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CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 401k Plan overview

Plan NameCAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN
Plan identification number 003

CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 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.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
  • 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

CAMERON MEMORIAL COMMUNITY HOSPITAL INC. has sponsored the creation of one or more 401k plans.

Company Name:CAMERON MEMORIAL COMMUNITY HOSPITAL INC.
Employer identification number (EIN):350211370
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0032022-01-01
0032021-01-01
0032021-01-01
0032020-01-01
0032020-01-01
0032019-01-01
0032018-01-01
0032017-01-01DOUG BOMBA
0032016-01-01DOUG BOMBA
0032015-01-01DOUG BOMBA
0032014-01-01NANCY COVELL
0032013-01-01NANCY COVELL
0032012-01-01NANCY COVELL

Plan Statistics for CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN

401k plan membership statisitcs for CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN

Measure Date Value
2022: CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01677
Total number of active participants reported on line 7a of the Form 55002022-01-01603
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-01104
Total of all active and inactive participants2022-01-01707
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01707
Number of participants with account balances2022-01-01681
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01636
Total number of active participants reported on line 7a of the Form 55002021-01-01593
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0184
Total of all active and inactive participants2021-01-01677
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01677
Number of participants with account balances2021-01-01624
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01709
Total number of active participants reported on line 7a of the Form 55002020-01-01538
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0198
Total of all active and inactive participants2020-01-01636
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01636
Number of participants with account balances2020-01-01550
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01642
Total number of active participants reported on line 7a of the Form 55002019-01-01555
Number of retired or separated participants receiving benefits2019-01-0146
Number of other retired or separated participants entitled to future benefits2019-01-01107
Total of all active and inactive participants2019-01-01708
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-011
Total participants2019-01-01709
Number of participants with account balances2019-01-01575
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01585
Total number of active participants reported on line 7a of the Form 55002018-01-01530
Number of retired or separated participants receiving benefits2018-01-0131
Number of other retired or separated participants entitled to future benefits2018-01-0182
Total of all active and inactive participants2018-01-01643
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01643
Number of participants with account balances2018-01-01533
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01557
Total number of active participants reported on line 7a of the Form 55002017-01-01531
Number of retired or separated participants receiving benefits2017-01-0116
Number of other retired or separated participants entitled to future benefits2017-01-0142
Total of all active and inactive participants2017-01-01589
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-01589
Number of participants with account balances2017-01-01471
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-013
2016: CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01496
Total number of active participants reported on line 7a of the Form 55002016-01-01493
Number of retired or separated participants receiving benefits2016-01-015
Number of other retired or separated participants entitled to future benefits2016-01-0142
Total of all active and inactive participants2016-01-01540
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-01540
Number of participants with account balances2016-01-01405
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-0111
2015: CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01491
Total number of active participants reported on line 7a of the Form 55002015-01-01451
Number of retired or separated participants receiving benefits2015-01-014
Number of other retired or separated participants entitled to future benefits2015-01-0136
Total of all active and inactive participants2015-01-01491
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-01491
Number of participants with account balances2015-01-01390
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-017
2014: CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01461
Total number of active participants reported on line 7a of the Form 55002014-01-01447
Number of retired or separated participants receiving benefits2014-01-018
Number of other retired or separated participants entitled to future benefits2014-01-0138
Total of all active and inactive participants2014-01-01493
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-01493
Number of participants with account balances2014-01-01367
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-0111
2013: CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01454
Total number of active participants reported on line 7a of the Form 55002013-01-01421
Number of retired or separated participants receiving benefits2013-01-014
Number of other retired or separated participants entitled to future benefits2013-01-0128
Total of all active and inactive participants2013-01-01453
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-011
Total participants2013-01-01454
Number of participants with account balances2013-01-01344
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-018
2012: CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01444
Total number of active participants reported on line 7a of the Form 55002012-01-01406
Number of retired or separated participants receiving benefits2012-01-012
Number of other retired or separated participants entitled to future benefits2012-01-0135
Total of all active and inactive participants2012-01-01443
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-011
Total participants2012-01-01444
Number of participants with account balances2012-01-01363
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010

Financial Data on CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN

Measure Date Value
2022 : CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2022 401k financial data
Unrealized appreciation/depreciation of real estate assets2022-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2022-12-31$-9,672
