401k Plan data: BLUE VALLEY HOSPITAL 401(K) PLAN 401K PLAN plan

BLUE VALLEY HOSPITAL 401(K) PLAN 401K PLAN 401k Plan overview

Plan Name	BLUE VALLEY HOSPITAL 401(K) PLAN 401K PLAN
Plan identification number	001

BLUE VALLEY HOSPITAL 401(K) PLAN 401K 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.
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

BLUE VALLEY HOSPITAL, INC has sponsored the creation of one or more 401k plans.

Company Name: BLUE VALLEY HOSPITAL, INC

Employer identification number (EIN): 271202880

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BLUE VALLEY HOSPITAL 401(K) PLAN 401K PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2018-01-01 DALE FARRELL 2019-10-14 DALE FARRELL 2019-10-14
001 2017-01-01 RODNEY DOWNEY RODNEY DOWNEY 2018-10-16
001 2016-01-01 RODNEY DOWNEY RODNEY DOWNEY 2017-10-18
001 2015-01-01 RODNEY DOWNEY 2016-10-14 RODNEY DOWNEY 2016-10-14
001 2014-01-01 RODNEY DOWNEY 2015-10-14 RODNEY DOWNEY 2015-10-14
001 2013-01-01 RODNEY DOWNEY 2014-10-14 RODNEY DOWNEY 2014-10-14
001 2012-01-01 RODNEY DOWNEY 2013-06-05
001 2011-01-01 RODNEY DOWNEY 2012-07-16
001 2010-01-01 RODNEY DOWNEY 2011-07-29

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2018-01-01	DALE FARRELL	2019-10-14	DALE FARRELL	2019-10-14
001	2017-01-01	RODNEY DOWNEY		RODNEY DOWNEY	2018-10-16
001	2016-01-01	RODNEY DOWNEY		RODNEY DOWNEY	2017-10-18
001	2015-01-01	RODNEY DOWNEY	2016-10-14	RODNEY DOWNEY	2016-10-14
001	2014-01-01	RODNEY DOWNEY	2015-10-14	RODNEY DOWNEY	2015-10-14
001	2013-01-01	RODNEY DOWNEY	2014-10-14	RODNEY DOWNEY	2014-10-14
001	2012-01-01	RODNEY DOWNEY	2013-06-05
001	2011-01-01	RODNEY DOWNEY	2012-07-16
001	2010-01-01	RODNEY DOWNEY	2011-07-29

Plan Statistics for BLUE VALLEY HOSPITAL 401(K) PLAN 401K PLAN

401k plan membership statisitcs for BLUE VALLEY HOSPITAL 401(K) PLAN 401K PLAN

Measure Date Value
2018: BLUE VALLEY HOSPITAL 401(K) PLAN 401K PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 202
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 143
Number of retired or separated participants receiving benefits 2018-01-01 1
Number of other retired or separated participants entitled to future benefits 2018-01-01 34
Total of all active and inactive participants 2018-01-01 178
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 178
Number of participants with account balances 2018-01-01 118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: BLUE VALLEY HOSPITAL 401(K) PLAN 401K PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 183
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 164
Number of retired or separated participants receiving benefits 2017-01-01 1
Number of other retired or separated participants entitled to future benefits 2017-01-01 37
Total of all active and inactive participants 2017-01-01 202
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 202
Number of participants with account balances 2017-01-01 118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: BLUE VALLEY HOSPITAL 401(K) PLAN 401K PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 148
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 153
Number of retired or separated participants receiving benefits 2016-01-01 1
Number of other retired or separated participants entitled to future benefits 2016-01-01 34
Total of all active and inactive participants 2016-01-01 188
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 188
Number of participants with account balances 2016-01-01 101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0

Measure	Date	Value
2018: BLUE VALLEY HOSPITAL 401(K) PLAN 401K PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	202
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	143
Number of retired or separated participants receiving benefits	2018-01-01	1
Number of other retired or separated participants entitled to future benefits	2018-01-01	34
Total of all active and inactive participants	2018-01-01	178
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	178
Number of participants with account balances	2018-01-01	118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: BLUE VALLEY HOSPITAL 401(K) PLAN 401K PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	183
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	164
Number of retired or separated participants receiving benefits	2017-01-01	1
Number of other retired or separated participants entitled to future benefits	2017-01-01	37
Total of all active and inactive participants	2017-01-01	202
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	202
Number of participants with account balances	2017-01-01	118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: BLUE VALLEY HOSPITAL 401(K) PLAN 401K PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	148
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	153
Number of retired or separated participants receiving benefits	2016-01-01	1
Number of other retired or separated participants entitled to future benefits	2016-01-01	34
Total of all active and inactive participants	2016-01-01	188
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	188
Number of participants with account balances	2016-01-01	101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0

