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HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 401k Plan overview

Plan NameHAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN
Plan identification number 002

HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • 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

HAYES GREEN BEACH MEMORIAL HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name:HAYES GREEN BEACH MEMORIAL HOSPITAL
Employer identification number (EIN):382007629
NAIC Classification:622000
NAIC Description: Hospitals

Additional information about HAYES GREEN BEACH MEMORIAL HOSPITAL

Jurisdiction of Incorporation: Michigan Secretary of State
Incorporation Date: 0000-00-00
Company Identification Number: 874086
Legal Registered Office Address: 321 E HARRIS CHARLOTTE


United States of America (USA)
48813

More information about HAYES GREEN BEACH MEMORIAL HOSPITAL

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022020-01-01
0022019-01-01
0022018-04-01
0022018-04-01
0022017-04-01KIM CAPPS
0022016-04-01JENNIFER BUCIENSKI
0022015-04-01JENNIFER BUCIENSKI
0022014-04-01JENNIFER BUCIENSKI
0022013-04-01JENNIFER BUCIENSKI
0022012-04-01JENNIFER BUCIENSKI
0022011-04-01JENNIFER BUCIENSKI
0022010-04-01JENNIFER BUCIENSKI
0022009-04-01JENNIFER BUCIENSKI

Plan Statistics for HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN

401k plan membership statisitcs for HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN

Measure Date Value
2020: HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01420
Total number of active participants reported on line 7a of the Form 55002020-01-010
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-010
Number of participants with account balances2020-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01489
Total number of active participants reported on line 7a of the Form 55002019-01-01420
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01420
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01420
Number of participants with account balances2019-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-018
2018: HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year2018-04-01582
Total number of active participants reported on line 7a of the Form 55002018-04-01443
Number of retired or separated participants receiving benefits2018-04-011
Number of other retired or separated participants entitled to future benefits2018-04-01151
Total of all active and inactive participants2018-04-01595
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-04-011
Total participants2018-04-01596
Number of participants with account balances2018-04-01571
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-04-0121
2017: HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year2017-04-01555
Total number of active participants reported on line 7a of the Form 55002017-04-01452
Number of retired or separated participants receiving benefits2017-04-012
Number of other retired or separated participants entitled to future benefits2017-04-01129
Total of all active and inactive participants2017-04-01583
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-04-011
Total participants2017-04-01584
Number of participants with account balances2017-04-01553
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-04-0123
2016: HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year2016-04-01518
Total number of active participants reported on line 7a of the Form 55002016-04-01442
Number of retired or separated participants receiving benefits2016-04-014
Number of other retired or separated participants entitled to future benefits2016-04-0199
Total of all active and inactive participants2016-04-01545
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-04-010
Total participants2016-04-01545
Number of participants with account balances2016-04-01527
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-04-0112
2015: HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year2015-04-01500
Total number of active participants reported on line 7a of the Form 55002015-04-01436
Number of retired or separated participants receiving benefits2015-04-013
Number of other retired or separated participants entitled to future benefits2015-04-0167
Total of all active and inactive participants2015-04-01506
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-04-010
Total participants2015-04-01506
Number of participants with account balances2015-04-01318
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-04-0120
2014: HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year2014-04-01508
Total number of active participants reported on line 7a of the Form 55002014-04-01436
Number of retired or separated participants receiving benefits2014-04-013
Number of other retired or separated participants entitled to future benefits2014-04-0159
Total of all active and inactive participants2014-04-01498
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-04-010
Total participants2014-04-01498
Number of participants with account balances2014-04-01326
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-04-0119
2013: HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year2013-04-01496
Total number of active participants reported on line 7a of the Form 55002013-04-01434
Number of retired or separated participants receiving benefits2013-04-013
Number of other retired or separated participants entitled to future benefits2013-04-0161
Total of all active and inactive participants2013-04-01498
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-04-010
Total participants2013-04-01498
Number of participants with account balances2013-04-01325
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-04-0127
2012: HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year2012-04-01552
Total number of active participants reported on line 7a of the Form 55002012-04-01445
Number of retired or separated participants receiving benefits2012-04-010
Number of other retired or separated participants entitled to future benefits2012-04-0152
Total of all active and inactive participants2012-04-01497
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-04-010
Total participants2012-04-01497
Number of participants with account balances2012-04-01329
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-04-0122
2011: HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year2011-04-01426
Total number of active participants reported on line 7a of the Form 55002011-04-01440
Number of retired or separated participants receiving benefits2011-04-011
Number of other retired or separated participants entitled to future benefits2011-04-0150
Total of all active and inactive participants2011-04-01491
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-04-010
Total participants2011-04-01491
Number of participants with account balances2011-04-01406
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-04-012
2010: HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year2010-04-01603
Total number of active participants reported on line 7a of the Form 55002010-04-01399
Number of retired or separated participants receiving benefits2010-04-0148
Number of other retired or separated participants entitled to future benefits2010-04-0158
Total of all active and inactive participants2010-04-01505
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-04-010
Total participants2010-04-01505
Number of participants with account balances2010-04-01389
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-04-014
2009: HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year2009-04-01568
Total number of active participants reported on line 7a of the Form 55002009-04-01533
Number of retired or separated participants receiving benefits2009-04-011
Number of other retired or separated participants entitled to future benefits2009-04-0169
Total of all active and inactive participants2009-04-01603
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-04-010
Total participants2009-04-01603
Number of participants with account balances2009-04-01404
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-04-0110

Financial Data on HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN

Measure Date Value
2020 : HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-03-31$0
Total unrealized appreciation/depreciation of assets2020-03-31$0
Total transfer of assets from this plan2020-03-31$19,140,358
Total transfer of assets from this plan2020-03-31$19,140,358
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-03-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-03-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-03-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-03-31$0
Total income from all sources (including contributions)2020-03-31$-232,975
Total income from all sources (including contributions)2020-03-31$-232,975
Total loss/gain on sale of assets2020-03-31$0
Total loss/gain on sale of assets2020-03-31$0
Total of all expenses incurred2020-03-31$0
Total of all expenses incurred2020-03-31$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-03-31$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-03-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-03-31$-232,807
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-03-31$-232,807
Value of total assets at end of year2020-03-31$0
Value of total assets at end of year2020-03-31$0
Value of total assets at beginning of year2020-03-31$19,373,333
Value of total assets at beginning of year2020-03-31$19,373,333
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-03-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-03-31$0
Total interest from all sources2020-03-31$-168
Total interest from all sources2020-03-31$-168
Total dividends received (eg from common stock, registered investment company shares)2020-03-31$0
Total dividends received (eg from common stock, registered investment company shares)2020-03-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-03-31No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-03-31No
Was this plan covered by a fidelity bond2020-03-31Yes
Value of fidelity bond cover2020-03-31$500,000
Value of fidelity bond cover2020-03-31$500,000
If this is an individual account plan, was there a blackout period2020-03-31Yes
If this is an individual account plan, was there a blackout period2020-03-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-03-31$0
Were there any nonexempt tranactions with any party-in-interest2020-03-31No
Were there any nonexempt tranactions with any party-in-interest2020-03-31No
Contributions received from participants2020-03-31$-58,070
Contributions received from participants2020-03-31$-58,070
Participant contributions at end of year2020-03-31$0
Participant contributions at end of year2020-03-31$0
Participant contributions at beginning of year2020-03-31$176,698
Participant contributions at beginning of year2020-03-31$176,698
Participant contributions at end of year2020-03-31$0
Participant contributions at end of year2020-03-31$0
Participant contributions at beginning of year2020-03-31$58,070
Participant contributions at beginning of year2020-03-31$58,070
Assets. Other investments not covered elsewhere at end of year2020-03-31$0
Assets. Other investments not covered elsewhere at end of year2020-03-31$0
Assets. Other investments not covered elsewhere at beginning of year2020-03-31$18,963,609
Assets. Other investments not covered elsewhere at beginning of year2020-03-31$18,963,609
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-03-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-03-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-03-31$219
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-03-31$219
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-03-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-03-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-03-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-03-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-03-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-03-31No
Value of net income/loss2020-03-31$-232,975
Value of net income/loss2020-03-31$-232,975
Value of net assets at end of year (total assets less liabilities)2020-03-31$0
Value of net assets at end of year (total assets less liabilities)2020-03-31$0
Value of net assets at beginning of year (total assets less liabilities)2020-03-31$19,373,333
Value of net assets at beginning of year (total assets less liabilities)2020-03-31$19,373,333
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-03-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-03-31No
Were any leases to which the plan was party in default or uncollectible2020-03-31No
Were any leases to which the plan was party in default or uncollectible2020-03-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-03-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-03-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-03-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-03-31$0
Value of interest in pooled separate accounts at end of year2020-03-31$0
Value of interest in pooled separate accounts at end of year2020-03-31$0
Value of interest in pooled separate accounts at beginning of year2020-03-31$0
Value of interest in pooled separate accounts at beginning of year2020-03-31$0
Interest on participant loans2020-03-31$51
Interest on participant loans2020-03-31$51
Interest earned on other investments2020-03-31$-219
Interest earned on other investments2020-03-31$-219
Value of interest in common/collective trusts at end of year2020-03-31$0
Value of interest in common/collective trusts at end of year2020-03-31$0
Value of interest in common/collective trusts at beginning of year2020-03-31$0
Value of interest in common/collective trusts at beginning of year2020-03-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-03-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-03-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-03-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-03-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-03-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-03-31No
Was there a failure to transmit to the plan any participant contributions2020-03-31No
Was there a failure to transmit to the plan any participant contributions2020-03-31No
Has the plan failed to provide any benefit when due under the plan2020-03-31No
Has the plan failed to provide any benefit when due under the plan2020-03-31No
Contributions received in cash from employer2020-03-31$-174,737
Contributions received in cash from employer2020-03-31$-174,737
Employer contributions (assets) at end of year2020-03-31$0
Employer contributions (assets) at end of year2020-03-31$0
Employer contributions (assets) at beginning of year2020-03-31$174,737
Employer contributions (assets) at beginning of year2020-03-31$174,737
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-03-31Yes
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-03-31Yes
Liabilities. Value of benefit claims payable at end of year2020-03-31$0
Liabilities. Value of benefit claims payable at end of year2020-03-31$0
Liabilities. Value of benefit claims payable at beginning of year2020-03-31$0
Liabilities. Value of benefit claims payable at beginning of year2020-03-31$0
Did the plan have assets held for investment2020-03-31No
Did the plan have assets held for investment2020-03-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-03-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-03-31Yes
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-03-31Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-03-31Yes
Opinion of an independent qualified public accountant for this plan2020-03-31Disclaimer
Opinion of an independent qualified public accountant for this plan2020-03-31Disclaimer
Accountancy firm name2020-03-31PLANTE MORAN
Accountancy firm EIN2020-03-31381357951
Accountancy firm EIN2020-03-31381357951
2019 : HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2019 401k financial data
Unrealized appreciation/depreciation of real estate assets2019-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2019-12-31$0
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total transfer of assets from this plan2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$5,695,314
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$3,541,198
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$3,423,193
Value of total corrective distributions2019-12-31$12
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$1,896,582
Value of total assets at end of year2019-12-31$19,373,333
Value of total assets at beginning of year2019-12-31$17,219,217
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$117,993
Total income from rents2019-12-31$0
Total interest from all sources2019-12-31$33,588
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$82,353
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$82,353
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
If this is an individual account plan, was there a blackout period2019-12-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$1,618,555
Participant contributions at end of year2019-12-31$176,698
Participant contributions at beginning of year2019-12-31$177,663
Participant contributions at end of year2019-12-31$58,070
Participant contributions at beginning of year2019-12-31$10,301
Assets. Other investments not covered elsewhere at end of year2019-12-31$18,963,609
Assets. Other investments not covered elsewhere at beginning of year2019-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$103,290
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2019-12-31$27
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$219
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$0
Other income not declared elsewhere2019-12-31$189
Administrative expenses (other) incurred2019-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$2,154,116
Value of net assets at end of year (total assets less liabilities)2019-12-31$19,373,333
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$17,219,217
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
Investment advisory and management fees2019-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$3,691,516
Value of interest in pooled separate accounts at end of year2019-12-31$0
Value of interest in pooled separate accounts at beginning of year2019-12-31$3,472,633
Interest on participant loans2019-12-31$10,017
Income. Interest from loans (other than to participants)2019-12-31$0
Interest earned on other investments2019-12-31$23,571
Income. Interest from US Government securities2019-12-31$0
Income. Interest from corporate debt instruments2019-12-31$0
Value of interest in common/collective trusts at end of year2019-12-31$0
Value of interest in common/collective trusts at beginning of year2019-12-31$8,273,616
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$1,481,404
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$724,616
Net investment gain/loss from pooled separate accounts2019-12-31$1,117,612
Net investment gain or loss from common/collective trusts2019-12-31$1,840,374
Net gain/loss from 103.12 investment entities2019-12-31$0
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$174,737
Employer contributions (assets) at end of year2019-12-31$174,737
Employer contributions (assets) at beginning of year2019-12-31$112,084
Income. Dividends from preferred stock2019-12-31$0
Income. Dividends from common stock2019-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$3,423,166
Contract administrator fees2019-12-31$117,993
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-12-31Yes
Liabilities. Value of benefit claims payable at end of year2019-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$0
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
Aggregate proceeds on sale of assets2019-12-31$0
Aggregate carrying amount (costs) on sale of assets2019-12-31$0
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 name2019-12-31PLANTE MORAN
Accountancy firm EIN2019-12-31381357951
2018 : HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2018 401k financial data
Unrealized appreciation/depreciation of real estate assets2018-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2018-12-31$0
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total income from all sources (including contributions)2018-12-31$223,684
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$1,266,777
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$1,166,936
Expenses. Certain deemed distributions of participant loans2018-12-31$6,271
Value of total corrective distributions2018-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$1,185,626
Value of total assets at end of year2018-12-31$17,205,915
Value of total assets at beginning of year2018-12-31$18,249,008
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$93,570
Total income from rents2018-12-31$0
Total interest from all sources2018-12-31$27,983
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$70,678
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$70,678
Administrative expenses professional fees incurred2018-12-31$0
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$500,000
If this is an individual account plan, was there a blackout period2018-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$1,066,136
Participant contributions at end of year2018-12-31$177,663
Participant contributions at beginning of year2018-12-31$224,491
Participant contributions at end of year2018-12-31$10,301
Participant contributions at beginning of year2018-12-31$-1,381
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$20,448
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2018-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-12-31$0
Other income not declared elsewhere2018-12-31$2
Administrative expenses (other) incurred2018-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Income. Non cash contributions2018-12-31$0
Value of net income/loss2018-12-31$-1,043,093
Value of net assets at end of year (total assets less liabilities)2018-12-31$17,205,915
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$18,249,008
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
Investment advisory and management fees2018-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$3,691,516
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$4,408,492
Value of interest in pooled separate accounts at end of year2018-12-31$3,472,633
Value of interest in pooled separate accounts at beginning of year2018-12-31$3,706,722
Interest on participant loans2018-12-31$9,023
Income. Interest from loans (other than to participants)2018-12-31$0
Interest earned on other investments2018-12-31$18,960
Income. Interest from US Government securities2018-12-31$0
Income. Interest from corporate debt instruments2018-12-31$0
Value of interest in common/collective trusts at end of year2018-12-31$8,273,616
Value of interest in common/collective trusts at beginning of year2018-12-31$8,448,278
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$1,481,404
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$1,308,278
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-338,335
Net investment gain/loss from pooled separate accounts2018-12-31$-85,869
Net investment gain or loss from common/collective trusts2018-12-31$-636,401
Net gain/loss from 103.12 investment entities2018-12-31$0
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$99,042
Employer contributions (assets) at end of year2018-12-31$98,782
Employer contributions (assets) at beginning of year2018-12-31$154,128
Income. Dividends from preferred stock2018-12-31$0
Income. Dividends from common stock2018-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$1,166,936
Contract administrator fees2018-12-31$93,570
Liabilities. Value of benefit claims payable at end of year2018-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2018-12-31$0
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
Aggregate proceeds on sale of assets2018-12-31$0
Aggregate carrying amount (costs) on sale of assets2018-12-31$0
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 name2018-12-31PLANTE MORAN
Accountancy firm EIN2018-12-31381357951
Unrealized appreciation/depreciation of real estate assets2018-03-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2018-03-31$0
Total unrealized appreciation/depreciation of assets2018-03-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-03-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-03-31$0
Total income from all sources (including contributions)2018-03-31$3,588,832
Total loss/gain on sale of assets2018-03-31$0
Total of all expenses incurred2018-03-31$1,317,434
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-03-31$1,278,374
Expenses. Certain deemed distributions of participant loans2018-03-31$3,161
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-03-31$1,610,739
Value of total assets at end of year2018-03-31$18,249,008
Value of total assets at beginning of year2018-03-31$15,977,610
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-03-31$35,899
Total income from rents2018-03-31$0
Total interest from all sources2018-03-31$28,952
Total dividends received (eg from common stock, registered investment company shares)2018-03-31$54,992
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-03-31No
Total dividends received from registered investment company shares (eg mutual funds)2018-03-31$54,992
Was this plan covered by a fidelity bond2018-03-31Yes
Value of fidelity bond cover2018-03-31$500,000
If this is an individual account plan, was there a blackout period2018-03-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-03-31$0
Were there any nonexempt tranactions with any party-in-interest2018-03-31No
Contributions received from participants2018-03-31$1,355,774
Participant contributions at end of year2018-03-31$224,491
Participant contributions at beginning of year2018-03-31$201,696
Participant contributions at end of year2018-03-31$-1,381
Participant contributions at beginning of year2018-03-31$101
Income. Received or receivable in cash from other sources (including rollovers)2018-03-31$101,349
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-03-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-03-31$0
Other income not declared elsewhere2018-03-31$2
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-03-31No
Value of net income/loss2018-03-31$2,271,398
Value of net assets at end of year (total assets less liabilities)2018-03-31$18,249,008
Value of net assets at beginning of year (total assets less liabilities)2018-03-31$15,977,610
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-03-31No
Were any leases to which the plan was party in default or uncollectible2018-03-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-03-31$4,408,492
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-03-31$6,219,578
Value of interest in pooled separate accounts at end of year2018-03-31$3,706,722
Value of interest in pooled separate accounts at beginning of year2018-03-31$725,649
Interest on participant loans2018-03-31$10,505
Interest earned on other investments2018-03-31$18,447
Value of interest in common/collective trusts at end of year2018-03-31$8,448,278
Value of interest in common/collective trusts at beginning of year2018-03-31$7,052,615
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-03-31$1,308,278
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-03-31$1,595,660
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-03-31$894,722
Net investment gain/loss from pooled separate accounts2018-03-31$199,947
Net investment gain or loss from common/collective trusts2018-03-31$799,478
Net gain/loss from 103.12 investment entities2018-03-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-03-31No
Was there a failure to transmit to the plan any participant contributions2018-03-31Yes
Has the plan failed to provide any benefit when due under the plan2018-03-31No
Contributions received in cash from employer2018-03-31$153,616
Employer contributions (assets) at end of year2018-03-31$154,128
Employer contributions (assets) at beginning of year2018-03-31$182,311
Income. Dividends from preferred stock2018-03-31$0
Income. Dividends from common stock2018-03-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-03-31$1,278,374
Contract administrator fees2018-03-31$35,899
Did the plan have assets held for investment2018-03-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-03-31No
Aggregate proceeds on sale of assets2018-03-31$0
Aggregate carrying amount (costs) on sale of assets2018-03-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-03-31Yes
Opinion of an independent qualified public accountant for this plan2018-03-31Disclaimer
Accountancy firm name2018-03-31PLANTE MORAN
Accountancy firm EIN2018-03-31381357951
2017 : HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-03-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-03-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-03-31$36,370
Total income from all sources (including contributions)2017-03-31$3,227,420
Total loss/gain on sale of assets2017-03-31$0
Total of all expenses incurred2017-03-31$1,139,856
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-03-31$1,114,985
Expenses. Certain deemed distributions of participant loans2017-03-31$5,600
Value of total corrective distributions2017-03-31$13,776
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-03-31$1,579,834
Value of total assets at end of year2017-03-31$15,977,610
Value of total assets at beginning of year2017-03-31$13,926,416
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-03-31$5,495
Total interest from all sources2017-03-31$31,659
Total dividends received (eg from common stock, registered investment company shares)2017-03-31$56,536
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-03-31No
Total dividends received from registered investment company shares (eg mutual funds)2017-03-31$56,536
Was this plan covered by a fidelity bond2017-03-31Yes
Value of fidelity bond cover2017-03-31$500,000
If this is an individual account plan, was there a blackout period2017-03-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-03-31$0
Were there any nonexempt tranactions with any party-in-interest2017-03-31No
Contributions received from participants2017-03-31$1,326,405
Participant contributions at end of year2017-03-31$201,696
Participant contributions at beginning of year2017-03-31$312,073
Participant contributions at end of year2017-03-31$101
Participant contributions at beginning of year2017-03-31$0
Income. Received or receivable in cash from other sources (including rollovers)2017-03-31$71,118
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-03-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-03-31$36,370
Other income not declared elsewhere2017-03-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-03-31No
Income. Non cash contributions2017-03-31$0
Value of net income/loss2017-03-31$2,087,564
Value of net assets at end of year (total assets less liabilities)2017-03-31$15,977,610
Value of net assets at beginning of year (total assets less liabilities)2017-03-31$13,890,046
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-03-31No
Were any leases to which the plan was party in default or uncollectible2017-03-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-03-31$6,219,578
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-03-31$5,545,897
Value of interest in pooled separate accounts at end of year2017-03-31$725,649
Value of interest in pooled separate accounts at beginning of year2017-03-31$498,476
Interest on participant loans2017-03-31$14,722
Income. Interest from loans (other than to participants)2017-03-31$0
Interest earned on other investments2017-03-31$16,937
Income. Interest from US Government securities2017-03-31$0
Income. Interest from corporate debt instruments2017-03-31$0
Value of interest in common/collective trusts at end of year2017-03-31$7,052,615
Value of interest in common/collective trusts at beginning of year2017-03-31$6,048,758
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-03-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-03-31$1,595,660
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-03-31$1,401,750
Expenses. Payments to insurance carriers foe the provision of benefits2017-03-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-03-31$756,385
Net investment gain/loss from pooled separate accounts2017-03-31$107,100
Net investment gain or loss from common/collective trusts2017-03-31$695,906
Net gain/loss from 103.12 investment entities2017-03-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-03-31No
Was there a failure to transmit to the plan any participant contributions2017-03-31Yes
Has the plan failed to provide any benefit when due under the plan2017-03-31No
Contributions received in cash from employer2017-03-31$182,311
Employer contributions (assets) at end of year2017-03-31$182,311
Employer contributions (assets) at beginning of year2017-03-31$119,462
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-03-31$1,114,985
Contract administrator fees2017-03-31$5,495
Did the plan have assets held for investment2017-03-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-03-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-03-31Yes
Opinion of an independent qualified public accountant for this plan2017-03-31Disclaimer
Accountancy firm name2017-03-31PLANTE MORAN
Accountancy firm EIN2017-03-31381357951
2016 : HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-03-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-03-31$36,370
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-03-31$0
Total income from all sources (including contributions)2016-03-31$642,713
Total loss/gain on sale of assets2016-03-31$0
Total of all expenses incurred2016-03-31$1,599,724
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-03-31$1,581,132
Expenses. Certain deemed distributions of participant loans2016-03-31$13,539
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-03-31$984,575
Value of total assets at end of year2016-03-31$13,926,416
Value of total assets at beginning of year2016-03-31$14,847,057
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-03-31$5,053
Total interest from all sources2016-03-31$29,631
Total dividends received (eg from common stock, registered investment company shares)2016-03-31$47,945
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-03-31No
Total dividends received from registered investment company shares (eg mutual funds)2016-03-31$47,945
Was this plan covered by a fidelity bond2016-03-31Yes
Value of fidelity bond cover2016-03-31$500,000
If this is an individual account plan, was there a blackout period2016-03-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-03-31$0
Were there any nonexempt tranactions with any party-in-interest2016-03-31No
Contributions received from participants2016-03-31$842,177
Participant contributions at end of year2016-03-31$312,073
Participant contributions at beginning of year2016-03-31$293,268
Participant contributions at end of year2016-03-31$0
Participant contributions at beginning of year2016-03-31$0
Income. Received or receivable in cash from other sources (including rollovers)2016-03-31$22,936
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-03-31$36,370
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-03-31$0
Administrative expenses (other) incurred2016-03-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-03-31No
Value of net income/loss2016-03-31$-957,011
Value of net assets at end of year (total assets less liabilities)2016-03-31$13,890,046
Value of net assets at beginning of year (total assets less liabilities)2016-03-31$14,847,057
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-03-31No
Were any leases to which the plan was party in default or uncollectible2016-03-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-03-31$5,545,897
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-03-31$5,736,496
Value of interest in pooled separate accounts at end of year2016-03-31$498,476
Value of interest in pooled separate accounts at beginning of year2016-03-31$658,738
Interest on participant loans2016-03-31$16,366
Interest earned on other investments2016-03-31$13,265
Value of interest in common/collective trusts at end of year2016-03-31$6,048,758
Value of interest in common/collective trusts at beginning of year2016-03-31$7,009,555
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-03-31$1,401,750
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-03-31$1,020,147
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-03-31$-255,952
Net investment gain/loss from pooled separate accounts2016-03-31$-8,242
Net investment gain or loss from common/collective trusts2016-03-31$-155,244
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-03-31No
Was there a failure to transmit to the plan any participant contributions2016-03-31No
Has the plan failed to provide any benefit when due under the plan2016-03-31No
Contributions received in cash from employer2016-03-31$119,462
Employer contributions (assets) at end of year2016-03-31$119,462
Employer contributions (assets) at beginning of year2016-03-31$128,853
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-03-31$1,581,132
Contract administrator fees2016-03-31$5,053
Did the plan have assets held for investment2016-03-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-03-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-03-31Yes
Opinion of an independent qualified public accountant for this plan2016-03-31Disclaimer
Accountancy firm name2016-03-31PLANTE MORAN
Accountancy firm EIN2016-03-31381357951
2015 : HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2015 401k financial data
Unrealized appreciation/depreciation of real estate assets2015-03-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2015-03-31$0
Total unrealized appreciation/depreciation of assets2015-03-31$0
Total transfer of assets to this plan2015-03-31$0
Total transfer of assets from this plan2015-03-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-03-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-03-31$0
Expenses. Interest paid2015-03-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022015-03-31$0
Total income from all sources (including contributions)2015-03-31$2,018,093
Total loss/gain on sale of assets2015-03-31$0
Total of all expenses incurred2015-03-31$1,476,060
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-03-31$1,451,217
Expenses. Certain deemed distributions of participant loans2015-03-31$16,678
Value of total corrective distributions2015-03-31$3,117
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-03-31$1,042,032
Value of total assets at end of year2015-03-31$14,847,057
Value of total assets at beginning of year2015-03-31$14,305,024
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-03-31$5,048
Total income from rents2015-03-31$0
Total interest from all sources2015-03-31$30,517
Total dividends received (eg from common stock, registered investment company shares)2015-03-31$37,978
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-03-31No
Total dividends received from registered investment company shares (eg mutual funds)2015-03-31$37,978
Administrative expenses professional fees incurred2015-03-31$0
Was this plan covered by a fidelity bond2015-03-31Yes
Value of fidelity bond cover2015-03-31$500,000
If this is an individual account plan, was there a blackout period2015-03-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-03-31$0
Were there any nonexempt tranactions with any party-in-interest2015-03-31No
Contributions received from participants2015-03-31$839,932
Participant contributions at end of year2015-03-31$293,268
Participant contributions at beginning of year2015-03-31$315,253
Participant contributions at end of year2015-03-31$0
Participant contributions at beginning of year2015-03-31$0
Income. Received or receivable in cash from other sources (including rollovers)2015-03-31$73,247
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2015-03-31$249
Administrative expenses (other) incurred2015-03-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-03-31No
Value of net income/loss2015-03-31$542,033
Value of net assets at end of year (total assets less liabilities)2015-03-31$14,847,057
Value of net assets at beginning of year (total assets less liabilities)2015-03-31$14,305,024
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-03-31No
Were any leases to which the plan was party in default or uncollectible2015-03-31No
Investment advisory and management fees2015-03-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-03-31$5,736,496
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-03-31$5,377,704
Value of interest in pooled separate accounts at end of year2015-03-31$658,738
Value of interest in pooled separate accounts at beginning of year2015-03-31$693,160
Interest on participant loans2015-03-31$15,775
Income. Interest from loans (other than to participants)2015-03-31$0
Interest earned on other investments2015-03-31$14,742
Income. Interest from US Government securities2015-03-31$0
Income. Interest from corporate debt instruments2015-03-31$0
Value of interest in common/collective trusts at end of year2015-03-31$7,009,555
Value of interest in common/collective trusts at beginning of year2015-03-31$6,658,206
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-03-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-03-31$1,020,147
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-03-31$1,133,141
Expenses. Payments to insurance carriers foe the provision of benefits2015-03-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-03-31$382,084
Net investment gain/loss from pooled separate accounts2015-03-31$79,191
Net investment gain or loss from common/collective trusts2015-03-31$446,291
Net gain/loss from 103.12 investment entities2015-03-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-03-31No
Was there a failure to transmit to the plan any participant contributions2015-03-31No
Has the plan failed to provide any benefit when due under the plan2015-03-31No