Total unrealized appreciation/depreciation of assets2022-12-31$-9,672
Total transfer of assets to this plan2022-12-31$0
Total transfer of assets from this plan2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Expenses. Interest paid2022-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022022-12-31$0
Total income from all sources (including contributions)2022-12-31$-1,456,208
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$1,749,271
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$1,661,301
Expenses. Certain deemed distributions of participant loans2022-12-31$1,400
Value of total corrective distributions2022-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$2,976,988
Value of total assets at end of year2022-12-31$21,190,292
Value of total assets at beginning of year2022-12-31$24,395,771
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$86,570
Total income from rents2022-12-31$0
Total interest from all sources2022-12-31$20,032
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$694,081
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$692,223
Assets. Real estate other than employer real property at end of year2022-12-31$0
Assets. Real estate other than employer real property at beginning of year2022-12-31$0
Administrative expenses professional fees incurred2022-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2022-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2022-12-31$0
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$1,633,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$1,670,374
Participant contributions at end of year2022-12-31$183,186
Participant contributions at beginning of year2022-12-31$161,049
Participant contributions at end of year2022-12-31$64,116
Participant contributions at beginning of year2022-12-31$0
Assets. Other investments not covered elsewhere at end of year2022-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2022-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$230,984
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2022-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$0
Assets. Loans (other than to participants) at end of year2022-12-31$0
Assets. Loans (other than to participants) at beginning of year2022-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$0
Other income not declared elsewhere2022-12-31$0
Administrative expenses (other) incurred2022-12-31$83,947
Liabilities. Value of operating payables at end of year2022-12-31$0
Liabilities. Value of operating payables at beginning of year2022-12-31$0
Total non interest bearing cash at end of year2022-12-31$0
Total non interest bearing cash at beginning of year2022-12-31$1,157
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Income. Non cash contributions2022-12-31$0
Value of net income/loss2022-12-31$-3,205,479
Value of net assets at end of year (total assets less liabilities)2022-12-31$21,190,292
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$24,395,771
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Assets. partnership/joint venture interests at end of year2022-12-31$0
Assets. partnership/joint venture interests at beginning of year2022-12-31$0
Investment advisory and management fees2022-12-31$2,623
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$19,741,830
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$22,907,793
Value of interest in pooled separate accounts at end of year2022-12-31$0
Value of interest in pooled separate accounts at beginning of year2022-12-31$0
Interest on participant loans2022-12-31$6,723
Income. Interest from loans (other than to participants)2022-12-31$0
Interest earned on other investments2022-12-31$0
Income. Interest from US Government securities2022-12-31$0
Income. Interest from corporate debt instruments2022-12-31$0
Value of interest in master investment trust accounts at end of year2022-12-31$0
Value of interest in master investment trust accounts at beginning of year2022-12-31$0
Value of interest in common/collective trusts at end of year2022-12-31$0
Value of interest in common/collective trusts at beginning of year2022-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$1,005,345
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$1,209,024
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$1,209,024
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$13,309
Assets. Value of investments in 103.12 investment entities at end of year2022-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2022-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$0
Asset value of US Government securities at end of year2022-12-31$0
Asset value of US Government securities at beginning of year2022-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-5,137,637
Net investment gain/loss from pooled separate accounts2022-12-31$0
Net investment gain or loss from common/collective trusts2022-12-31$0
Net gain/loss from 103.12 investment entities2022-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Assets. Invements in employer securities at end of year2022-12-31$0
Assets. Invements in employer securities at beginning of year2022-12-31$0
Assets. Value of employer real property at end of year2022-12-31$0
Assets. Value of employer real property at beginning of year2022-12-31$0
Contributions received in cash from employer2022-12-31$1,075,630
Employer contributions (assets) at end of year2022-12-31$35,813
Employer contributions (assets) at beginning of year2022-12-31$0
Income. Dividends from preferred stock2022-12-31$0
Income. Dividends from common stock2022-12-31$1,858
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$1,661,301
Asset. Corporate debt instrument preferred debt at end of year2022-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2022-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2022-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2022-12-31$0
Contract administrator fees2022-12-31$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32022-12-31No
Assets. Corporate common stocks other than exployer securities at end of year2022-12-31$160,002
Assets. Corporate common stocks other than exployer securities at beginning of year2022-12-31$116,748
Liabilities. Value of benefit claims payable at end of year2022-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2022-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2022-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2022-12-31$0
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Aggregate proceeds on sale of assets2022-12-31$0
Aggregate carrying amount (costs) on sale of assets2022-12-31$0
Liabilities. Value of acquisition indebtedness at end of year2022-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2022-12-31$0
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31WIPFLI LLP
Accountancy firm EIN2022-12-31390758449
2021 : CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2021 401k financial data
Unrealized appreciation/depreciation of real estate assets2021-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2021-12-31$10,473
