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SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 401k Plan overview

Plan NameSUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN
Plan identification number 501

SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental

401k Sponsoring company profile

SUSAN B. ALLEN MEMORIAL HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name:SUSAN B. ALLEN MEMORIAL HOSPITAL
Employer identification number (EIN):480581968
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-07-01
5012019-07-01
5012018-07-01
5012017-07-01
5012016-07-01JENNIFER GERKEN JENNIFER GERKEN2018-04-12
5012015-07-01GAY KIMBLE GAY KIMBLE2017-03-16
5012014-07-01GAY KIMBLE GAY KIMBLE2016-04-15
5012013-07-01ROBIN CRAWFORD ROBIN CRAWFORD2015-04-15
5012012-07-01GAYLE ARNETT
5012011-07-01GAYLE ARNETT GAYLE ARNETT2013-04-09
5012009-07-01GAYLE ARNETT

Plan Statistics for SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN

401k plan membership statisitcs for SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN

Measure Date Value
2022: SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01165
Total number of active participants reported on line 7a of the Form 55002022-01-01142
Number of retired or separated participants receiving benefits2022-01-012
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01144
2021: SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01183
Total number of active participants reported on line 7a of the Form 55002021-01-01163
Number of retired or separated participants receiving benefits2021-01-012
Total of all active and inactive participants2021-01-01165
2020: SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-01203
Total number of active participants reported on line 7a of the Form 55002020-07-01181
Number of retired or separated participants receiving benefits2020-07-013
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-01184
2019: SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01277
Total number of active participants reported on line 7a of the Form 55002019-07-01200
Number of retired or separated participants receiving benefits2019-07-013
Number of other retired or separated participants entitled to future benefits2019-07-010
Total of all active and inactive participants2019-07-01203
2018: SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01302
Total number of active participants reported on line 7a of the Form 55002018-07-01261
Number of retired or separated participants receiving benefits2018-07-010
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-01261
2017: SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-01299
Total number of active participants reported on line 7a of the Form 55002017-07-01302
Number of retired or separated participants receiving benefits2017-07-010
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-01302
2016: SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-01262
Total number of active participants reported on line 7a of the Form 55002016-07-01300
Number of retired or separated participants receiving benefits2016-07-010
Number of other retired or separated participants entitled to future benefits2016-07-010
Total of all active and inactive participants2016-07-01300
2015: SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-01277
Total number of active participants reported on line 7a of the Form 55002015-07-01259
Number of retired or separated participants receiving benefits2015-07-013
Number of other retired or separated participants entitled to future benefits2015-07-010
Total of all active and inactive participants2015-07-01262
2014: SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-01270
Total number of active participants reported on line 7a of the Form 55002014-07-01288
Number of retired or separated participants receiving benefits2014-07-010
Number of other retired or separated participants entitled to future benefits2014-07-010
Total of all active and inactive participants2014-07-01288
2013: SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-01263
Total number of active participants reported on line 7a of the Form 55002013-07-01268
Number of retired or separated participants receiving benefits2013-07-012
Total of all active and inactive participants2013-07-01270
2012: SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-01256
Total number of active participants reported on line 7a of the Form 55002012-07-01262
Number of retired or separated participants receiving benefits2012-07-011
Total of all active and inactive participants2012-07-01263
2011: SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-01157
Total number of active participants reported on line 7a of the Form 55002011-07-01154
Total of all active and inactive participants2011-07-01154
2009: SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-07-01277
Total number of active participants reported on line 7a of the Form 55002009-07-01266
Number of retired or separated participants receiving benefits2009-07-014
Total of all active and inactive participants2009-07-01270
Total participants2009-07-010

Financial Data on SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN

Measure Date Value
2017 : SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2017 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2017-06-30$27,491
Total unrealized appreciation/depreciation of assets2017-06-30$27,491
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-06-30$409,300
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-06-30$560,265
Total income from all sources (including contributions)2017-06-30$2,823,261
Total of all expenses incurred2017-06-30$3,826,707
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-06-30$3,685,073
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-06-30$2,788,255
Value of total assets at end of year2017-06-30$183,042
Value of total assets at beginning of year2017-06-30$1,337,453
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-06-30$141,634
Total interest from all sources2017-06-30$7,515
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-06-30No
Administrative expenses professional fees incurred2017-06-30$141,634
Was this plan covered by a fidelity bond2017-06-30Yes
Value of fidelity bond cover2017-06-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2017-06-30No
Contributions received from participants2017-06-30$683,725
Assets. Other investments not covered elsewhere at end of year2017-06-30$0
Assets. Other investments not covered elsewhere at beginning of year2017-06-30$93,134
Income. Received or receivable in cash from other sources (including rollovers)2017-06-30$47,749
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-06-30$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-06-30$1,094
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-06-30$409,300
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-06-30$542,680
Liabilities. Value of operating payables at beginning of year2017-06-30$0
Total non interest bearing cash at end of year2017-06-30$183,042
Total non interest bearing cash at beginning of year2017-06-30$334,380
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-06-30No
Value of net income/loss2017-06-30$-1,003,446
Value of net assets at end of year (total assets less liabilities)2017-06-30$-226,258
Value of net assets at beginning of year (total assets less liabilities)2017-06-30$777,188
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2017-06-30No
Were any leases to which the plan was party in default or uncollectible2017-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-06-30$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-06-30$128,401
Income. Interest from US Government securities2017-06-30$7,515
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-06-30$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-06-30$48,086
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-06-30$48,086
Expenses. Payments to insurance carriers foe the provision of benefits2017-06-30$596,219
Asset value of US Government securities at end of year2017-06-30$0
Asset value of US Government securities at beginning of year2017-06-30$87,225
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-06-30No
Was there a failure to transmit to the plan any participant contributions2017-06-30No
Has the plan failed to provide any benefit when due under the plan2017-06-30No
Contributions received in cash from employer2017-06-30$2,056,781
Employer contributions (assets) at end of year2017-06-30$0
Employer contributions (assets) at beginning of year2017-06-30$19,572
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-06-30$3,088,854
Asset. Corporate debt instrument debt (other) at end of year2017-06-30$0
Asset. Corporate debt instrument debt (other) at beginning of year2017-06-30$44,289
Assets. Corporate common stocks other than exployer securities at end of year2017-06-30$0
Assets. Corporate common stocks other than exployer securities at beginning of year2017-06-30$581,272
Liabilities. Value of benefit claims payable at end of year2017-06-30$0
Liabilities. Value of benefit claims payable at beginning of year2017-06-30$17,585
Did the plan have assets held for investment2017-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-06-30No
Opinion of an independent qualified public accountant for this plan2017-06-30Unqualified
Accountancy firm name2017-06-30BKD, LLP
Accountancy firm EIN2017-06-30440160260
2016 : SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2016 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2016-06-30$-83,185
Total unrealized appreciation/depreciation of assets2016-06-30$-83,185
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-06-30$560,265
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-06-30$361,404
Total income from all sources (including contributions)2016-06-30$3,994,115
Total of all expenses incurred2016-06-30$4,208,797
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-06-30$4,208,797
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-06-30$4,045,655
Value of total assets at end of year2016-06-30$1,337,453
Value of total assets at beginning of year2016-06-30$1,353,274
Total interest from all sources2016-06-30$31,645
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-06-30No
Was this plan covered by a fidelity bond2016-06-30Yes
Value of fidelity bond cover2016-06-30$500,000
Were there any nonexempt tranactions with any party-in-interest2016-06-30No
Contributions received from participants2016-06-30$602,345
Assets. Other investments not covered elsewhere at end of year2016-06-30$93,134
Assets. Other investments not covered elsewhere at beginning of year2016-06-30$106,099
Income. Received or receivable in cash from other sources (including rollovers)2016-06-30$162,072
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2016-06-30$477,792
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-06-30$1,094
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-06-30$1,394
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-06-30$542,680
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-06-30$295,194
Liabilities. Value of operating payables at end of year2016-06-30$0
Liabilities. Value of operating payables at beginning of year2016-06-30$15,810
Total non interest bearing cash at end of year2016-06-30$334,380
Total non interest bearing cash at beginning of year2016-06-30$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-06-30No
Value of net income/loss2016-06-30$-214,682
Value of net assets at end of year (total assets less liabilities)2016-06-30$777,188
Value of net assets at beginning of year (total assets less liabilities)2016-06-30$991,870
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2016-06-30No
Were any leases to which the plan was party in default or uncollectible2016-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-06-30$128,401
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-06-30$233,506
Income. Interest from US Government securities2016-06-30$31,645
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-06-30$48,086
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-06-30$66,399
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-06-30$66,399
Expenses. Payments to insurance carriers foe the provision of benefits2016-06-30$0
Asset value of US Government securities at end of year2016-06-30$87,225
Asset value of US Government securities at beginning of year2016-06-30$237,587
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-06-30Yes
Was there a failure to transmit to the plan any participant contributions2016-06-30No
Has the plan failed to provide any benefit when due under the plan2016-06-30No
Contributions received in cash from employer2016-06-30$3,281,238
Employer contributions (assets) at end of year2016-06-30$19,572
Employer contributions (assets) at beginning of year2016-06-30$33,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-06-30$3,731,005
Asset. Corporate debt instrument debt (other) at end of year2016-06-30$44,289
Asset. Corporate debt instrument debt (other) at beginning of year2016-06-30$53,148
Assets. Corporate common stocks other than exployer securities at end of year2016-06-30$581,272
Assets. Corporate common stocks other than exployer securities at beginning of year2016-06-30$622,141
Liabilities. Value of benefit claims payable at end of year2016-06-30$17,585
Liabilities. Value of benefit claims payable at beginning of year2016-06-30$50,400
Did the plan have assets held for investment2016-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-06-30No
Opinion of an independent qualified public accountant for this plan2016-06-30Unqualified
Accountancy firm name2016-06-30BKD, LLP
Accountancy firm EIN2016-06-30440160260
2015 : SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2015 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2015-06-30$-5,022
Total unrealized appreciation/depreciation of assets2015-06-30$-5,022
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-06-30$361,404
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-06-30$503,303
Total income from all sources (including contributions)2015-06-30$3,615,451
Total of all expenses incurred2015-06-30$4,405,535
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-06-30$4,405,535
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-06-30$3,606,479
Value of total assets at end of year2015-06-30$1,353,274
Value of total assets at beginning of year2015-06-30$2,285,257
Total interest from all sources2015-06-30$13,994
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-06-30No
Was this plan covered by a fidelity bond2015-06-30Yes
Value of fidelity bond cover2015-06-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2015-06-30No
Contributions received from participants2015-06-30$572,177
Assets. Other investments not covered elsewhere at end of year2015-06-30$106,099
Income. Received or receivable in cash from other sources (including rollovers)2015-06-30$169,726
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-06-30$1,394
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-06-30$8,813
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-06-30$295,194
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-06-30$360,199
Liabilities. Value of operating payables at end of year2015-06-30$15,810
Liabilities. Value of operating payables at beginning of year2015-06-30$0
Total non interest bearing cash at end of year2015-06-30$0
Total non interest bearing cash at beginning of year2015-06-30$479,256
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-06-30No
Value of net income/loss2015-06-30$-790,084
Value of net assets at end of year (total assets less liabilities)2015-06-30$991,870
Value of net assets at beginning of year (total assets less liabilities)2015-06-30$1,781,954
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2015-06-30No
Were any leases to which the plan was party in default or uncollectible2015-06-30No
Assets. partnership/joint venture interests at beginning of year2015-06-30$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-06-30$233,506
Income. Interest from US Government securities2015-06-30$13,994
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-06-30$66,399
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-06-30$969,984
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-06-30$969,984
Expenses. Payments to insurance carriers foe the provision of benefits2015-06-30$458,203
Asset value of US Government securities at end of year2015-06-30$237,587
Asset value of US Government securities at beginning of year2015-06-30$827,204
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-06-30Yes
Was there a failure to transmit to the plan any participant contributions2015-06-30No
Has the plan failed to provide any benefit when due under the plan2015-06-30No
Contributions received in cash from employer2015-06-30$2,864,576
Employer contributions (assets) at end of year2015-06-30$33,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-06-30$3,947,332
Asset. Corporate debt instrument debt (other) at end of year2015-06-30$53,148
Assets. Corporate common stocks other than exployer securities at end of year2015-06-30$622,141
Liabilities. Value of benefit claims payable at end of year2015-06-30$50,400
Liabilities. Value of benefit claims payable at beginning of year2015-06-30$143,104
Did the plan have assets held for investment2015-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-06-30No
Opinion of an independent qualified public accountant for this plan2015-06-30Unqualified
Accountancy firm name2015-06-30BKD, LLP
Accountancy firm EIN2015-06-30440160260
2014 : SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2014-06-30$-85,886
Total unrealized appreciation/depreciation of assets2014-06-30$-85,886
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-06-30$503,303
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-06-30$431,074
Total income from all sources (including contributions)2014-06-30$3,687,346
Total of all expenses incurred2014-06-30$3,810,287
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-06-30$3,690,256
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-06-30$3,671,615
Value of total assets at end of year2014-06-30$2,285,257
Value of total assets at beginning of year2014-06-30$2,335,969
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-06-30$120,031
Total interest from all sources2014-06-30$101,617
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-06-30No
Administrative expenses professional fees incurred2014-06-30$120,031
Was this plan covered by a fidelity bond2014-06-30Yes
Value of fidelity bond cover2014-06-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2014-06-30No
Contributions received from participants2014-06-30$600,980
Participant contributions at end of year2014-06-30$0
Participant contributions at beginning of year2014-06-30$49,048
Income. Received or receivable in cash from other sources (including rollovers)2014-06-30$27,710
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2014-06-30$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-06-30$8,813
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-06-30$8,796
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-06-30$360,199
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-06-30$247,019
Administrative expenses (other) incurred2014-06-30$0
Liabilities. Value of operating payables at end of year2014-06-30$0
Liabilities. Value of operating payables at beginning of year2014-06-30$36,255
Total non interest bearing cash at end of year2014-06-30$479,256
Total non interest bearing cash at beginning of year2014-06-30$322,447
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-06-30No
Income. Non cash contributions2014-06-30$0
Value of net income/loss2014-06-30$-122,941
Value of net assets at end of year (total assets less liabilities)2014-06-30$1,781,954
Value of net assets at beginning of year (total assets less liabilities)2014-06-30$1,904,895
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2014-06-30No
Were any leases to which the plan was party in default or uncollectible2014-06-30No
Income. Interest from US Government securities2014-06-30$101,617
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-06-30$969,984
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-06-30$875,003
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-06-30$875,003
Expenses. Payments to insurance carriers foe the provision of benefits2014-06-30$311,032
Asset value of US Government securities at end of year2014-06-30$827,204
Asset value of US Government securities at beginning of year2014-06-30$853,511
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-06-30Yes
Was there a failure to transmit to the plan any participant contributions2014-06-30No
Has the plan failed to provide any benefit when due under the plan2014-06-30No
Contributions received in cash from employer2014-06-30$3,042,925
Employer contributions (assets) at end of year2014-06-30$0
Employer contributions (assets) at beginning of year2014-06-30$227,164
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-06-30$3,379,224
Liabilities. Value of benefit claims payable at end of year2014-06-30$143,104
Liabilities. Value of benefit claims payable at beginning of year2014-06-30$147,800
Did the plan have assets held for investment2014-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-06-30No
Opinion of an independent qualified public accountant for this plan2014-06-30Unqualified
Accountancy firm name2014-06-30BKD, LLP
Accountancy firm EIN2014-06-30440160260
2013 : SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2013-06-30$-32,426
Total unrealized appreciation/depreciation of assets2013-06-30$-32,426
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-06-30$431,074
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-06-30$447,526
Total income from all sources (including contributions)2013-06-30$3,685,547
Total loss/gain on sale of assets2013-06-30$0
Total of all expenses incurred2013-06-30$3,846,554
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-06-30$3,734,304
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-06-30$3,689,667
Value of total assets at end of year2013-06-30$2,335,969
Value of total assets at beginning of year2013-06-30$2,513,428
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-06-30$112,250
Total interest from all sources2013-06-30$28,306
Total dividends received (eg from common stock, registered investment company shares)2013-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-06-30No
Administrative expenses professional fees incurred2013-06-30$109,720
Was this plan covered by a fidelity bond2013-06-30Yes
Value of fidelity bond cover2013-06-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2013-06-30No
Contributions received from participants2013-06-30$571,206
Participant contributions at end of year2013-06-30$49,048
Participant contributions at beginning of year2013-06-30$44,647
Income. Received or receivable in cash from other sources (including rollovers)2013-06-30$138,864
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-06-30$8,796
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-06-30$33,779
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-06-30$247,019
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-06-30$348,861
Administrative expenses (other) incurred2013-06-30$2,530
Liabilities. Value of operating payables at end of year2013-06-30$36,255
Liabilities. Value of operating payables at beginning of year2013-06-30$37,381
Total non interest bearing cash at end of year2013-06-30$322,447
Total non interest bearing cash at beginning of year2013-06-30$495,766
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-06-30No
Value of net income/loss2013-06-30$-161,007
Value of net assets at end of year (total assets less liabilities)2013-06-30$1,904,895
Value of net assets at beginning of year (total assets less liabilities)2013-06-30$2,065,902
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2013-06-30No
Were any leases to which the plan was party in default or uncollectible2013-06-30No
Income. Interest from US Government securities2013-06-30$28,306
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-06-30$875,003
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-06-30$833,001
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-06-30$833,001
Expenses. Payments to insurance carriers foe the provision of benefits2013-06-30$253,725
Asset value of US Government securities at end of year2013-06-30$853,511
Asset value of US Government securities at beginning of year2013-06-30$900,082
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-06-30No
Was there a failure to transmit to the plan any participant contributions2013-06-30No
Has the plan failed to provide any benefit when due under the plan2013-06-30No
Contributions received in cash from employer2013-06-30$2,979,597
Employer contributions (assets) at end of year2013-06-30$227,164
Employer contributions (assets) at beginning of year2013-06-30$206,153
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-06-30$3,480,579
Liabilities. Value of benefit claims payable at end of year2013-06-30$147,800
Liabilities. Value of benefit claims payable at beginning of year2013-06-30$61,284
Did the plan have assets held for investment2013-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-06-30No
Opinion of an independent qualified public accountant for this plan2013-06-30Unqualified
Accountancy firm name2013-06-30BKD, LLP
Accountancy firm EIN2013-06-30440160260
2012 : SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2012-06-30$35,745
Total unrealized appreciation/depreciation of assets2012-06-30$35,745
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-06-30$447,526
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-06-30$402,271
Total income from all sources (including contributions)2012-06-30$3,451,693
Total of all expenses incurred2012-06-30$3,366,998
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-06-30$3,223,044
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-06-30$3,384,498
Value of total assets at end of year2012-06-30$2,513,428
Value of total assets at beginning of year2012-06-30$2,383,478
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-06-30$143,954
Total interest from all sources2012-06-30$31,450
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-06-30No
Administrative expenses professional fees incurred2012-06-30$108,354
Was this plan covered by a fidelity bond2012-06-30Yes
Value of fidelity bond cover2012-06-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2012-06-30No
Contributions received from participants2012-06-30$595,761
Participant contributions at end of year2012-06-30$44,647
Participant contributions at beginning of year2012-06-30$0
Assets. Other investments not covered elsewhere at end of year2012-06-30$0
Income. Received or receivable in cash from other sources (including rollovers)2012-06-30$50,360
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-06-30$33,779