Financial Data on BLUE VALLEY HOSPITAL 401(K) PLAN 401K PLAN

Measure	Date	Value
2018 : BLUE VALLEY HOSPITAL 401(K) PLAN 401K PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total transfer of assets from this plan	2018-12-31	$743,627
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$233
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$5,593
Total income from all sources (including contributions)	2018-12-31	$603,728
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$355,303
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$324,095
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$814,073
Value of total assets at end of year	2018-12-31	$2,315,466
Value of total assets at beginning of year	2018-12-31	$2,816,028
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$31,208
Total interest from all sources	2018-12-31	$1,708
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$51,246
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$51,246
Administrative expenses professional fees incurred	2018-12-31	$14,141
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$100,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$482,319
Participant contributions at end of year	2018-12-31	$51,041
Participant contributions at beginning of year	2018-12-31	$21,574
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$73,870
Administrative expenses (other) incurred	2018-12-31	$3,862
Liabilities. Value of operating payables at end of year	2018-12-31	$233
Liabilities. Value of operating payables at beginning of year	2018-12-31	$5,593
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	$248,425
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$2,315,233
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$2,810,435
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
Investment advisory and management fees	2018-12-31	$13,205
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$2,263,169
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$2,788,757
Interest on participant loans	2018-12-31	$1,708
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-12-31	$1,256
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-12-31	$5,697
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-12-31	$5,697
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-263,299
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	$257,884
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$324,095
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	MICHAEL D. PEROO, CPA, PA
Accountancy firm EIN	2018-12-31	202448366
2017 : BLUE VALLEY HOSPITAL 401(K) PLAN 401K 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	$5,593
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$30,113
Total income from all sources (including contributions)	2017-12-31	$1,083,713
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$249,417
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$221,052
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$678,006
Value of total assets at end of year	2017-12-31	$2,816,028
Value of total assets at beginning of year	2017-12-31	$2,006,252
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$28,365
Total interest from all sources	2017-12-31	$1,016
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$63,323
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$63,323
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$100,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$421,755
Participant contributions at end of year	2017-12-31	$21,574
Participant contributions at beginning of year	2017-12-31	$6,671
Participant contributions at beginning of year	2017-12-31	$16,963
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$29,995
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2017-12-31	$26,277
Liabilities. Value of operating payables at end of year	2017-12-31	$5,593
Liabilities. Value of operating payables at beginning of year	2017-12-31	$3,836
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	$834,296
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$2,810,435
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$1,976,139
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
Investment advisory and management fees	2017-12-31	$10,774
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$2,788,757
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$1,968,122
Interest on participant loans	2017-12-31	$1,016
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-12-31	$5,697
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-12-31	$5,182
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-12-31	$5,182
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$341,368
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	$226,256
Employer contributions (assets) at beginning of year	2017-12-31	$9,314
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$221,052
Contract administrator fees	2017-12-31	$17,591
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	MICHAEL D. PEROO, CPA, PA
Accountancy firm EIN	2017-12-31	202448366
2016 : BLUE VALLEY HOSPITAL 401(K) PLAN 401K 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	$30,113
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	$655,985
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$262,391
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$219,802
Expenses. Certain deemed distributions of participant loans	2016-12-31	$14,375
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$505,942
Value of total assets at end of year	2016-12-31	$2,006,252
Value of total assets at beginning of year	2016-12-31	$1,582,545
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$28,214
Total interest from all sources	2016-12-31	$776
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$100,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$289,012
Participant contributions at end of year	2016-12-31	$6,671
Participant contributions at beginning of year	2016-12-31	$23,880
Participant contributions at end of year	2016-12-31	$16,963
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$48,240
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2016-12-31	$26,277
Administrative expenses (other) incurred	2016-12-31	$458
Liabilities. Value of operating payables at end of year	2016-12-31	$3,836
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	$393,594
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$1,976,139
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$1,582,545
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
Investment advisory and management fees	2016-12-31	$9,233
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$1,968,122
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$1,551,975
Interest on participant loans	2016-12-31	$771
Income. Interest from US Government securities	2016-12-31	$5
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2016-12-31	$5,182
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-12-31	$6,690
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-12-31	$6,690
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$149,267
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	$168,690
Employer contributions (assets) at end of year	2016-12-31	$9,314
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$219,802
Contract administrator fees	2016-12-31	$18,523
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	MICHAEL D. PEROO, CPA, PA
Accountancy firm EIN	2016-12-31	202448366

Form 5500 Responses for BLUE VALLEY HOSPITAL 401(K) PLAN 401K PLAN

2018: BLUE VALLEY HOSPITAL 401(K) PLAN 401K 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 – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: BLUE VALLEY HOSPITAL 401(K) PLAN 401K 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 – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: BLUE VALLEY HOSPITAL 401(K) PLAN 401K PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
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 – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	BLUE VALLEY HOSPITAL, INC
Employer identification number (EIN):	271202880
NAIC Classification:	622000
NAIC Description:	Hospitals