Total unrealized appreciation/depreciation of assets2021-12-31$10,473
Total transfer of assets to this plan2021-12-31$0
Total transfer of assets from this plan2021-12-31$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
Expenses. Interest paid2021-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022021-12-31$0
Total income from all sources (including contributions)2021-12-31$5,618,918
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$2,611,227
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$2,525,119
Expenses. Certain deemed distributions of participant loans2021-12-31$0
Value of total corrective distributions2021-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$2,551,303
Value of total assets at end of year2021-12-31$24,395,771
Value of total assets at beginning of year2021-12-31$21,388,080
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$86,108
Total income from rents2021-12-31$0
Total interest from all sources2021-12-31$4,083
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$698,912
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$697,793
Assets. Real estate other than employer real property at end of year2021-12-31$0
Assets. Real estate other than employer real property at beginning of year2021-12-31$0
Administrative expenses professional fees incurred2021-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2021-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2021-12-31$0
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$1,633,000
If this is an individual account plan, was there a blackout period2021-12-31No
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$1,386,250
Participant contributions at end of year2021-12-31$161,049
Participant contributions at beginning of year2021-12-31$68,428
Participant contributions at end of year2021-12-31$0
Participant contributions at beginning of year2021-12-31$40,241
Assets. Other investments not covered elsewhere at end of year2021-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2021-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$219,055
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2021-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$0
Assets. Loans (other than to participants) at end of year2021-12-31$0
Assets. Loans (other than to participants) at beginning of year2021-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-12-31$0
Other income not declared elsewhere2021-12-31$0
Administrative expenses (other) incurred2021-12-31$85,566
Liabilities. Value of operating payables at end of year2021-12-31$0
Liabilities. Value of operating payables at beginning of year2021-12-31$0
Total non interest bearing cash at end of year2021-12-31$1,157
Total non interest bearing cash at beginning of year2021-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Income. Non cash contributions2021-12-31$0
Value of net income/loss2021-12-31$3,007,691
Value of net assets at end of year (total assets less liabilities)2021-12-31$24,395,771
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$21,388,080
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Assets. partnership/joint venture interests at end of year2021-12-31$0
Assets. partnership/joint venture interests at beginning of year2021-12-31$0
Investment advisory and management fees2021-12-31$542
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$22,907,793
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$20,037,101
Value of interest in pooled separate accounts at end of year2021-12-31$0
Value of interest in pooled separate accounts at beginning of year2021-12-31$0
Interest on participant loans2021-12-31$3,949
Income. Interest from loans (other than to participants)2021-12-31$0
Interest earned on other investments2021-12-31$0
Income. Interest from US Government securities2021-12-31$0
Income. Interest from corporate debt instruments2021-12-31$0
Value of interest in master investment trust accounts at end of year2021-12-31$0
Value of interest in master investment trust accounts at beginning of year2021-12-31$0
Value of interest in common/collective trusts at end of year2021-12-31$0
Value of interest in common/collective trusts at beginning of year2021-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-12-31$1,209,024
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-12-31$1,212,748
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-12-31$1,212,748
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-12-31$134
Assets. Value of investments in 103.12 investment entities at end of year2021-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2021-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$0
Asset value of US Government securities at end of year2021-12-31$0
Asset value of US Government securities at beginning of year2021-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$2,354,147
Net investment gain/loss from pooled separate accounts2021-12-31$0
Net investment gain or loss from common/collective trusts2021-12-31$0
Net gain/loss from 103.12 investment entities2021-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Assets. Invements in employer securities at end of year2021-12-31$0
Assets. Invements in employer securities at beginning of year2021-12-31$0
Assets. Value of employer real property at end of year2021-12-31$0
Assets. Value of employer real property at beginning of year2021-12-31$0
Contributions received in cash from employer2021-12-31$945,998
Employer contributions (assets) at end of year2021-12-31$0
Employer contributions (assets) at beginning of year2021-12-31$29,562
Income. Dividends from preferred stock2021-12-31$0
Income. Dividends from common stock2021-12-31$1,119
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$2,525,119
Asset. Corporate debt instrument preferred debt at end of year2021-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2021-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2021-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2021-12-31$0
Contract administrator fees2021-12-31$0
Assets. Corporate common stocks other than exployer securities at end of year2021-12-31$116,748
Assets. Corporate common stocks other than exployer securities at beginning of year2021-12-31$0
Liabilities. Value of benefit claims payable at end of year2021-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2021-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2021-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2021-12-31$0
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Aggregate proceeds on sale of assets2021-12-31$0
Aggregate carrying amount (costs) on sale of assets2021-12-31$0
Liabilities. Value of acquisition indebtedness at end of year2021-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2021-12-31$0
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31BLUE AND COMPANY, LLC
Accountancy firm EIN2021-12-31351178661
2020 : CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2020 401k financial data
Unrealized appreciation/depreciation of real estate assets2020-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2020-12-31$0
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total transfer of assets to this plan2020-12-31$0
Total transfer of assets from this plan2020-12-31$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$3,877
Expenses. Interest paid2020-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022020-12-31$0
Total income from all sources (including contributions)2020-12-31$5,482,949
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$3,158,862
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$3,126,517
Expenses. Certain deemed distributions of participant loans2020-12-31$0
Value of total corrective distributions2020-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$2,169,925
Value of total assets at end of year2020-12-31$21,388,080
Value of total assets at beginning of year2020-12-31$19,067,870
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$32,345
Total income from rents2020-12-31$0
Total interest from all sources2020-12-31$105,504
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$318,889
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$318,889
Assets. Real estate other than employer real property at end of year2020-12-31$0
Assets. Real estate other than employer real property at beginning of year2020-12-31$0
Administrative expenses professional fees incurred2020-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2020-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2020-12-31$0
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$1,633,000
If this is an individual account plan, was there a blackout period2020-12-31Yes
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$937,292
Participant contributions at end of year2020-12-31$68,428
Participant contributions at beginning of year2020-12-31$0
Participant contributions at end of year2020-12-31$40,241
Participant contributions at beginning of year2020-12-31$0
Assets. Other investments not covered elsewhere at end of year2020-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2020-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$358,604
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2020-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$0
Assets. Loans (other than to participants) at end of year2020-12-31$0
Assets. Loans (other than to participants) at beginning of year2020-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$3,877
Other income not declared elsewhere2020-12-31$0
Administrative expenses (other) incurred2020-12-31$32,345
Liabilities. Value of operating payables at end of year2020-12-31$0
Liabilities. Value of operating payables at beginning of year2020-12-31$0
Total non interest bearing cash at end of year2020-12-31$0
Total non interest bearing cash at beginning of year2020-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Income. Non cash contributions2020-12-31$0
Value of net income/loss2020-12-31$2,324,087
Value of net assets at end of year (total assets less liabilities)2020-12-31$21,388,080
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$19,063,993
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Assets. partnership/joint venture interests at end of year2020-12-31$0
Assets. partnership/joint venture interests at beginning of year2020-12-31$0
Investment advisory and management fees2020-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$20,037,101
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$0
Value of interest in pooled separate accounts at end of year2020-12-31$0
Value of interest in pooled separate accounts at beginning of year2020-12-31$17,351,723
Interest on participant loans2020-12-31$218
Income. Interest from loans (other than to participants)2020-12-31$0
Interest earned on other investments2020-12-31$105,255
Income. Interest from US Government securities2020-12-31$0
Income. Interest from corporate debt instruments2020-12-31$0
Value of interest in master investment trust accounts at end of year2020-12-31$0
Value of interest in master investment trust accounts at beginning of year2020-12-31$0
Value of interest in common/collective trusts at end of year2020-12-31$0
Value of interest in common/collective trusts at beginning of year2020-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-12-31$1,212,748
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-12-31$31
Assets. Value of investments in 103.12 investment entities at end of year2020-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2020-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$1,684,058
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$0
Asset value of US Government securities at end of year2020-12-31$0
Asset value of US Government securities at beginning of year2020-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$1,625,059
Net investment gain/loss from pooled separate accounts2020-12-31$1,263,572
Net investment gain or loss from common/collective trusts2020-12-31$0
Net gain/loss from 103.12 investment entities2020-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Assets. Invements in employer securities at end of year2020-12-31$0
Assets. Invements in employer securities at beginning of year2020-12-31$0
Assets. Value of employer real property at end of year2020-12-31$0
Assets. Value of employer real property at beginning of year2020-12-31$0
Contributions received in cash from employer2020-12-31$874,029
Employer contributions (assets) at end of year2020-12-31$29,562
Employer contributions (assets) at beginning of year2020-12-31$32,089
Income. Dividends from preferred stock2020-12-31$0
Income. Dividends from common stock2020-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$3,126,517
Asset. Corporate debt instrument preferred debt at end of year2020-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2020-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2020-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2020-12-31$0
Contract administrator fees2020-12-31$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-12-31Yes
Assets. Corporate common stocks other than exployer securities at end of year2020-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2020-12-31$0
Liabilities. Value of benefit claims payable at end of year2020-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2020-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2020-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2020-12-31$0
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Aggregate proceeds on sale of assets2020-12-31$0
Aggregate carrying amount (costs) on sale of assets2020-12-31$0
Liabilities. Value of acquisition indebtedness at end of year2020-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2020-12-31$0
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31BLUE AND COMPANY, LLC
Accountancy firm EIN2020-12-31351178661
2019 : CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$3,877