Contributions received in cash from employer2015-03-31$128,853
Employer contributions (assets) at end of year2015-03-31$128,853
Employer contributions (assets) at beginning of year2015-03-31$127,560
Income. Dividends from preferred stock2015-03-31$0
Income. Dividends from common stock2015-03-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-03-31$1,450,968
Contract administrator fees2015-03-31$5,048
Did the plan have assets held for investment2015-03-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-03-31No
Aggregate proceeds on sale of assets2015-03-31$0
Aggregate carrying amount (costs) on sale of assets2015-03-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-03-31Yes
Opinion of an independent qualified public accountant for this plan2015-03-31Disclaimer
Accountancy firm name2015-03-31PLANTE MORAN
Accountancy firm EIN2015-03-31381357951
2014 : HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-03-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-03-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-03-31$0
Total income from all sources (including contributions)2014-03-31$2,771,136
Total loss/gain on sale of assets2014-03-31$0
Total of all expenses incurred2014-03-31$1,735,753
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-03-31$1,706,204
Expenses. Certain deemed distributions of participant loans2014-03-31$14,717
Value of total corrective distributions2014-03-31$10,552
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-03-31$1,038,847
Value of total assets at end of year2014-03-31$14,305,024
Value of total assets at beginning of year2014-03-31$13,269,641
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-03-31$4,280
Total interest from all sources2014-03-31$32,335
Total dividends received (eg from common stock, registered investment company shares)2014-03-31$32,476
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-03-31No
Total dividends received from registered investment company shares (eg mutual funds)2014-03-31$32,476
Was this plan covered by a fidelity bond2014-03-31Yes
Value of fidelity bond cover2014-03-31$500,000
If this is an individual account plan, was there a blackout period2014-03-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-03-31$0
Were there any nonexempt tranactions with any party-in-interest2014-03-31No
Contributions received from participants2014-03-31$768,648
Participant contributions at end of year2014-03-31$315,253
Participant contributions at beginning of year2014-03-31$369,144
Participant contributions at end of year2014-03-31$0
Participant contributions at beginning of year2014-03-31$0
Income. Received or receivable in cash from other sources (including rollovers)2014-03-31$142,639
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-03-31No
Value of net income/loss2014-03-31$1,035,383
Value of net assets at end of year (total assets less liabilities)2014-03-31$14,305,024
Value of net assets at beginning of year (total assets less liabilities)2014-03-31$13,269,641
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-03-31No
Were any leases to which the plan was party in default or uncollectible2014-03-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-03-31$5,377,704
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-03-31$4,692,136
Value of interest in pooled separate accounts at end of year2014-03-31$693,160
Value of interest in pooled separate accounts at beginning of year2014-03-31$569,910
Interest on participant loans2014-03-31$16,499
Interest earned on other investments2014-03-31$15,836
Value of interest in common/collective trusts at end of year2014-03-31$6,658,206
Value of interest in common/collective trusts at beginning of year2014-03-31$6,437,593
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-03-31$1,133,141
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-03-31$1,086,016
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-03-31$765,661
Net investment gain/loss from pooled separate accounts2014-03-31$107,867
Net investment gain or loss from common/collective trusts2014-03-31$793,950
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-03-31No
Was there a failure to transmit to the plan any participant contributions2014-03-31No
Has the plan failed to provide any benefit when due under the plan2014-03-31No
Contributions received in cash from employer2014-03-31$127,560
Employer contributions (assets) at end of year2014-03-31$127,560
Employer contributions (assets) at beginning of year2014-03-31$114,842
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-03-31$1,706,204
Contract administrator fees2014-03-31$4,280
Did the plan have assets held for investment2014-03-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-03-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-03-31Yes
Opinion of an independent qualified public accountant for this plan2014-03-31Disclaimer
Accountancy firm name2014-03-31PLANTE MORAN
Accountancy firm EIN2014-03-31381357951
2013 : HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-03-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-03-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-03-31$0
Total income from all sources (including contributions)2013-03-31$2,039,442
Total loss/gain on sale of assets2013-03-31$0
Total of all expenses incurred2013-03-31$1,014,488
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-03-31$1,012,152
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-03-31$908,203
Value of total assets at end of year2013-03-31$13,269,641
Value of total assets at beginning of year2013-03-31$12,244,687
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-03-31$2,336
Total interest from all sources2013-03-31$31,865
Total dividends received (eg from common stock, registered investment company shares)2013-03-31$45,116
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-03-31No
Total dividends received from registered investment company shares (eg mutual funds)2013-03-31$45,116
Was this plan covered by a fidelity bond2013-03-31Yes
Value of fidelity bond cover2013-03-31$500,000
If this is an individual account plan, was there a blackout period2013-03-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-03-31$0
Were there any nonexempt tranactions with any party-in-interest2013-03-31No
Contributions received from participants2013-03-31$744,586
Participant contributions at end of year2013-03-31$369,144
Participant contributions at beginning of year2013-03-31$357,790
Participant contributions at end of year2013-03-31$0
Participant contributions at beginning of year2013-03-31$15,437
Income. Received or receivable in cash from other sources (including rollovers)2013-03-31$50,799
Other income not declared elsewhere2013-03-31$1,769
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-03-31No
Value of net income/loss2013-03-31$1,024,954
Value of net assets at end of year (total assets less liabilities)2013-03-31$13,269,641
Value of net assets at beginning of year (total assets less liabilities)2013-03-31$12,244,687
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-03-31No
Were any leases to which the plan was party in default or uncollectible2013-03-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-03-31$4,692,136
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-03-31$4,740,692
Value of interest in pooled separate accounts at end of year2013-03-31$569,910
Value of interest in pooled separate accounts at beginning of year2013-03-31$478,378
Interest on participant loans2013-03-31$17,430
Interest earned on other investments2013-03-31$14,435
Value of interest in common/collective trusts at end of year2013-03-31$6,437,593
Value of interest in common/collective trusts at beginning of year2013-03-31$5,811,049
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-03-31$1,086,016
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-03-31$732,070
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-03-31$368,439
Net investment gain/loss from pooled separate accounts2013-03-31$76,252
Net investment gain or loss from common/collective trusts2013-03-31$607,798
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-03-31No
Was there a failure to transmit to the plan any participant contributions2013-03-31Yes
Has the plan failed to provide any benefit when due under the plan2013-03-31No
Contributions received in cash from employer2013-03-31$112,818
Employer contributions (assets) at end of year2013-03-31$114,842
Employer contributions (assets) at beginning of year2013-03-31$109,271
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-03-31$1,012,152
