMORIAL HOSPITAL, INC. 401K PROFIT SHARING PLAN AND TRUST 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: CALDWELL MEMORIAL HOSPITAL, INC. 401K PROFIT SHARING PLAN AND TRUST 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: CALDWELL MEMORIAL HOSPITAL, INC. 401K PROFIT SHARING PLAN AND TRUST 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG39853
Policy instance 1
Insurance contract or identification numberG39853
Number of Individuals Covered74
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG39853
Policy instance 1
Insurance contract or identification numberG39853
Number of Individuals Covered78
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )
Policy contract number804873-000
Policy instance 1
Insurance contract or identification number804873-000
Number of Individuals Covered78
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $507
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees507
Additional information about fees paid to insurance brokerADMINISTRATIVE
Insurance broker organization code?5
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG39853
Policy instance 2
Insurance contract or identification numberG39853
Number of Individuals Covered81
Insurance policy start date2020-06-01
Insurance policy end date2020-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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