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$3,877
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$1,506
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$1,506
Total income from all sources (including contributions)2019-12-31$5,052,254
Total income from all sources (including contributions)2019-12-31$5,052,254
Total loss/gain on sale of assets2019-12-31$0
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$1,190,587
Total of all expenses incurred2019-12-31$1,190,587
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$1,161,665
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$1,161,665
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$1,790,067
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$1,790,067
Value of total assets at end of year2019-12-31$19,067,870
Value of total assets at end of year2019-12-31$19,067,870
Value of total assets at beginning of year2019-12-31$15,203,832
Value of total assets at beginning of year2019-12-31$15,203,832
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$28,922
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$28,922
Total interest from all sources2019-12-31$22,670
Total interest from all sources2019-12-31$22,670
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Was this plan covered by a fidelity bond2019-12-31Yes
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$1,633,000
Value of fidelity bond cover2019-12-31$1,633,000
If this is an individual account plan, was there a blackout period2019-12-31No
If this is an individual account plan, was there a blackout period2019-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$784,524
Contributions received from participants2019-12-31$784,524
Participant contributions at end of year2019-12-31$0
Participant contributions at end of year2019-12-31$0
Participant contributions at beginning of year2019-12-31$821
Participant contributions at beginning of year2019-12-31$821
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$166,120
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$166,120
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$3,877
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$3,877
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$1,506
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$1,506
Total non interest bearing cash at end of year2019-12-31$0
Total non interest bearing cash at end of year2019-12-31$0
Total non interest bearing cash at beginning of year2019-12-31$0
Total non interest bearing cash at beginning of year2019-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Income. Non cash contributions2019-12-31$0
Income. Non cash contributions2019-12-31$0
Value of net income/loss2019-12-31$3,861,667
Value of net income/loss2019-12-31$3,861,667
Value of net assets at end of year (total assets less liabilities)2019-12-31$19,063,993
Value of net assets at end of year (total assets less liabilities)2019-12-31$19,063,993
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$15,202,326
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$15,202,326
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in pooled separate accounts at end of year2019-12-31$17,351,723
Value of interest in pooled separate accounts at end of year2019-12-31$17,351,723
Value of interest in pooled separate accounts at beginning of year2019-12-31$13,483,132
Value of interest in pooled separate accounts at beginning of year2019-12-31$13,483,132
Interest earned on other investments2019-12-31$22,670
Interest earned on other investments2019-12-31$22,670
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$1,684,058
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$1,684,058
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$1,663,032
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$1,663,032
Net investment gain/loss from pooled separate accounts2019-12-31$3,239,517
Net investment gain/loss from pooled separate accounts2019-12-31$3,239,517
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31Yes
Was there a failure to transmit to the plan any participant contributions2019-12-31Yes
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Assets. Invements in employer securities at end of year2019-12-31$0
Assets. Invements in employer securities at end of year2019-12-31$0
Assets. Invements in employer securities at beginning of year2019-12-31$0
Assets. Invements in employer securities at beginning of year2019-12-31$0
Contributions received in cash from employer2019-12-31$839,423
Contributions received in cash from employer2019-12-31$839,423
Employer contributions (assets) at end of year2019-12-31$32,089
Employer contributions (assets) at end of year2019-12-31$32,089
Employer contributions (assets) at beginning of year2019-12-31$56,847
Employer contributions (assets) at beginning of year2019-12-31$56,847
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$1,161,665
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$1,161,665
Contract administrator fees2019-12-31$28,922
Contract administrator fees2019-12-31$28,922
Did the plan have assets held for investment2019-12-31Yes
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31BLUE AND COMPANY, LLC
Accountancy firm name2019-12-31BLUE AND COMPANY, LLC
Accountancy firm EIN2019-12-31351178661
Accountancy firm EIN2019-12-31351178661
2018 : CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$1,506
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$6,878
Total income from all sources (including contributions)2018-12-31$717,521
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$1,284,449
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$1,265,421
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$1,642,043
Value of total assets at end of year2018-12-31$15,203,832
Value of total assets at beginning of year2018-12-31$15,776,132
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$19,028
Total interest from all sources2018-12-31$22,758
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$0
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$1,633,000
If this is an individual account plan, was there a blackout period2018-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$763,421
Participant contributions at end of year2018-12-31$821
Participant contributions at beginning of year2018-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$89,995
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-12-31$1,506
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-12-31$6,878
Total non interest bearing cash at end of year2018-12-31$0
Total non interest bearing cash at beginning of year2018-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-566,928
Value of net assets at end of year (total assets less liabilities)2018-12-31$15,202,326
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$15,769,254
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Value of interest in pooled separate accounts at end of year2018-12-31$13,483,132
Value of interest in pooled separate accounts at beginning of year2018-12-31$14,148,446
Interest earned on other investments2018-12-31$22,758
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$1,663,032
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$1,608,001
Net investment gain/loss from pooled separate accounts2018-12-31$-947,280
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Assets. Invements in employer securities at end of year2018-12-31$0
Assets. Invements in employer securities at beginning of year2018-12-31$0
Contributions received in cash from employer2018-12-31$788,627
Employer contributions (assets) at end of year2018-12-31$56,847
Employer contributions (assets) at beginning of year2018-12-31$19,685
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$1,265,421
Contract administrator fees2018-12-31$19,028
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31BLUE AND COMPANY, LLC
Accountancy firm EIN2018-12-31351178661
2017 : CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$6,878
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$3,848,584
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$1,397,438
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$1,379,368
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$1,604,560
Value of total assets at end of year2017-12-31$15,776,132
Value of total assets at beginning of year2017-12-31$13,318,108
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$18,070
Total interest from all sources2017-12-31$21,915
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$0
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$1,000,000
If this is an individual account plan, was there a blackout period2017-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$653,474
Participant contributions at end of year2017-12-31$0
Participant contributions at beginning of year2017-12-31$22,863
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$281,952
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-12-31$6,878
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-12-31$0
Total non interest bearing cash at end of year2017-12-31$0
Total non interest bearing cash at beginning of year2017-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$2,451,146
Value of net assets at end of year (total assets less liabilities)2017-12-31$15,769,254
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$13,318,108
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Investment advisory and management fees2017-12-31$18,070
Value of interest in pooled separate accounts at end of year2017-12-31$14,148,446
Value of interest in pooled separate accounts at beginning of year2017-12-31$11,637,443
Interest earned on other investments2017-12-31$21,915
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-12-31$1,608,001
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-12-31$1,628,911
Net investment gain/loss from pooled separate accounts2017-12-31$2,222,109
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Assets. Invements in employer securities at end of year2017-12-31$0
Assets. Invements in employer securities at beginning of year2017-12-31$0
Contributions received in cash from employer2017-12-31$669,134
Employer contributions (assets) at end of year2017-12-31$19,685
Employer contributions (assets) at beginning of year2017-12-31$28,891
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$1,379,368
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31Yes
Opinion of an independent qualified public accountant for this plan2017-12-31Disclaimer
Accountancy firm name2017-12-31BLUE AND COMPANY, LLC
Accountancy firm EIN2017-12-31351178661
2016 : CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$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$2,331,538
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$629,146
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$616,844
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$1,280,660
Value of total assets at end of year2016-12-31$13,318,108
Value of total assets at beginning of year2016-12-31$11,615,716
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$12,302
Total interest from all sources2016-12-31$26,800
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$0
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$1,000,000
If this is an individual account plan, was there a blackout period2016-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$584,792
Participant contributions at end of year2016-12-31$22,863
Participant contributions at beginning of year2016-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$26,372
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-12-31$0
Total non interest bearing cash at end of year2016-12-31$0
Total non interest bearing cash at beginning of year2016-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$1,702,392
Value of net assets at end of year (total assets less liabilities)2016-12-31$13,318,108
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$11,615,716
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Investment advisory and management fees2016-12-31$12,302
Value of interest in pooled separate accounts at end of year2016-12-31$11,637,443
Value of interest in pooled separate accounts at beginning of year2016-12-31$10,056,692
Interest earned on other investments2016-12-31$26,800
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$1,628,911
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$1,558,271
Net investment gain/loss from pooled separate accounts2016-12-31$1,024,078
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Assets. Invements in employer securities at end of year2016-12-31$0
Assets. Invements in employer securities at beginning of year2016-12-31$0
Contributions received in cash from employer2016-12-31$669,496
Employer contributions (assets) at end of year2016-12-31$28,891
Employer contributions (assets) at beginning of year2016-12-31$753
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$616,844
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31BLUE AND COMPANY, LLC
Accountancy firm EIN2016-12-31351178661
2015 : CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$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$1,105,836
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$856,415
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$834,313
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$1,150,906
Value of total assets at end of year2015-12-31$11,615,716
Value of total assets at beginning of year2015-12-31$11,366,295
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$22,102
Total interest from all sources2015-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$0
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$1,000,000
If this is an individual account plan, was there a blackout period2015-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$454,926
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$138,532
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-12-31$0
