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SUSQUEHANNA VALLEY EMERGENCY MEDICA SERVICES EMPLOYEE BENEFIT PLAN (501) 401k Plan overview

Plan NameSUSQUEHANNA VALLEY EMERGENCY MEDICA SERVICES EMPLOYEE BENEFIT PLAN (501)
Plan identification number 501

SUSQUEHANNA VALLEY EMERGENCY MEDICA SERVICES EMPLOYEE BENEFIT PLAN (501) Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

SUSQUEHANNA VALLEY EMERGENCY MEDICA SERVICES has sponsored the creation of one or more 401k plans.

Company Name:SUSQUEHANNA VALLEY EMERGENCY MEDICA SERVICES
Employer identification number (EIN):236447141
NAIC Classification:621900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SUSQUEHANNA VALLEY EMERGENCY MEDICA SERVICES EMPLOYEE BENEFIT PLAN (501)

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-07-01
5012020-07-01
5012019-07-01

Plan Statistics for SUSQUEHANNA VALLEY EMERGENCY MEDICA SERVICES EMPLOYEE BENEFIT PLAN (501)

401k plan membership statisitcs for SUSQUEHANNA VALLEY EMERGENCY MEDICA SERVICES EMPLOYEE BENEFIT PLAN (501)

Measure Date Value
2021: SUSQUEHANNA VALLEY EMERGENCY MEDICA SERVICES EMPLOYEE BENEFIT PLAN (501) 2021 401k membership
Total participants, beginning-of-year2021-07-0126
Total number of active participants reported on line 7a of the Form 55002021-07-010
Number of retired or separated participants receiving benefits2021-07-010
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-010
2020: SUSQUEHANNA VALLEY EMERGENCY MEDICA SERVICES EMPLOYEE BENEFIT PLAN (501) 2020 401k membership
Total participants, beginning-of-year2020-07-0130
Total number of active participants reported on line 7a of the Form 55002020-07-0125
Number of retired or separated participants receiving benefits2020-07-011
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-0126
2019: SUSQUEHANNA VALLEY EMERGENCY MEDICA SERVICES EMPLOYEE BENEFIT PLAN (501) 2019 401k membership
Total participants, beginning-of-year2019-07-0134
Total number of active participants reported on line 7a of the Form 55002019-07-0130
Number of retired or separated participants receiving benefits2019-07-010
Number of other retired or separated participants entitled to future benefits2019-07-010
Total of all active and inactive participants2019-07-0130

Financial Data on SUSQUEHANNA VALLEY EMERGENCY MEDICA SERVICES EMPLOYEE BENEFIT PLAN (501)

Measure Date Value
2022 : SUSQUEHANNA VALLEY EMERGENCY MEDICA SERVICES EMPLOYEE BENEFIT PLAN (501) 2022 401k financial data
Total plan liabilities at beginning of year2022-06-30$43,932
Total income from all sources2022-06-30$95,366
Expenses. Total of all expenses incurred2022-06-30$61,498
Benefits paid (including direct rollovers)2022-06-30$32,377
Total plan assets at end of year2022-06-30$10
Total plan assets at beginning of year2022-06-30$10,074
Value of fidelity bond covering the plan2022-06-30$30,000
Expenses. Other expenses not covered elsewhere2022-06-30$28,634
Other income received2022-06-30$8
Net income (gross income less expenses)2022-06-30$33,868
Net plan assets at end of year (total assets less liabilities)2022-06-30$10
Net plan assets at beginning of year (total assets less liabilities)2022-06-30$-33,858
Total contributions received or receivable from employer(s)2022-06-30$95,358
Expenses. Administrative service providers (salaries,fees and commissions)2022-06-30$487
2021 : SUSQUEHANNA VALLEY EMERGENCY MEDICA SERVICES EMPLOYEE BENEFIT PLAN (501) 2021 401k financial data
Total plan liabilities at end of year2021-06-30$43,932
Total plan liabilities at beginning of year2021-06-30$18,631
Total income from all sources2021-06-30$208,704
Expenses. Total of all expenses incurred2021-06-30$240,260
Benefits paid (including direct rollovers)2021-06-30$152,897
Total plan assets at end of year2021-06-30$10,074
Total plan assets at beginning of year2021-06-30$16,329
Value of fidelity bond covering the plan2021-06-30$30,000
Total contributions received or receivable from participants2021-06-30$69,595
Expenses. Other expenses not covered elsewhere2021-06-30$80,726
Other income received2021-06-30$32
Net income (gross income less expenses)2021-06-30$-31,556
Net plan assets at end of year (total assets less liabilities)2021-06-30$-33,858
Net plan assets at beginning of year (total assets less liabilities)2021-06-30$-2,302
Total contributions received or receivable from employer(s)2021-06-30$139,077
Expenses. Administrative service providers (salaries,fees and commissions)2021-06-30$6,637
2020 : SUSQUEHANNA VALLEY EMERGENCY MEDICA SERVICES EMPLOYEE BENEFIT PLAN (501) 2020 401k financial data
Total plan liabilities at end of year2020-06-30$18,631
Total plan liabilities at beginning of year2020-06-30$0
Total income from all sources2020-06-30$232,960
Expenses. Total of all expenses incurred2020-06-30$235,262
Benefits paid (including direct rollovers)2020-06-30$116,179
Total plan assets at end of year2020-06-30$16,329
Total plan assets at beginning of year2020-06-30$0
Value of fidelity bond covering the plan2020-06-30$30,000
Total contributions received or receivable from participants2020-06-30$69,828
Expenses. Other expenses not covered elsewhere2020-06-30$113,080
Contributions received from other sources (not participants or employers)2020-06-30$410
Other income received2020-06-30$25
Net income (gross income less expenses)2020-06-30$-2,302
Net plan assets at end of year (total assets less liabilities)2020-06-30$-2,302
Net plan assets at beginning of year (total assets less liabilities)2020-06-30$0
Total contributions received or receivable from employer(s)2020-06-30$162,697
Expenses. Administrative service providers (salaries,fees and commissions)2020-06-30$6,003

