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THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) PLAN 401k Plan overview

Plan NameTHE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) PLAN
Plan identification number 001

THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • 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.
  • Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
  • 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

THE LAKES COMMUNITY HEALTH CENTER, INC has sponsored the creation of one or more 401k plans.

Company Name:THE LAKES COMMUNITY HEALTH CENTER, INC
Employer identification number (EIN):352297925
NAIC Classification:621498
NAIC Description:All Other Outpatient Care Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01
0012021-01-01
0012020-01-01
0012019-01-01
0012018-01-01
0012017-01-01BRIAN AHLGREN BRIAN AHLGREN2018-10-11
0012016-01-01BRIAN AHLGREN BRIAN AHLGREN2017-10-12
0012016-01-01 BRIAN AHLGREN2017-10-09
0012015-01-01BRIAN AHLGREN BRIAN AHLGREN2016-10-13
0012014-01-01BRIAN AHLGREN BRIAN AHLGREN2015-10-14

Plan Statistics for THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) PLAN

401k plan membership statisitcs for THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) PLAN

Measure Date Value
2022: THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01486
Total number of active participants reported on line 7a of the Form 55002022-01-01359
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-01125
Total of all active and inactive participants2022-01-01484
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01484
Number of participants with account balances2022-01-01449
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01455
Total number of active participants reported on line 7a of the Form 55002021-01-01354
Number of other retired or separated participants entitled to future benefits2021-01-01122
Total of all active and inactive participants2021-01-01476
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01476
Number of participants with account balances2021-01-01452
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01471
Total number of active participants reported on line 7a of the Form 55002020-01-01342
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-01101
Total of all active and inactive participants2020-01-01443
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01443
Number of participants with account balances2020-01-01411
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01437
Total number of active participants reported on line 7a of the Form 55002019-01-01351
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-01117
Total of all active and inactive participants2019-01-01468
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01468
Number of participants with account balances2019-01-01441
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01309
Total number of active participants reported on line 7a of the Form 55002018-01-01282
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-0191
Total of all active and inactive participants2018-01-01373
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01373
Number of participants with account balances2018-01-01342
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01262
Total number of active participants reported on line 7a of the Form 55002017-01-01219
Number of retired or separated participants receiving benefits2017-01-018
Number of other retired or separated participants entitled to future benefits2017-01-0167
Total of all active and inactive participants2017-01-01294
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-01294
Number of participants with account balances2017-01-01286
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01215
Total number of active participants reported on line 7a of the Form 55002016-01-01213
Number of retired or separated participants receiving benefits2016-01-016
Number of other retired or separated participants entitled to future benefits2016-01-0141
Total of all active and inactive participants2016-01-01260
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-01260
Number of participants with account balances2016-01-01245
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01156
Total number of active participants reported on line 7a of the Form 55002015-01-01180
Number of retired or separated participants receiving benefits2015-01-016
Number of other retired or separated participants entitled to future benefits2015-01-0128
Total of all active and inactive participants2015-01-01214
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-01214
Number of participants with account balances2015-01-01197
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01121
Total number of active participants reported on line 7a of the Form 55002014-01-01157
Number of retired or separated participants receiving benefits2014-01-012
Number of other retired or separated participants entitled to future benefits2014-01-014
Total of all active and inactive participants2014-01-01163
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-01163
Number of participants with account balances2014-01-01143
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010