Total non interest bearing cash at end of year2015-12-31$0
Total non interest bearing cash at beginning of year2015-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$249,421
Value of net assets at end of year (total assets less liabilities)2015-12-31$11,615,716
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$11,366,295
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Value of interest in pooled separate accounts at end of year2015-12-31$10,056,692
Value of interest in pooled separate accounts at beginning of year2015-12-31$9,884,279
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$1,558,271
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-31$1,477,024
Net investment gain/loss from pooled separate accounts2015-12-31$-45,070
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Assets. Invements in employer securities at end of year2015-12-31$0
Assets. Invements in employer securities at beginning of year2015-12-31$0
Contributions received in cash from employer2015-12-31$557,448
Employer contributions (assets) at end of year2015-12-31$753
Employer contributions (assets) at beginning of year2015-12-31$4,992
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$834,313
Contract administrator fees2015-12-31$22,102
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31BLUE AND COMPANY, LLC
Accountancy firm EIN2015-12-31351178661
2014 : CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-12-31$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$3,762
Total income from all sources (including contributions)2014-12-31$1,732,684
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$513,688
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$492,786
Value of total corrective distributions2014-12-31$3,762
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$1,113,891
Value of total assets at end of year2014-12-31$11,366,295
Value of total assets at beginning of year2014-12-31$10,151,061
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$17,140
Total interest from all sources2014-12-31$25,564
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$0
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$1,000,000
If this is an individual account plan, was there a blackout period2014-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$429,479
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$166,336
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-12-31$3,762
Total non interest bearing cash at end of year2014-12-31$0
Total non interest bearing cash at beginning of year2014-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$1,218,996
Value of net assets at end of year (total assets less liabilities)2014-12-31$11,366,295
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$10,147,299
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Investment advisory and management fees2014-12-31$17,140
Value of interest in pooled separate accounts at end of year2014-12-31$9,884,279
Value of interest in pooled separate accounts at beginning of year2014-12-31$8,771,088
Interest earned on other investments2014-12-31$25,564
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-12-31$1,477,024
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-12-31$1,379,672
Net investment gain/loss from pooled separate accounts2014-12-31$593,229
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Assets. Invements in employer securities at end of year2014-12-31$0
Assets. Invements in employer securities at beginning of year2014-12-31$0
Contributions received in cash from employer2014-12-31$518,076
Employer contributions (assets) at end of year2014-12-31$4,992
Employer contributions (assets) at beginning of year2014-12-31$301
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$492,786
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31BLUE AND COMPANY, LLC
Accountancy firm EIN2014-12-31351178661
2013 : CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$3,762
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$3,143
Total income from all sources (including contributions)2013-12-31$2,595,748
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$1,229,655
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$1,217,120
Value of total corrective distributions2013-12-31$3,247
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$997,955
Value of total assets at end of year2013-12-31$10,151,061
Value of total assets at beginning of year2013-12-31$8,784,349
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$9,288
Total interest from all sources2013-12-31$26,790
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$0
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$1,000,000
If this is an individual account plan, was there a blackout period2013-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$465,400
Income. Received or receivable in cash from other sources (including rollovers)2013-12-31$42,671
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-12-31$3,762
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-12-31$3,143
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$1,366,093
Value of net assets at end of year (total assets less liabilities)2013-12-31$10,147,299
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$8,781,206
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Investment advisory and management fees2013-12-31$6,541
Value of interest in pooled separate accounts at end of year2013-12-31$8,771,088
Value of interest in pooled separate accounts at beginning of year2013-12-31$7,366,690
Interest earned on other investments2013-12-31$26,790
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-12-31$1,379,672
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-12-31$1,414,003
Net investment gain/loss from pooled separate accounts2013-12-31$1,571,003
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Assets. Invements in employer securities at end of year2013-12-31$0
Assets. Invements in employer securities at beginning of year2013-12-31$0
Contributions received in cash from employer2013-12-31$489,884
Employer contributions (assets) at end of year2013-12-31$301
Employer contributions (assets) at beginning of year2013-12-31$3,656
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$1,217,120
Contract administrator fees2013-12-31$2,747
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31Yes
Opinion of an independent qualified public accountant for this plan2013-12-31Disclaimer
Accountancy firm name2013-12-31BLUE AND COMPANY, LLC
Accountancy firm EIN2013-12-31351178661
2012 : CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-12-31$0
Total transfer of assets to this plan2012-12-31$6,159,316
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$3,143
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$3,168,124
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$546,234
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$542,024
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$2,307,211
Value of total assets at end of year2012-12-31$8,784,349
Value of total assets at beginning of year2012-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$4,210
Total interest from all sources2012-12-31$28,233
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$0
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$1,000,000
If this is an individual account plan, was there a blackout period2012-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$478,831
Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$1,350,526
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-12-31$3,143
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$2,621,890
Value of net assets at end of year (total assets less liabilities)2012-12-31$8,781,206
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Value of interest in pooled separate accounts at end of year2012-12-31$7,366,690
Value of interest in pooled separate accounts at beginning of year2012-12-31$0
Interest earned on other investments2012-12-31$28,233
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-12-31$1,414,003
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-12-31$0
Net investment gain/loss from pooled separate accounts2012-12-31$832,680
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$477,854
Employer contributions (assets) at end of year2012-12-31$3,656
Employer contributions (assets) at beginning of year2012-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$542,024
Contract administrator fees2012-12-31$4,210
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31Yes
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31BKD, LLP
Accountancy firm EIN2012-12-31440160260

Form 5500 Responses for CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN

2022: CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01This submission is the final filingNo
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement - TrustYes
2021: CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedYes
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 – TrustYes
2021-01-01Plan benefit arrangement - TrustYes
2020: CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 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
2019: CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: CAMERON MEMORIAL COMMUNITY HOSPITAL, INC. EMPLOYEES' RETIREMENT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01First time form 5500 has been submittedYes
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number810646
Policy instance 1
Insurance contract or identification number810646
Number of Individuals Covered660
Insurance policy start date2020-01-01
Insurance policy end date2020-10-14
Total amount of commissions paid to insurance brokerUSD $45,640
Total amount of fees paid to insurance companyUSD $9,121
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $45,640
Amount paid for insurance broker fees9121
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number810646
Policy instance 1
Insurance contract or identification number810646
Number of Individuals Covered569
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $51,433
Total amount of fees paid to insurance companyUSD $8,373
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
Commission paid to Insurance BrokerUSD $51,433
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Welfare Benefit Premiums Paid to CarrierUSD $803,325
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number810646
Policy instance 1
Insurance contract or identification number810646
Number of Individuals Covered518
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $47,913
Total amount of fees paid to insurance companyUSD $7,940
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
Commission paid to Insurance BrokerUSD $47,913
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number810646
Policy instance 1
Insurance contract or identification number810646
Number of Individuals Covered459
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $43,458
Total amount of fees paid to insurance companyUSD $7,029
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
Commission paid to Insurance BrokerUSD $43,458
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameRETIREMENT PLAN CONCEPTS & SERVICES
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number810646
Policy instance 1
Insurance contract or identification number810646
Number of Individuals Covered396
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $34,508
Total amount of fees paid to insurance companyUSD $5,720
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 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
Commission paid to Insurance BrokerUSD $34,508
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameRETIREMENT PLAN CONCEPTS & SERVICES
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberGH5580
Policy instance 1
Insurance contract or identification numberGH5580
Number of Individuals Covered368
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $32,178
Total amount of fees paid to insurance companyUSD $4,416
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 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
Commission paid to Insurance BrokerUSD $32,178
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameRETIREMENT PLAN CONCEPTS & SERVICES
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberGH5580
Policy instance 1
Insurance contract or identification numberGH5580
Number of Individuals Covered0
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $27,821
Total amount of fees paid to insurance companyUSD $4,531
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 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
Commission paid to Insurance BrokerUSD $27,821
Insurance broker organization code?3
Amount paid for insurance broker fees4531
Additional information about fees paid to insurance brokerTPA PARTNERSHIP PROGRAM
Insurance broker nameRETIREMENT PLAN CONCEPTS & SERVICES
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number810646
Policy instance 2
Insurance contract or identification number810646
Number of Individuals Covered356
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
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 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
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberGH5580
Policy instance 1
Insurance contract or identification numberGH5580
Number of Individuals Covered444
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $30,039
Total amount of fees paid to insurance companyUSD $3,631
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 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
Commission paid to Insurance BrokerUSD $19,280
Insurance broker organization code?3
Amount paid for insurance broker fees3631
Additional information about fees paid to insurance brokerTPA PARTNERSHIP PROGRAM
Insurance broker nameRETIREMENT PLAN CONCEPTS & SERVICES

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