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-06-30$8,883
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-06-30$348,861
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-06-30$221,237
Administrative expenses (other) incurred2012-06-30$35,600
Liabilities. Value of operating payables at end of year2012-06-30$37,381
Liabilities. Value of operating payables at beginning of year2012-06-30$31,985
Total non interest bearing cash at end of year2012-06-30$495,766
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-06-30No
Value of net income/loss2012-06-30$84,695
Value of net assets at end of year (total assets less liabilities)2012-06-30$2,065,902
Value of net assets at beginning of year (total assets less liabilities)2012-06-30$1,981,207
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2012-06-30No
Were any leases to which the plan was party in default or uncollectible2012-06-30No
Income. Interest from US Government securities2012-06-30$30,620
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-06-30$833,001
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-06-30$1,499,158
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-06-30$1,499,158
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-06-30$830
Expenses. Payments to insurance carriers foe the provision of benefits2012-06-30$247,831
Asset value of US Government securities at end of year2012-06-30$900,082
Asset value of US Government securities at beginning of year2012-06-30$875,437
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-06-30No
Was there a failure to transmit to the plan any participant contributions2012-06-30No
Has the plan failed to provide any benefit when due under the plan2012-06-30No
Contributions received in cash from employer2012-06-30$2,738,377
Employer contributions (assets) at end of year2012-06-30$206,153
Employer contributions (assets) at beginning of year2012-06-30$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-06-30$2,975,213
Liabilities. Value of benefit claims payable at end of year2012-06-30$61,284
Liabilities. Value of benefit claims payable at beginning of year2012-06-30$149,049
Did the plan have assets held for investment2012-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-06-30No
Opinion of an independent qualified public accountant for this plan2012-06-30Unqualified
Accountancy firm name2012-06-30BKD, LLP
Accountancy firm EIN2012-06-30440160260
2011 : SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2011-06-30$13,170
Total unrealized appreciation/depreciation of assets2011-06-30$13,170
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-06-30$402,271
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-06-30$269,855
Total income from all sources (including contributions)2011-06-30$3,848,900
Total of all expenses incurred2011-06-30$3,280,908
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-06-30$3,160,180
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-06-30$3,805,374
Value of total assets at end of year2011-06-30$2,383,478
Value of total assets at beginning of year2011-06-30$1,683,070
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-06-30$120,728
Total interest from all sources2011-06-30$30,356
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-06-30No
Administrative expenses professional fees incurred2011-06-30$102,944
Was this plan covered by a fidelity bond2011-06-30Yes
Value of fidelity bond cover2011-06-30$1,000,000
If this is an individual account plan, was there a blackout period2011-06-30No
Were there any nonexempt tranactions with any party-in-interest2011-06-30No
Contributions received from participants2011-06-30$732,094
Participant contributions at end of year2011-06-30$0
Participant contributions at beginning of year2011-06-30$2,311
Income. Received or receivable in cash from other sources (including rollovers)2011-06-30$59,328
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-06-30$8,883
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-06-30$9,674
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-06-30$221,237
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-06-30$184,293
Administrative expenses (other) incurred2011-06-30$17,784
Liabilities. Value of operating payables at end of year2011-06-30$31,985
Liabilities. Value of operating payables at beginning of year2011-06-30$2,230
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-06-30No
Value of net income/loss2011-06-30$567,992
Value of net assets at end of year (total assets less liabilities)2011-06-30$1,981,207
Value of net assets at beginning of year (total assets less liabilities)2011-06-30$1,413,215
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2011-06-30No
Were any leases to which the plan was party in default or uncollectible2011-06-30No
Income. Interest from US Government securities2011-06-30$29,192
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-06-30$1,499,158
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-06-30$720,340
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-06-30$720,340
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-06-30$1,164
Expenses. Payments to insurance carriers foe the provision of benefits2011-06-30$385,132
Asset value of US Government securities at end of year2011-06-30$875,437
Asset value of US Government securities at beginning of year2011-06-30$950,745
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-06-30Yes
Was there a failure to transmit to the plan any participant contributions2011-06-30No
Has the plan failed to provide any benefit when due under the plan2011-06-30No
Contributions received in cash from employer2011-06-30$3,013,952
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-06-30$2,775,048
Liabilities. Value of benefit claims payable at end of year2011-06-30$149,049
Liabilities. Value of benefit claims payable at beginning of year2011-06-30$83,332
Did the plan have assets held for investment2011-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-06-30No
Opinion of an independent qualified public accountant for this plan2011-06-30Unqualified
Accountancy firm name2011-06-30BKD, LLP
Accountancy firm EIN2011-06-30440160260

Form 5500 Responses for SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN

2022: SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Submission has been amendedNo
2020-07-01This submission is the final filingNo
2020-07-01This return/report is a short plan year return/report (less than 12 months)Yes
2020-07-01Plan is a collectively bargained planNo
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan funding arrangement – General assets of the sponsorYes
2020-07-01Plan benefit arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – General assets of the sponsorYes
2019: SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Submission has been amendedNo
2019-07-01This submission is the final filingNo
2019-07-01This return/report is a short plan year return/report (less than 12 months)No
2019-07-01Plan is a collectively bargained planNo
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan funding arrangement – General assets of the sponsorYes
2019-07-01Plan benefit arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – General assets of the sponsorYes
2018: SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Submission has been amendedNo
2018-07-01This submission is the final filingNo
2018-07-01This return/report is a short plan year return/report (less than 12 months)No
2018-07-01Plan is a collectively bargained planNo
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan funding arrangement – General assets of the sponsorYes
2018-07-01Plan benefit arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – General assets of the sponsorYes
2017: SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Submission has been amendedNo
2017-07-01This submission is the final filingNo
2017-07-01This return/report is a short plan year return/report (less than 12 months)No
2017-07-01Plan is a collectively bargained planNo
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan funding arrangement – General assets of the sponsorYes
2017-07-01Plan benefit arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – General assets of the sponsorYes
2016: SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Submission has been amendedNo
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)No
2016-07-01Plan is a collectively bargained planNo
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan funding arrangement – TrustYes
2016-07-01Plan benefit arrangement – InsuranceYes
2016-07-01Plan benefit arrangement - TrustYes
2015: SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingNo
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – TrustYes
2015-07-01Plan benefit arrangement - TrustYes
2014: SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Submission has been amendedNo
2014-07-01This submission is the final filingNo
2014-07-01This return/report is a short plan year return/report (less than 12 months)No
2014-07-01Plan is a collectively bargained planNo
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan funding arrangement – TrustYes
2014-07-01Plan benefit arrangement – InsuranceYes
2014-07-01Plan benefit arrangement - TrustYes
2013: SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan funding arrangement – TrustYes
2013-07-01Plan benefit arrangement – InsuranceYes
2013-07-01Plan benefit arrangement - TrustYes
2012: SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedNo
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan funding arrangement – TrustYes
2012-07-01Plan benefit arrangement – InsuranceYes
2012-07-01Plan benefit arrangement - TrustYes
2011: SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Submission has been amendedNo
2011-07-01This submission is the final filingNo
2011-07-01This return/report is a short plan year return/report (less than 12 months)No
2011-07-01Plan is a collectively bargained planNo
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan funding arrangement – TrustYes
2011-07-01Plan benefit arrangement – InsuranceYes
2011-07-01Plan benefit arrangement - TrustYes
2009: SUSAN B. ALLEN MEMORIAL HOSPITAL EMPLOYEE GROUP BENEFIT PLAN 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01Submission has been amendedNo
2009-07-01This submission is the final filingNo
2009-07-01This return/report is a short plan year return/report (less than 12 months)No
2009-07-01Plan is a collectively bargained planNo
2009-07-01Plan funding arrangement – InsuranceYes
2009-07-01Plan funding arrangement – TrustYes
2009-07-01Plan benefit arrangement – InsuranceYes
2009-07-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )
Policy contract number52092-00-00002
Policy instance 2
Insurance contract or identification number52092-00-00002