Financial Data on THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) PLAN

Measure Date Value
2022 : THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) PLAN 2022 401k financial data
Total income from all sources (including contributions)2022-12-31$-27,880
Total of all expenses incurred2022-12-31$1,478,658
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$1,338,027
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$2,986,603
Value of total assets at end of year2022-12-31$16,324,717
Value of total assets at beginning of year2022-12-31$17,831,255
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$140,631
Total interest from all sources2022-12-31$3,733
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$1,000,000
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$1,934,527
Participant contributions at end of year2022-12-31$64,555
Participant contributions at beginning of year2022-12-31$73,755
Participant contributions at beginning of year2022-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$214,362
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$14
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-1,506,538
Value of net assets at end of year (total assets less liabilities)2022-12-31$16,324,717
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$17,831,255
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
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$15,649,894
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$17,757,449
Interest on participant loans2022-12-31$3,733
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$610,268
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-3,018,216
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 contributions2022-12-31Yes
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$837,714
Employer contributions (assets) at beginning of year2022-12-31$37
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$1,338,027
Contract administrator fees2022-12-31$140,631
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
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31WIPFLI LLP
Accountancy firm EIN2022-12-31390758449
2021 : THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) PLAN 2021 401k financial data
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$4,851,101
Total of all expenses incurred2021-12-31$814,082
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$680,056
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$2,887,716
Value of total assets at end of year2021-12-31$17,831,255
Value of total assets at beginning of year2021-12-31$13,794,236
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$134,026
Total interest from all sources2021-12-31$3,526
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$1,000,000
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$1,755,744
Participant contributions at end of year2021-12-31$73,755
Participant contributions at beginning of year2021-12-31$75,944
Participant contributions at end of year2021-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$321,189
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$14
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
Value of net income/loss2021-12-31$4,037,019
Value of net assets at end of year (total assets less liabilities)2021-12-31$17,831,255
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$13,794,236
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
Investment advisory and management fees2021-12-31$134,026
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$17,757,449
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$12,849,028
Income. Interest from loans (other than to participants)2021-12-31$3,526
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$869,264
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$1,959,859
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 contributions2021-12-31Yes
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$810,783
Employer contributions (assets) at end of year2021-12-31$37
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$680,056
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
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31CLIFTONLARSONALLEN, LLP
Accountancy firm EIN2021-12-31410746749
2020 : THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$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$0
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$4,105,987
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$890,772
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$809,512
Expenses. Certain deemed distributions of participant loans2020-12-31$2,571
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$2,375,737
Value of total assets at end of year2020-12-31$13,794,236
Value of total assets at beginning of year2020-12-31$10,579,021
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$78,689
Total interest from all sources2020-12-31$4,544
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$356,728
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$356,728
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$1,000,000
If this is an individual account plan, was there a blackout period2020-12-31No
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$1,443,666
Participant contributions at end of year2020-12-31$75,944
Participant contributions at beginning of year2020-12-31$65,937
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$275,932
Other income not declared elsewhere2020-12-31$0
Administrative expenses (other) incurred2020-12-31$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
Value of net income/loss2020-12-31$3,215,215
Value of net assets at end of year (total assets less liabilities)2020-12-31$13,794,236
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$10,579,021
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
Investment advisory and management fees2020-12-31$78,689
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$12,849,028
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$10,501,019
Income. Interest from loans (other than to participants)2020-12-31$4,544
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$869,264
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$12,065
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$1,368,978
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 contributions2020-12-31Yes
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$656,139
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$809,512
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
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31CLIFTONLARSONALLEN, LLP
Accountancy firm EIN2020-12-31410746749
2019 : THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) PLAN 2019 401k financial data
Total income from all sources (including contributions)2019-12-31$5,230,107
Total of all expenses incurred2019-12-31$564,151
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$551,751
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$3,721,992
Value of total assets at end of year2019-12-31$10,579,021
Value of total assets at beginning of year2019-12-31$5,913,065
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$12,400
Total interest from all sources2019-12-31$4,252
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$257,059
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2019-12-31$257,059
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$1,000,000
If this is an individual account plan, was there a blackout period2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$1,453,276
Participant contributions at end of year2019-12-31$65,937
Participant contributions at beginning of year2019-12-31$47,751
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$1,533,226
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
Value of net income/loss2019-12-31$4,665,956
Value of net assets at end of year (total assets less liabilities)2019-12-31$10,579,021
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$5,913,065
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 leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$10,501,019
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$5,862,198
Interest on participant loans2019-12-31$4,252
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$12,065
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$3,116
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$1,246,804
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
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$735,490
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$551,751
Contract administrator fees2019-12-31$12,400
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
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
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31CLIFTONLARSONALLEN, LLP
Accountancy firm EIN2019-12-31410746749
2018 : THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) PLAN 2018 401k financial data
Total income from all sources (including contributions)2018-12-31$1,081,728
Total of all expenses incurred2018-12-31$252,293
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$248,438
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$1,419,793
Value of total assets at end of year2018-12-31$5,913,065
Value of total assets at beginning of year2018-12-31$5,083,630
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$3,855
Total interest from all sources2018-12-31$1,585
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$210,519
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2018-12-31$210,519
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$1,000,000
If this is an individual account plan, was there a blackout period2018-12-31Yes
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$851,526
Participant contributions at end of year2018-12-31$47,751
Participant contributions at beginning of year2018-12-31$24,686
Participant contributions at beginning of year2018-12-31$33,156
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$162,915
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-12-31$65
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$829,435
Value of net assets at end of year (total assets less liabilities)2018-12-31$5,913,065
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$5,083,630
