401k Plan data: BOTSFORD HOSPITAL 403(B) PLAN plan

BOTSFORD HOSPITAL 403(B) PLAN 401k Plan overview

Plan Name	BOTSFORD HOSPITAL 403(B) PLAN
Plan identification number	002

BOTSFORD HOSPITAL 403(B) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
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.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

BOTSFORD DEFINED CONTRIBUTION RETIREMENT PLAN has sponsored the creation of one or more 401k plans.

Company Name: BOTSFORD DEFINED CONTRIBUTION RETIREMENT PLAN

Employer identification number (EIN): 381426919

NAIC Classification: 813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BOTSFORD HOSPITAL 403(B) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2016-01-01 JOHN KERNDL J PAUL CONWAY 2017-10-13
002 2015-01-01 JOHN T FOX J PAUL CONWAY 2016-10-17

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2016-01-01	JOHN KERNDL		J PAUL CONWAY	2017-10-13
002	2015-01-01	JOHN T FOX		J PAUL CONWAY	2016-10-17

Plan Statistics for BOTSFORD HOSPITAL 403(B) PLAN

401k plan membership statisitcs for BOTSFORD HOSPITAL 403(B) PLAN

Measure Date Value
2016: BOTSFORD HOSPITAL 403(B) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 4,585
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 0
Number of participants with account balances 2016-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 19
2015: BOTSFORD HOSPITAL 403(B) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 4,485
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 3,967
Number of retired or separated participants receiving benefits 2015-01-01 16
Number of other retired or separated participants entitled to future benefits 2015-01-01 574
Total of all active and inactive participants 2015-01-01 4,557
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 28
Total participants 2015-01-01 4,585
Number of participants with account balances 2015-01-01 2,282
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 21

Measure	Date	Value
2016: BOTSFORD HOSPITAL 403(B) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	4,585
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	0
Number of participants with account balances	2016-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	19
2015: BOTSFORD HOSPITAL 403(B) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	4,485
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	3,967
Number of retired or separated participants receiving benefits	2015-01-01	16
Number of other retired or separated participants entitled to future benefits	2015-01-01	574
Total of all active and inactive participants	2015-01-01	4,557
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	28
Total participants	2015-01-01	4,585
Number of participants with account balances	2015-01-01	2,282
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	21

Financial Data on BOTSFORD HOSPITAL 403(B) PLAN

Measure	Date	Value
2016 : BOTSFORD HOSPITAL 403(B) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total transfer of assets from this plan	2016-12-31	$79,808,565
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	$13,961,749
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$11,196,327
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$11,174,264
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$9,223,224
Value of total assets at end of year	2016-12-31	$0
Value of total assets at beginning of year	2016-12-31	$77,043,143
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$22,063
Total interest from all sources	2016-12-31	$75,329
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$1,274,403
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$1,274,403
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$7,198,879
Participant contributions at end of year	2016-12-31	$0
Participant contributions at beginning of year	2016-12-31	$1,452,425
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$282,911
Administrative expenses (other) incurred	2016-12-31	$22,063
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$2,765,422
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$77,043,143
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$66,753,165
Value of interest in pooled separate accounts at end of year	2016-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$8,302,413
Interest on participant loans	2016-12-31	$75,329
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$22,287
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$3,388,793
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$1,741,434
Employer contributions (assets) at end of year	2016-12-31	$0
Employer contributions (assets) at beginning of year	2016-12-31	$512,853
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$11,174,264
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2016-12-31	No
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	PLANTE & MORAN LLP
Accountancy firm EIN	2016-12-31	381357951
2015 : BOTSFORD HOSPITAL 403(B) PLAN 2015 401k financial data
Total income from all sources (including contributions)	2015-12-31	$8,332,847
Total of all expenses incurred	2015-12-31	$5,695,211
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$5,674,931
Expenses. Certain deemed distributions of participant loans	2015-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$7,603,693
Value of total assets at end of year	2015-12-31	$77,043,143
Value of total assets at beginning of year	2015-12-31	$74,405,507
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$20,280
Total interest from all sources	2015-12-31	$183,195
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$1,157,483
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$1,157,483
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$6,767,517
Participant contributions at end of year	2015-12-31	$1,452,425
Participant contributions at beginning of year	2015-12-31	$1,372,515
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$501,205
Administrative expenses (other) incurred	2015-12-31	$20,280
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$2,637,636
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$77,043,143
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$74,405,507
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$66,753,165
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$65,201,643
Value of interest in pooled separate accounts at end of year	2015-12-31	$8,302,413
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$7,530,296
Interest on participant loans	2015-12-31	$79,194
Interest earned on other investments	2015-12-31	$104,001
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$22,287
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$1,888
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-584,848
Net investment gain/loss from pooled separate accounts	2015-12-31	$-26,676
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$334,971
Employer contributions (assets) at end of year	2015-12-31	$512,853
Employer contributions (assets) at beginning of year	2015-12-31	$299,165
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$5,674,931
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2015-12-31	No
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	PLANTE & MORAN LLP
Accountancy firm EIN	2015-12-31	381357951

Form 5500 Responses for BOTSFORD HOSPITAL 403(B) PLAN

2016: BOTSFORD HOSPITAL 403(B) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: BOTSFORD HOSPITAL 403(B) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract number	TT069163
Policy instance	1

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Company Name:	BOTSFORD DEFINED CONTRIBUTION RETIREMENT PLAN
Employer identification number (EIN):	381426919
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations