401k Plan data: TRANSFORM HEALTH RX plan

TRANSFORM HEALTH RX 401k Plan overview

Plan Name	TRANSFORM HEALTH RX
Plan identification number	001

TRANSFORM HEALTH RX 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.
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

TRANSFORM HEALTH RX has sponsored the creation of one or more 401k plans.

Company Name: TRANSFORM HEALTH RX

Employer identification number (EIN): 800379683

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TRANSFORM HEALTH RX

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 STEVEN CARDWELL 2017-08-07 STEVEN CARDWELL 2017-08-07
001 2015-01-01 STEVEN CARDWELL
001 2015-01-01 STEVEN CARDWELL
001 2014-01-01 JERRI MATHIS
001 2014-01-01 JERRY MATHIS 2015-10-21
001 2013-01-01 JERRY MATHIS 2014-07-21
001 2012-01-01 JERRY MATHIS 2013-10-02
001 2011-01-01 JERRY MATHIS 2012-07-26

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2016-01-01	STEVEN CARDWELL	2017-08-07	STEVEN CARDWELL	2017-08-07
001	2015-01-01	STEVEN CARDWELL
001	2015-01-01	STEVEN CARDWELL
001	2014-01-01	JERRI MATHIS
001	2014-01-01	JERRY MATHIS	2015-10-21
001	2013-01-01	JERRY MATHIS	2014-07-21
001	2012-01-01	JERRY MATHIS	2013-10-02
001	2011-01-01	JERRY MATHIS	2012-07-26

Plan Statistics for TRANSFORM HEALTH RX

401k plan membership statisitcs for TRANSFORM HEALTH RX

Measure Date Value
2015: TRANSFORM HEALTH RX 2015 401k membership
Total participants, beginning-of-year 2015-01-01 139
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 132
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 1
Total of all active and inactive participants 2015-01-01 133
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 133
Number of participants with account balances 2015-01-01 12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: TRANSFORM HEALTH RX 2014 401k membership
Total participants, beginning-of-year 2014-01-01 130
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 145
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 3
Total of all active and inactive participants 2014-01-01 148
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 148
Number of participants with account balances 2014-01-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0

Measure	Date	Value
2015: TRANSFORM HEALTH RX 2015 401k membership
Total participants, beginning-of-year	2015-01-01	139
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	132
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	1
Total of all active and inactive participants	2015-01-01	133
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	133
Number of participants with account balances	2015-01-01	12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: TRANSFORM HEALTH RX 2014 401k membership
Total participants, beginning-of-year	2014-01-01	130
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	145
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	3
Total of all active and inactive participants	2014-01-01	148
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	148
Number of participants with account balances	2014-01-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0

Financial Data on TRANSFORM HEALTH RX

Measure	Date	Value
2015 : TRANSFORM HEALTH RX 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total transfer of assets to this plan	2015-12-31	$0
Total transfer of assets from this plan	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	$29,633
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$30,823
Value of total assets at end of year	2015-12-31	$97,898
Value of total assets at beginning of year	2015-12-31	$68,265
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$0
Total interest from all sources	2015-12-31	$73
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$3,879
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$3,879
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$7,000
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	$30,823
Participant contributions at end of year	2015-12-31	$987
Participant contributions at beginning of year	2015-12-31	$1,860
Participant contributions at end of year	2015-12-31	$667
Participant contributions at beginning of year	2015-12-31	$726
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-12-31	$12,570
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	$29,633
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$97,898
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$68,265
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	$81,517
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$52,270
Interest on participant loans	2015-12-31	$73
Value of interest in common/collective trusts at end of year	2015-12-31	$433
Value of interest in common/collective trusts at beginning of year	2015-12-31	$95
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$14,961
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$14,040
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$14,040
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-5,121
Net investment gain or loss from common/collective trusts	2015-12-31	$-21
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
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	KAY PROCTOR
Accountancy firm EIN	2015-12-31	581820903
2014 : TRANSFORM HEALTH RX 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total transfer of assets to this plan	2014-12-31	$0
Total transfer of assets from this plan	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	$20,883
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$2,838
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$2,613
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$19,104
Value of total assets at end of year	2014-12-31	$68,265
Value of total assets at beginning of year	2014-12-31	$50,220
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$225
Total interest from all sources	2014-12-31	$98
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$2,763
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$2,763
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$6,000
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	$19,104
Participant contributions at end of year	2014-12-31	$1,860
Participant contributions at beginning of year	2014-12-31	$1,344
Administrative expenses (other) incurred	2014-12-31	$225
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	$18,045
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$68,265
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$50,220
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	$52,270
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$34,850
Interest on participant loans	2014-12-31	$98
Value of interest in common/collective trusts at end of year	2014-12-31	$95
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$14,040
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$14,026
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$14,026
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$-1,082
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	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$2,613
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	KAY PROCTOR
Accountancy firm EIN	2014-12-31	581820903

Form 5500 Responses for TRANSFORM HEALTH RX

2015: TRANSFORM HEALTH RX 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 – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: TRANSFORM HEALTH RX 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 – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes

Potentially related plans

TRANSFORM HEALTH AND WELFARE PLAN [EIN = 833374195]

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Company Name:	TRANSFORM HEALTH RX
Employer identification number (EIN):	800379683
NAIC Classification:	624100
NAIC Description:	Individual and Family Services