Number of Individuals Covered3
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $683
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )
Policy contract number52092-000-00001
Policy instance 1
Insurance contract or identification number52092-000-00001
Number of Individuals Covered143
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $107,304
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )
Policy contract number52092-00-00002
Policy instance 2
Insurance contract or identification number52092-00-00002
Number of Individuals Covered2
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $-2,267
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )
Policy contract number52092-000-00001
Policy instance 1
Insurance contract or identification number52092-000-00001
Number of Individuals Covered158
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $123,803
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )
Policy contract number52092-000-00001
Policy instance 1
Insurance contract or identification number52092-000-00001
Number of Individuals Covered182
Insurance policy start date2020-07-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $61,285
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )
Policy contract number52092-00-00002
Policy instance 2
Insurance contract or identification number52092-00-00002
Number of Individuals Covered1
Insurance policy start date2020-07-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $928
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )
Policy contract number52092-000-00001
Policy instance 1
Insurance contract or identification number52092-000-00001
Number of Individuals Covered199
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $168,634
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )
Policy contract number52092-00-00002
Policy instance 2
Insurance contract or identification number52092-00-00002
Number of Individuals Covered6
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,259
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )
Policy contract number52092-00-00002
Policy instance 2
Insurance contract or identification number52092-00-00002
Number of Individuals Covered5
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,456
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )
Policy contract number52092-000-00001
Policy instance 1
Insurance contract or identification number52092-000-00001
Number of Individuals Covered267
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $206,165
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )
Policy contract number52092-000-00001
Policy instance 1
Insurance contract or identification number52092-000-00001
Number of Individuals Covered307
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $226,158
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL31270
Policy instance 1
Insurance contract or identification numberHCL31270
Number of Individuals Covered281
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $3,307
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $330,683
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,307
Insurance broker organization code?3
Insurance broker nameBAS
INTERNATIONAL INSURANCE AGENCY (National Association of Insurance Commissioners NAIC id number: 86355 )
Policy contract numberXBS10-003303
Policy instance 1
Insurance contract or identification numberXBS10-003303
Number of Individuals Covered273
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $3,363
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $336,335
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,363
Insurance broker organization code?3
Insurance broker nameBENEFIT ADMINISTRATIVE SYSTEMS, INC
INTERNATIONAL INSURANCE AGENCY (National Association of Insurance Commissioners NAIC id number: 86355 )
Policy contract numberXBS10-0033-2
Policy instance 1
Insurance contract or identification numberXBS10-0033-2
Number of Individuals Covered264
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $2,770
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
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
Welfare Benefit Premiums Paid to CarrierUSD $277,040
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,770
Insurance broker organization code?3
Insurance broker nameBENEFIT ADMINISTRATIVE SYSTEMS, LLC
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract numberXBS10-0033-1
Policy instance 1
Insurance contract or identification numberXBS10-0033-1
Number of Individuals Covered255
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $2,692
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $269,225
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract numberAH209
Policy instance 2
Insurance contract or identification numberAH209
Number of Individuals Covered161
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $6,305
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TRUSTMARK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62863 )
Policy contract number09868
Policy instance 1
Insurance contract or identification number09868
Number of Individuals Covered262
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $29,007
Total amount of fees paid to insurance companyUSD $14,504
Welfare Benefit Premiums Paid to CarrierUSD $290,074
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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