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 registered invesment companies (eg mutual funds) at end of year2018-12-31$5,862,198
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$4,796,979
Interest on participant loans2018-12-31$1,585
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$3,116
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$215,744
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-550,169
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 contributions2018-12-31Yes
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$405,352
Employer contributions (assets) at beginning of year2018-12-31$13,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$248,438
Contract administrator fees2018-12-31$3,855
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-12-31Yes
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 name2018-12-31CLIFTONLARSONALLEN, LLP
Accountancy firm EIN2018-12-31410746749
2017 : THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) 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$0
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$2,155,313
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$180,179
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$177,534
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$1,554,607
Value of total assets at end of year2017-12-31$5,083,630
Value of total assets at beginning of year2017-12-31$3,108,496
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$2,645
Total interest from all sources2017-12-31$1,015
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$86,247
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2017-12-31$86,247
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
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$750,176
Participant contributions at end of year2017-12-31$24,686
Participant contributions at beginning of year2017-12-31$8,491
Participant contributions at end of year2017-12-31$33,156
Participant contributions at beginning of year2017-12-31$67,646
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$462,116
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-12-31$65
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-12-31$1,151
Total non interest bearing cash at beginning of year2017-12-31$1,083
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$1,975,134
Value of net assets at end of year (total assets less liabilities)2017-12-31$5,083,630
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$3,108,496
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
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$4,796,979
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$2,823,713
Interest on participant loans2017-12-31$1,015
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-12-31$215,744
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-12-31$169,649
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$513,444
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 contributions2017-12-31Yes
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$342,315
Employer contributions (assets) at end of year2017-12-31$13,000
Employer contributions (assets) at beginning of year2017-12-31$36,763
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$177,534
Contract administrator fees2017-12-31$2,645
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 name2017-12-31CLIFTONLARSONALLEN
Accountancy firm EIN2017-12-31410746749
2016 : THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) 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$1,596,715
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$87,435
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$85,575
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$1,348,398
Value of total assets at end of year2016-12-31$3,108,496
Value of total assets at beginning of year2016-12-31$1,599,216
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$1,860
Total interest from all sources2016-12-31$584
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$51,508
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$51,508
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
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$614,772
Participant contributions at end of year2016-12-31$8,491
Participant contributions at beginning of year2016-12-31$5,617
Participant contributions at end of year2016-12-31$67,646
Participant contributions at beginning of year2016-12-31$76
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$440,177
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$1,151
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$87
Total non interest bearing cash at end of year2016-12-31$1,083
Total non interest bearing cash at beginning of year2016-12-31$383
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$1,509,280
Value of net assets at end of year (total assets less liabilities)2016-12-31$3,108,496
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$1,599,216
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
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$2,823,713
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$1,455,617
Interest on participant loans2016-12-31$584
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$169,649
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$137,360
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$196,225
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
Contributions received in cash from employer2016-12-31$293,449
Employer contributions (assets) at end of year2016-12-31$36,763
Employer contributions (assets) at beginning of year2016-12-31$76
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$85,575
Contract administrator fees2016-12-31$1,860
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 name2016-12-31CLIFTONLARSONALLEN
Accountancy firm EIN2016-12-31410746749
2015 : THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) 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$745,038
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$34,333
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$33,073
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$767,084
Value of total assets at end of year2015-12-31$1,599,216
Value of total assets at beginning of year2015-12-31$888,511
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$1,260
Total interest from all sources2015-12-31$1,582
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$25,704
Total dividends received from registered investment company shares (eg mutual funds)2015-12-31$25,704
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
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$462,738
Participant contributions at end of year2015-12-31$5,617
Participant contributions at beginning of year2015-12-31$4,351
Participant contributions at end of year2015-12-31$76
Participant contributions at beginning of year2015-12-31$16,017
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$71,708
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-12-31$87
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-12-31$44
Total non interest bearing cash at end of year2015-12-31$383
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$710,705
Value of net assets at end of year (total assets less liabilities)2015-12-31$1,599,216
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$888,511
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 registered invesment companies (eg mutual funds) at end of year2015-12-31$1,455,617
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$808,804
Interest on participant loans2015-12-31$228
Interest earned on other investments2015-12-31$1,354
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$137,360
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-31$50,888
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-49,332
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
Contributions received in cash from employer2015-12-31$232,638
Employer contributions (assets) at end of year2015-12-31$76
Employer contributions (assets) at beginning of year2015-12-31$8,407
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$33,073
Contract administrator fees2015-12-31$1,260
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 name2015-12-31WIPFLI
Accountancy firm EIN2015-12-31390758449
2014 : THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) 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$0
Total income from all sources (including contributions)2014-12-31$908,095
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$19,584
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$18,854
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$871,425
Value of total assets at end of year2014-12-31$888,511
Value of total assets at beginning of year2014-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$730
Total interest from all sources2014-12-31$786
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$15,108
Total dividends received from registered investment company shares (eg mutual funds)2014-12-31$15,108
Was this plan covered by a fidelity bond2014-12-31No
If this is an individual account plan, was there a blackout period2014-12-31No
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$389,534
Participant contributions at end of year2014-12-31$4,351
Participant contributions at end of year2014-12-31$16,017
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$295,417
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-12-31$44
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$888,511
Value of net assets at end of year (total assets less liabilities)2014-12-31$888,511
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$0
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$730
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$808,804
Interest on participant loans2014-12-31$192
Interest earned on other investments2014-12-31$594
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-12-31$50,888
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$20,776
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
Contributions received in cash from employer2014-12-31$186,474
Employer contributions (assets) at end of year2014-12-31$8,407
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$18,854
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 name2014-12-31WIPFLI
Accountancy firm EIN2014-12-31390758449

