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EVERGREEN EMERGENCY SERVICES LTD. 401K PLAN 401k Plan overview

Plan NameEVERGREEN EMERGENCY SERVICES LTD. 401K PLAN
Plan identification number 003

EVERGREEN EMERGENCY SERVICES LTD. 401K 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.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

EVERGREEN EMERGENCY SERVICES has sponsored the creation of one or more 401k plans.

Company Name:EVERGREEN EMERGENCY SERVICES
Employer identification number (EIN):364028911
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EVERGREEN EMERGENCY SERVICES LTD. 401K PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0032016-01-01MICHAEL OMARA2016-11-21
0032015-01-01MICHAEL OMARA2016-03-02
0032014-01-01MICHAEL OMARA2015-02-17
0032013-01-01MICHAEL OMARA2014-04-07
0032012-01-01MICHAEL OMARA
0032011-01-01MICHAEL OMARA
0032010-01-01MICHAEL OMARA
0032009-01-01MICHAEL OMARA
0032009-01-01MICHAEL OMARA

Plan Statistics for EVERGREEN EMERGENCY SERVICES LTD. 401K PLAN

401k plan membership statisitcs for EVERGREEN EMERGENCY SERVICES LTD. 401K PLAN

Measure Date Value
2012: EVERGREEN EMERGENCY SERVICES LTD. 401K PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0119
Total number of active participants reported on line 7a of the Form 55002012-01-0117
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-016
Total of all active and inactive participants2012-01-0123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0123
Number of participants with account balances2012-01-0121
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: EVERGREEN EMERGENCY SERVICES LTD. 401K PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0119
Total number of active participants reported on line 7a of the Form 55002011-01-0116
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-013
Total of all active and inactive participants2011-01-0119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0119
Number of participants with account balances2011-01-0119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: EVERGREEN EMERGENCY SERVICES LTD. 401K PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-0119
Total number of active participants reported on line 7a of the Form 55002010-01-0116
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-013
Total of all active and inactive participants2010-01-0119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-0119
Number of participants with account balances2010-01-0119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-011
2009: EVERGREEN EMERGENCY SERVICES LTD. 401K PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0119
Total number of active participants reported on line 7a of the Form 55002009-01-0117
Number of retired or separated participants receiving benefits2009-01-011
Number of other retired or separated participants entitled to future benefits2009-01-012
Total of all active and inactive participants2009-01-0120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0120
Number of participants with account balances2009-01-0120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on EVERGREEN EMERGENCY SERVICES LTD. 401K PLAN

Measure Date Value
2012 : EVERGREEN EMERGENCY SERVICES LTD. 401K PLAN 2012 401k financial data
Total income from all sources2012-12-31$1,236,086
Expenses. Total of all expenses incurred2012-12-31$114,455
Benefits paid (including direct rollovers)2012-12-31$111,672
Total plan assets at end of year2012-12-31$5,652,556
Total plan assets at beginning of year2012-12-31$4,530,925
Value of fidelity bond covering the plan2012-12-31$500,000
Total contributions received or receivable from participants2012-12-31$243,938
Other income received2012-12-31$742,148
Net income (gross income less expenses)2012-12-31$1,121,631
Net plan assets at end of year (total assets less liabilities)2012-12-31$5,652,556
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$4,530,925
Assets. Value of participant loans2012-12-31$8,683
Total contributions received or receivable from employer(s)2012-12-31$250,000
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$2,783
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : EVERGREEN EMERGENCY SERVICES LTD. 401K PLAN 2011 401k financial data
Total income from all sources2011-12-31$375,575
Expenses. Total of all expenses incurred2011-12-31$32,467
Benefits paid (including direct rollovers)2011-12-31$30,000
Total plan assets at end of year2011-12-31$4,530,925
Total plan assets at beginning of year2011-12-31$4,187,817
Value of fidelity bond covering the plan2011-12-31$500,000
Total contributions received or receivable from participants2011-12-31$244,591
Other income received2011-12-31$-119,016
Net income (gross income less expenses)2011-12-31$343,108
Net plan assets at end of year (total assets less liabilities)2011-12-31$4,530,925
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$4,187,817
Assets. Value of participant loans2011-12-31$14,231
Total contributions received or receivable from employer(s)2011-12-31$250,000
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$2,467
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : EVERGREEN EMERGENCY SERVICES LTD. 401K PLAN 2010 401k financial data
Total income from all sources2010-12-31$708,789
Expenses. Total of all expenses incurred2010-12-31$30,573
Benefits paid (including direct rollovers)2010-12-31$30,000
Total plan assets at end of year2010-12-31$4,187,817
Total plan assets at beginning of year2010-12-31$3,509,601
Value of fidelity bond covering the plan2010-12-31$500,000
Total contributions received or receivable from participants2010-12-31$252,336
Other income received2010-12-31$206,453
Net income (gross income less expenses)2010-12-31$678,216
Net plan assets at end of year (total assets less liabilities)2010-12-31$4,187,817
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$3,509,601
Assets. Value of participant loans2010-12-31$19,504
Total contributions received or receivable from employer(s)2010-12-31$250,000
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$573
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0

Form 5500 Responses for EVERGREEN EMERGENCY SERVICES LTD. 401K PLAN

2012: EVERGREEN EMERGENCY SERVICES LTD. 401K PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
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
2011: EVERGREEN EMERGENCY SERVICES LTD. 401K PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: EVERGREEN EMERGENCY SERVICES LTD. 401K PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement - TrustYes
2009: EVERGREEN EMERGENCY SERVICES LTD. 401K PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number97918
Policy instance 1
Insurance contract or identification number97918
Number of Individuals Covered21
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $22,428
Total amount of fees paid to insurance companyUSD $2,523
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?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 $22,428
Insurance broker organization code?3
Amount paid for insurance broker fees2523
Additional information about fees paid to insurance brokerTPA FEES AND TPA COMPENSATION
Insurance broker nameBENEFIT SERVICES GROUP, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number97918
Policy instance 1
Insurance contract or identification number97918
Number of Individuals Covered19
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $12,638
Total amount of fees paid to insurance companyUSD $11,679
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?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

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