Contract administrator fees2013-03-31$2,336
Did the plan have assets held for investment2013-03-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-03-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-03-31Yes
Opinion of an independent qualified public accountant for this plan2013-03-31Disclaimer
Accountancy firm name2013-03-31ADAMS, BROWN, BERAN & BALL CHTD.
Accountancy firm EIN2013-03-31481040139
2012 : HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-03-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-03-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-03-31$0
Total income from all sources (including contributions)2012-03-31$1,526,264
Total loss/gain on sale of assets2012-03-31$0
Total of all expenses incurred2012-03-31$1,994,533
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-03-31$1,985,424
Value of total corrective distributions2012-03-31$6,183
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-03-31$1,060,583
Value of total assets at end of year2012-03-31$12,244,687
Value of total assets at beginning of year2012-03-31$12,712,956
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-03-31$2,926
Total interest from all sources2012-03-31$31,478
Total dividends received (eg from common stock, registered investment company shares)2012-03-31$42,495
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-03-31No
Total dividends received from registered investment company shares (eg mutual funds)2012-03-31$42,495
Was this plan covered by a fidelity bond2012-03-31Yes
Value of fidelity bond cover2012-03-31$500,000
If this is an individual account plan, was there a blackout period2012-03-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-03-31$0
Were there any nonexempt tranactions with any party-in-interest2012-03-31No
Contributions received from participants2012-03-31$782,163
Participant contributions at end of year2012-03-31$357,790
Participant contributions at beginning of year2012-03-31$303,892
Participant contributions at end of year2012-03-31$15,437
Income. Received or receivable in cash from other sources (including rollovers)2012-03-31$183,880
Other income not declared elsewhere2012-03-31$-106
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-03-31No
Value of net income/loss2012-03-31$-468,269
Value of net assets at end of year (total assets less liabilities)2012-03-31$12,244,687
Value of net assets at beginning of year (total assets less liabilities)2012-03-31$12,712,956
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-03-31No
Were any leases to which the plan was party in default or uncollectible2012-03-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-03-31$4,740,692
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-03-31$4,780,209
Value of interest in pooled separate accounts at end of year2012-03-31$478,378
Value of interest in pooled separate accounts at beginning of year2012-03-31$336,923
Interest on participant loans2012-03-31$16,838
Interest earned on other investments2012-03-31$14,640
Value of interest in common/collective trusts at end of year2012-03-31$5,811,049
Value of interest in common/collective trusts at beginning of year2012-03-31$6,505,505
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-03-31$732,070
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-03-31$671,138
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-03-31$114,189
Net investment gain/loss from pooled separate accounts2012-03-31$39,159
Net investment gain or loss from common/collective trusts2012-03-31$238,466
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-03-31No
Was there a failure to transmit to the plan any participant contributions2012-03-31Yes
Has the plan failed to provide any benefit when due under the plan2012-03-31No
Contributions received in cash from employer2012-03-31$94,540
Employer contributions (assets) at end of year2012-03-31$109,271
Employer contributions (assets) at beginning of year2012-03-31$115,289
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-03-31$1,985,424
Contract administrator fees2012-03-31$2,926
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-03-31Yes
Did the plan have assets held for investment2012-03-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-03-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-03-31Yes
Opinion of an independent qualified public accountant for this plan2012-03-31Disclaimer
Accountancy firm name2012-03-31ADAMS, BROWN, BERAN & BALL CHTD.
Accountancy firm EIN2012-03-31481040139
2011 : HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-03-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-03-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-03-31$0
Total income from all sources (including contributions)2011-03-31$1,965,231
Total loss/gain on sale of assets2011-03-31$0
Total of all expenses incurred2011-03-31$1,009,700
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-03-31$996,554
Expenses. Certain deemed distributions of participant loans2011-03-31$8,594
Value of total corrective distributions2011-03-31$3,864
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-03-31$831,475
Value of total assets at end of year2011-03-31$12,712,956
Value of total assets at beginning of year2011-03-31$11,757,425
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-03-31$688
Total interest from all sources2011-03-31$23,282
Total dividends received (eg from common stock, registered investment company shares)2011-03-31$6,348
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-03-31No
Total dividends received from registered investment company shares (eg mutual funds)2011-03-31$6,348
Administrative expenses professional fees incurred2011-03-31$688
Was this plan covered by a fidelity bond2011-03-31Yes
Value of fidelity bond cover2011-03-31$500,000
If this is an individual account plan, was there a blackout period2011-03-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-03-31$0
Were there any nonexempt tranactions with any party-in-interest2011-03-31No
Contributions received from participants2011-03-31$691,414
Participant contributions at end of year2011-03-31$303,892
Participant contributions at beginning of year2011-03-31$272,171
Income. Received or receivable in cash from other sources (including rollovers)2011-03-31$26,555
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-03-31No
Value of net income/loss2011-03-31$955,531
Value of net assets at end of year (total assets less liabilities)2011-03-31$12,712,956
Value of net assets at beginning of year (total assets less liabilities)2011-03-31$11,757,425
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-03-31No
Were any leases to which the plan was party in default or uncollectible2011-03-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-03-31$4,780,209
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-03-31$11,366,260
Value of interest in pooled separate accounts at end of year2011-03-31$336,923
Interest on participant loans2011-03-31$19,299
Interest earned on other investments2011-03-31$3,816
Value of interest in common/collective trusts at end of year2011-03-31$6,505,505
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-03-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-03-31$167
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-03-31$671,138
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-03-31$940,759
Net investment gain/loss from pooled separate accounts2011-03-31$6,245
Net investment gain or loss from common/collective trusts2011-03-31$157,122
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-03-31No
Was there a failure to transmit to the plan any participant contributions2011-03-31Yes
Has the plan failed to provide any benefit when due under the plan2011-03-31No
Contributions received in cash from employer2011-03-31$113,506
Employer contributions (assets) at end of year2011-03-31$115,289
Employer contributions (assets) at beginning of year2011-03-31$118,994
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-03-31$996,554
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-03-31Yes
Did the plan have assets held for investment2011-03-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-03-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-03-31Yes
Opinion of an independent qualified public accountant for this plan2011-03-31Disclaimer
Accountancy firm name2011-03-31ADAMS, BROWN, BERAN & BALL CHTD.
Accountancy firm EIN2011-03-31481040139
2010 : HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2010 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-03-31$0