Form 5500 Responses for SUSQUEHANNA VALLEY EMERGENCY MEDICA SERVICES EMPLOYEE BENEFIT PLAN (501)

2021: SUSQUEHANNA VALLEY EMERGENCY MEDICA SERVICES EMPLOYEE BENEFIT PLAN (501) 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Submission has been amendedNo
2021-07-01This submission is the final filingNo
2021-07-01This return/report is a short plan year return/report (less than 12 months)No
2021-07-01Plan is a collectively bargained planNo
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan funding arrangement – TrustYes
2021-07-01Plan benefit arrangement – InsuranceYes
2021-07-01Plan benefit arrangement - TrustYes
2020: SUSQUEHANNA VALLEY EMERGENCY MEDICA SERVICES EMPLOYEE BENEFIT PLAN (501) 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Submission has been amendedNo
2020-07-01This submission is the final filingNo
2020-07-01This return/report is a short plan year return/report (less than 12 months)No
2020-07-01Plan is a collectively bargained planNo
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan funding arrangement – TrustYes
2020-07-01Plan benefit arrangement – InsuranceYes
2020-07-01Plan benefit arrangement - TrustYes
2019: SUSQUEHANNA VALLEY EMERGENCY MEDICA SERVICES EMPLOYEE BENEFIT PLAN (501) 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01First time form 5500 has been submittedYes
2019-07-01Submission has been amendedNo
2019-07-01This submission is the final filingNo
2019-07-01This return/report is a short plan year return/report (less than 12 months)No
2019-07-01Plan is a collectively bargained planNo
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan funding arrangement – TrustYes
2019-07-01Plan benefit arrangement – InsuranceYes
2019-07-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number31000080
Policy instance 1
Insurance contract or identification number31000080
Number of Individuals Covered0
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $23,799
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number913734
Policy instance 2
Insurance contract or identification number913734
Number of Individuals Covered0
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D, ACCIDENT, CRITICAL ILLNESS, CHILD LIFE & AD&D
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 CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerNONE
Insurance broker organization code?3
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number31000080
Policy instance 1
Insurance contract or identification number31000080
Number of Individuals Covered21
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $62,791
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number913734
Policy instance 2
Insurance contract or identification number913734
Number of Individuals Covered25
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $5,032
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D, ACCIDENT, CRITICAL ILLNESS, CHILD LIFE & AD&D
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 CarrierUSD $36,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,032
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerNONE
Insurance broker organization code?3
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number31000080
Policy instance 1
Insurance contract or identification number31000080
Number of Individuals Covered30
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $90,119
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number913734
Policy instance 2
Insurance contract or identification number913734
Number of Individuals Covered27
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $4,647
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D, ACCIDENT, CRITICAL ILLNESS, CHILD LIFE & AD&D
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 CarrierUSD $41,857
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,617
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerNONE
Insurance broker organization code?3

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