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SIOUX CENTER HEALTH 403(B) PLAN 401k Plan overview

Plan NameSIOUX CENTER HEALTH 403(B) PLAN
Plan identification number 001

SIOUX CENTER HEALTH 403(B) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • 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 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
  • Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • 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

SIOUX CENTER HEALTH has sponsored the creation of one or more 401k plans.

Company Name:SIOUX CENTER HEALTH
Employer identification number (EIN):420796764
NAIC Classification:622000
NAIC Description: Hospitals

Additional information about SIOUX CENTER HEALTH

Jurisdiction of Incorporation: Iowa Secretary of State Business Entities
Incorporation Date: 1948-01-27
Company Identification Number: 081856
Legal Registered Office Address: 1101 9TH ST SE

SIOUX CENTER
United States of America (USA)
51250

More information about SIOUX CENTER HEALTH

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SIOUX CENTER HEALTH 403(B) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012018-01-01KARI TIMMER2019-01-31 KARI TIMMER2019-01-31
0012017-01-01JACKSON SCHUITEMAN2018-04-05 JACKSON SCHUITEMAN2018-04-05
0012016-01-01JACKSON SCHUITEMAN2017-03-09 JACKSON SCHUITEMAN2017-03-09
0012015-01-01JACKSON SCHUITEMAN2016-03-23 JACKSON SCHUITEMAN2016-03-23
0012014-01-01JACKSON SCHUITEMAN2015-04-30 JACKSON SCHUITEMAN2015-04-30
0012013-01-01KARA DIELEMAN2014-04-24 KARA DIELEMAN2014-04-24
0012012-01-01KARA DIELEMAN KARA DIELEMAN2013-10-14
0012011-01-01JACK SCHUITEMAN
0012009-01-01JACK SCHUITEMAN

Plan Statistics for SIOUX CENTER HEALTH 403(B) PLAN

401k plan membership statisitcs for SIOUX CENTER HEALTH 403(B) PLAN

Measure Date Value
2012: SIOUX CENTER HEALTH 403(B) PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01440
Total number of active participants reported on line 7a of the Form 55002012-01-01440
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-011
Total of all active and inactive participants2012-01-01441
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-01441
Number of participants with account balances2012-01-0115
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: SIOUX CENTER HEALTH 403(B) PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01441
Total number of active participants reported on line 7a of the Form 55002011-01-01440
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01440
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-01440
Number of participants with account balances2011-01-0113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2009: SIOUX CENTER HEALTH 403(B) PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01441
Total number of active participants reported on line 7a of the Form 55002009-01-01440
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01440
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-01440
Number of participants with account balances2009-01-0110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on SIOUX CENTER HEALTH 403(B) PLAN

Measure Date Value
2012 : SIOUX CENTER HEALTH 403(B) PLAN 2012 401k financial data
Unrealized appreciation/depreciation of real estate assets2012-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2012-12-31$0
Total unrealized appreciation/depreciation of assets2012-12-31$0
Total transfer of assets to this plan2012-12-31$0
Total transfer of assets from this plan2012-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Expenses. Interest paid2012-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022012-12-31$0
Total income from all sources (including contributions)2012-12-31$166,143
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$100,328
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$95,396
Value of total corrective distributions2012-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$117,655
Value of total assets at end of year2012-12-31$460,255
Value of total assets at beginning of year2012-12-31$394,440
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$4,932
Total income from rents2012-12-31$0
Total interest from all sources2012-12-31$155
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$6,280
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2012-12-31$6,280
Administrative expenses professional fees incurred2012-12-31$0
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$1,000,000
If this is an individual account plan, was there a blackout period2012-12-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Amount of non-exempt transactions with any party-in-interest2012-12-31$0
Contributions received from participants2012-12-31$117,655
Participant contributions at end of year2012-12-31$9,813
Participant contributions at beginning of year2012-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2012-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-12-31$0
Other income not declared elsewhere2012-12-31$0
Administrative expenses (other) incurred2012-12-31$0
Liabilities. Value of operating payables at beginning of year2012-12-31$0
Total non interest bearing cash at end of year2012-12-31$0
Total non interest bearing cash at beginning of year2012-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Income. Non cash contributions2012-12-31$0
Value of net income/loss2012-12-31$65,815
Value of net assets at end of year (total assets less liabilities)2012-12-31$460,255
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$394,440
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year2012-12-31$0
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year2012-12-31$0
Investment advisory and management fees2012-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-12-31$414,821
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$392,237
Income. Interest from loans (other than to participants)2012-12-31$0
Interest earned on other investments2012-12-31$155
Income. Interest from US Government securities2012-12-31$0
Income. Interest from corporate debt instruments2012-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-12-31$2,203
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$2,203
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-12-31$35,621
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2012-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-12-31$42,053
Net investment gain/loss from pooled separate accounts2012-12-31$0
Net investment gain or loss from common/collective trusts2012-12-31$0
Net gain/loss from 103.12 investment entities2012-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$0
Employer contributions (assets) at end of year2012-12-31$0
Employer contributions (assets) at beginning of year2012-12-31$0
Income. Dividends from preferred stock2012-12-31$0
Income. Dividends from common stock2012-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$95,396
Contract administrator fees2012-12-31$4,932
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-12-31Yes
Liabilities. Value of benefit claims payable at beginning of year2012-12-31$0
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Aggregate proceeds on sale of assets2012-12-31$0
Aggregate carrying amount (costs) on sale of assets2012-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2012-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31Yes
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31EIDE BAILLY LLP
Accountancy firm EIN2012-12-31450250958
2011 : SIOUX CENTER HEALTH 403(B) PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$0
Total income from all sources (including contributions)2011-12-31$58,068
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$27,582
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$27,582
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$71,611
Value of total assets at end of year2011-12-31$394,440
Value of total assets at beginning of year2011-12-31$363,954
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$0
Total interest from all sources2011-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$1,000,000
If this is an individual account plan, was there a blackout period2011-12-31No
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$71,611
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$30,486
Value of net assets at end of year (total assets less liabilities)2011-12-31$394,440
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$363,954
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$392,237
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$363,954
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$2,203
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$-13,543
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$27,582
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31EIDE BAILLY LLP
Accountancy firm EIN2011-12-31450250958
2010 : SIOUX CENTER HEALTH 403(B) PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets2010-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total income from all sources (including contributions)2010-12-31$194,490
Total loss/gain on sale of assets2010-12-31$0
Total of all expenses incurred2010-12-31$1,260
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$152,624
Value of total assets at end of year2010-12-31$363,954
Value of total assets at beginning of year2010-12-31$170,724
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$1,260
Total interest from all sources2010-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$1,000,000
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$86,793
Income. Received or receivable in cash from other sources (including rollovers)2010-12-31$65,831
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$193,230
Value of net assets at end of year (total assets less liabilities)2010-12-31$363,954
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$170,724
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Investment advisory and management fees2010-12-31$1,260
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$363,954
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$170,724
Net investment gain/loss from registered investment companies (e.g. mutual funds)2010-12-31$41,866
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31Yes
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31No
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31EIDE BAILLY LLP
Accountancy firm EIN2010-12-31450250958

Form 5500 Responses for SIOUX CENTER HEALTH 403(B) PLAN

2012: SIOUX CENTER HEALTH 403(B) PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: SIOUX CENTER HEALTH 403(B) PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement - TrustYes
2009: SIOUX CENTER HEALTH 403(B) PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01First time form 5500 has been submittedYes
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

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 Covered15
Insurance policy start date2012-10-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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