Form 5500 Responses for HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN

2020: HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingYes
2020-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2018 form 5500 responses
2018-04-01Type of plan entitySingle employer plan
2018-04-01Submission has been amendedYes
2018-04-01This submission is the final filingNo
2018-04-01This return/report is a short plan year return/report (less than 12 months)Yes
2018-04-01Plan is a collectively bargained planNo
2018-04-01Plan funding arrangement – InsuranceYes
2018-04-01Plan funding arrangement – TrustYes
2018-04-01Plan benefit arrangement – InsuranceYes
2018-04-01Plan benefit arrangement - TrustYes
2017: HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01Submission has been amendedNo
2017-04-01This submission is the final filingNo
2017-04-01This return/report is a short plan year return/report (less than 12 months)No
2017-04-01Plan is a collectively bargained planNo
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan funding arrangement – TrustYes
2017-04-01Plan benefit arrangement – InsuranceYes
2017-04-01Plan benefit arrangement - TrustYes
2016: HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01Submission has been amendedNo
2016-04-01This submission is the final filingNo
2016-04-01This return/report is a short plan year return/report (less than 12 months)No
2016-04-01Plan is a collectively bargained planNo
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan funding arrangement – TrustYes
2016-04-01Plan benefit arrangement – InsuranceYes
2016-04-01Plan benefit arrangement - TrustYes
2015: HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2015 form 5500 responses
2015-04-01Type of plan entitySingle employer plan
2015-04-01Submission has been amendedNo
2015-04-01This submission is the final filingNo
2015-04-01This return/report is a short plan year return/report (less than 12 months)No
2015-04-01Plan is a collectively bargained planNo
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan funding arrangement – TrustYes
2015-04-01Plan benefit arrangement – InsuranceYes
2015-04-01Plan benefit arrangement - TrustYes
2014: HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2014 form 5500 responses
2014-04-01Type of plan entitySingle employer plan
2014-04-01Submission has been amendedNo
2014-04-01This submission is the final filingNo
2014-04-01This return/report is a short plan year return/report (less than 12 months)No
2014-04-01Plan is a collectively bargained planNo
2014-04-01Plan funding arrangement – InsuranceYes
2014-04-01Plan funding arrangement – TrustYes
2014-04-01Plan benefit arrangement – InsuranceYes
2014-04-01Plan benefit arrangement - TrustYes
2013: HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2013 form 5500 responses
2013-04-01Type of plan entitySingle employer plan
2013-04-01Submission has been amendedNo
2013-04-01This submission is the final filingNo
2013-04-01This return/report is a short plan year return/report (less than 12 months)No
2013-04-01Plan is a collectively bargained planNo
2013-04-01Plan funding arrangement – InsuranceYes
2013-04-01Plan funding arrangement – TrustYes
2013-04-01Plan benefit arrangement – InsuranceYes
2013-04-01Plan benefit arrangement - TrustYes
2012: HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2012 form 5500 responses
2012-04-01Type of plan entitySingle employer plan
2012-04-01Submission has been amendedNo
2012-04-01This submission is the final filingNo
2012-04-01This return/report is a short plan year return/report (less than 12 months)No
2012-04-01Plan is a collectively bargained planNo
2012-04-01Plan funding arrangement – InsuranceYes
2012-04-01Plan funding arrangement – TrustYes
2012-04-01Plan benefit arrangement – InsuranceYes
2012-04-01Plan benefit arrangement - TrustYes
2011: HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2011 form 5500 responses
2011-04-01Type of plan entitySingle employer plan
2011-04-01Submission has been amendedNo
2011-04-01This submission is the final filingNo
2011-04-01This return/report is a short plan year return/report (less than 12 months)No
2011-04-01Plan is a collectively bargained planNo
2011-04-01Plan funding arrangement – InsuranceYes
2011-04-01Plan funding arrangement – TrustYes
2011-04-01Plan benefit arrangement – InsuranceYes
2011-04-01Plan benefit arrangement - TrustYes
2010: HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2010 form 5500 responses
2010-04-01Type of plan entitySingle employer plan
2010-04-01Submission has been amendedNo
2010-04-01This submission is the final filingNo
2010-04-01This return/report is a short plan year return/report (less than 12 months)No
2010-04-01Plan is a collectively bargained planNo
2010-04-01Plan funding arrangement – InsuranceYes
2010-04-01Plan funding arrangement – TrustYes
2010-04-01Plan benefit arrangement – InsuranceYes
2010-04-01Plan benefit arrangement - TrustYes
2009: HAYES GREEN BEACH MEMORIAL HOSPITAL 401(K) EMPLOYEE RETIREMENT PLAN 2009 form 5500 responses
2009-04-01Type of plan entitySingle employer plan
2009-04-01Submission has been amendedNo
2009-04-01This submission is the final filingNo
2009-04-01This return/report is a short plan year return/report (less than 12 months)No
2009-04-01Plan is a collectively bargained planNo
2009-04-01Plan funding arrangement – TrustYes
2009-04-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered608
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $3,437
Total amount of fees paid to insurance companyUSD $687
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,437
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number806505
Policy instance 2
Insurance contract or identification number806505
Number of Individuals Covered608
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $9,731
Total amount of fees paid to insurance companyUSD $1,946
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?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 $9,731
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered601
Insurance policy start date2018-04-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,829
Total amount of fees paid to insurance companyUSD $366
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,829
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number806505
Policy instance 2
Insurance contract or identification number806505
Number of Individuals Covered601
Insurance policy start date2018-04-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $5,003
Total amount of fees paid to insurance companyUSD $1,001
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?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 $5,003
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number806505
Policy instance 4
Insurance contract or identification number806505
Number of Individuals Covered0
Insurance policy start date2018-04-01
Insurance policy end date2018-04-25
Total amount of commissions paid to insurance brokerUSD $2,317
Total amount of fees paid to insurance companyUSD $924
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?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 $2,317
Insurance broker organization code?3
Amount paid for insurance broker fees924
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 3
Insurance contract or identification number613953
Number of Individuals Covered0
Insurance policy start date2018-04-01
Insurance policy end date2018-04-25
Total amount of commissions paid to insurance brokerUSD $818
Total amount of fees paid to insurance companyUSD $326
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?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 $818
Insurance broker organization code?3
Amount paid for insurance broker fees326
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered585
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $4,046
Total amount of fees paid to insurance companyUSD $1,622
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,046
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?3
Insurance broker nameKUSHNER & COMPANY
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number806505
Policy instance 2
Insurance contract or identification number806505
Number of Individuals Covered585
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Total amount of commissions paid to insurance brokerUSD $2,156
Total amount of fees paid to insurance companyUSD $871
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?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 $2,156
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?3
Insurance broker nameKUSHNER AND COMPNAY
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered522
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $2,604
Total amount of fees paid to insurance companyUSD $1,010
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,604
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?3
Insurance broker nameKUSHNER & COMPANY
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number806505
Policy instance 2
Insurance contract or identification number806505
Number of Individuals Covered522
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Total amount of commissions paid to insurance brokerUSD $1,305
Total amount of fees paid to insurance companyUSD $506
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 $1,305
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?3
Insurance broker nameKUSHNER AND COMPNAY
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number806505
Policy instance 2
Insurance contract or identification number806505
Number of Individuals Covered398
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $1,907
Total amount of fees paid to insurance companyUSD $739
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 $1,907
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?3
Insurance broker nameKUSHNER AND COMPNAY
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered398
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $2,651
Total amount of fees paid to insurance companyUSD $1,028
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,651
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?3
Insurance broker nameKUSHNER & COMPANY
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered396
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $21,101
Total amount of fees paid to insurance companyUSD $24,984
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,101
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?3
Insurance broker nameWELLS FARGO ADVISORS LLC
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number806505
Policy instance 2
Insurance contract or identification number806505
Number of Individuals Covered396
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?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
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered406
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $13,714
Total amount of fees paid to insurance companyUSD $19,568
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,714
Insurance broker organization code?3
Amount paid for insurance broker fees10740
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker nameWELLS FARGO ADVISORS LLC
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number806505
Policy instance 2
Insurance contract or identification number806505
Number of Individuals Covered406
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?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
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered424
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $22,044
Total amount of fees paid to insurance companyUSD $26,504
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
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered465
Insurance policy start date2010-12-15
Insurance policy end date2011-03-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number806505
Policy instance 2
Insurance contract or identification number806505
Number of Individuals Covered465
Insurance policy start date2010-12-15
Insurance policy end date2011-03-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?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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