Form 5500 Responses for THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) PLAN

2022: THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) 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 benefit arrangement – InsuranceYes
2019: THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) 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 benefit arrangement – InsuranceYes
2018: THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) 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 benefit arrangement – InsuranceYes
2017: THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) 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: THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) 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: THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) 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: THE LAKES COMMUNITY HEALTH CENTER, INC. 403(B) PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01First time form 5500 has been submittedYes
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

Insurance Providers Used on plan

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number
Policy instance 1
Number of Individuals Covered450
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,118
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Commission paid to Insurance BrokerUSD $1,118
Additional information about fees paid to insurance brokerCOMMISSIONS/FEES
Insurance broker organization code?3
Amount paid for insurance broker fees0
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number
Policy instance 1
Number of Individuals Covered453
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,539
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Commission paid to Insurance BrokerUSD $1,539
Additional information about fees paid to insurance brokerCOMMISSIONS/FEES
Insurance broker organization code?3
Amount paid for insurance broker fees0
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number
Policy instance 1
Number of Individuals Covered410
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $28,431
Total amount of fees paid to insurance companyUSD $9,524
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Commission paid to Insurance BrokerUSD $28,431
Additional information about fees paid to insurance brokerCOMMISSIONS/FEES
Insurance broker organization code?3
Amount paid for insurance broker fees9524
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number
Policy instance 1
Number of Individuals Covered440
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $22,896
Total amount of fees paid to insurance companyUSD $5,842
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Commission paid to Insurance BrokerUSD $22,896
Additional information about fees paid to insurance brokerCOMMISSIONS/FEES
Insurance broker organization code?3
Amount paid for insurance broker fees5842
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number
Policy instance 1
Number of Individuals Covered344
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $6,072
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees6072
Additional information about fees paid to insurance brokerCOMMISSIONS/FEES
Insurance broker organization code?3
PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )
Policy contract numberGA-63329
Policy instance 1
Insurance contract or identification numberGA-63329
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?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
PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )
Policy contract numberGA-63329
Policy instance 1
Insurance contract or identification numberGA-63329
Number of Individuals Covered21
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?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
PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )
Policy contract numberGA-63329
Policy instance 1
Insurance contract or identification numberGA-63329
Number of Individuals Covered14
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?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

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